Non-Headache Symptoms Predict Migraine Onset

Migraineurs who claim early nonheadache warning signs predict a migraine are correct, results of study indicate. The findings could have considerable implications for understanding the pathophysiology of migraine and its management.

Dr. Peter J. Goadsby of the Institute of Neurology in London and colleagues had 97 migraineurs aged 16 or older record nonheadache symptoms in a hand-held electronic diary before, during, and after a migraine. They did this daily for 3 months. The patients were specifically selected because they had a history of premonitory symptoms and felt they could predict a migraine.

In the March 25th issue of Neurology, the team reports that 97% recorded premonitory symptoms in the diary, most often tiredness (72%), difficulty concentrating (51%), and stiff neck (50%).

"Patients correctly predicted migraine headaches from 72% of diary entries with premonitory symptoms," the investigators report.

The majority of nonheadache premonitory symptoms were present before, during, and after the migraine, "implying ongoing brain events with headache as just one feature of the attack," the authors write.

In comments to Reuters Health, Dr. Goadsby said this study shows that "migraine attacks start long before we may have suspected. There are profound changes in the brain well before the aura symptoms or headache. Understanding these premonitory symptoms will give a window into the
earliest part of the disorder, and ultimately guide treatment of acute attacks."

Neurology 2003;60:935-940.
NEW YORK (Reuters Health) Apr 18 2003