Sensitivity to light, sound, fatigue, neck pain most common prodromal headache symptoms

Key takeaways:

• Researchers analyzed prodromal headache symptoms reported by more than 500 individuals.
• Secondary common symptoms were dizziness, irritability, nausea difficulty concentrating.

SAN DIEGO — In a small cohort of adults with headache, the most common prodromal symptoms were light and sound sensitivity, fatigue and neck pain, according to research presented at the American Headache Society Annual Scientific Meeting.

“A migraine attack consists of up to four phases: prodrome, aura, headache and postdrome,” Todd J. Schwedt, MD, of the neurology faculty at the Mayo Clinic in Phoenix, Arizona, and colleagues wrote. “The objective of this analysis was to characterize symptoms reported during the prodrome of a migraine attack by participants in the PRODROME trial.”

PRODROME was a randomized, double-blind, placebo-controlled, crossover study that consisted of two periods: a 60-day screening interval and a double-blind treatment interval lasting up to 60 days during which prodromal symptom type, severity and time to headache onset were reported.

During the screening period, participants were asked open-ended questions regarding their symptoms followed by selecting their prodromal symptoms from a comprehensive checklist. Data ranging from three to 16 qualifying prodrome events were required for participant randomization to double-blind treatment. From the initial screened cohort of 1,087 individuals, 518 met study criteria, with 480 participants treating at least one qualifying prodrome event for inclusion (for a total of 4,802 prodromal events) within the safety population.

During the double-blind portion of the trial, each participant treated two qualifying prodrome events (one with ubrogepant, one with placebo). A qualifying prodrome event was defined as: a headache that was not currently present; participant having not experienced a headache in the previous 48 hours; acute treatment(s) for headache had not been taken in the previous 48 hours; participant reported confidence in headache occurrence within 1 to 6 hours.

Differentiation of prodromal from aura-related headache symptoms followed a 1-hour minimum for chosen treatment to take effect. When a prodromal event occurred, enrollees recorded their symptoms and intensity (mild, moderate or severe).

The most common prodromal symptoms reported were sensitivity to light (57.2%), fatigue (50.1%), neck pain (41.9%), sensitivity to sound (33.9%), dizziness (27.8%), irritability (26.4%), nausea (23.1%), and difficulty concentrating (20.8%). Difficulty concentrating and difficulty thinking were separate prodromal symptoms in the screening symptom checklist; however, upon concurrent evaluation, 30.0% of qualifying prodrome events during the screening period included at least 1 of these cognitive symptoms.

Data further showed that, although most prodromal symptoms were mild in intensity, moderate- or severe-intensity symptoms were frequent, especially for fatigue and neck pain. Results gathered during the double-blind period were similar to those of the screening period.

“Although rates varied across the individual prodromal symptoms, between 29.9% and 60.8% were reported to be moderate or severe in intensity,” Schwedt and colleagues wrote.