Migraine attack risk increases with each premonitory symptom

PHILADELPHIA — The risk for migraine attack may increase with the presence of each premonitory symptom, including excessive yawning, mood changes and excessive fatigue, according to early results from a study presented at the American Headache Society Annual Meeting.

“Premonitory symptoms are defined as nonpainful symptoms that occur hours to days before, and can be harbingers of, a migraine attack,” Peter Schmidt, MD, MSc, of Zosano Pharma, and colleagues wrote in the abstract. “They are increasingly recognized as part of the continuum of migraine as a brain disease.”

Researchers gave participants from a large clinical trial with episodic migraine an electronic diary to record their migraine attacks for 14 to 21 days. When they did not have symptoms of migraine, patients were asked to record whether or not they were experiencing mood changes, excessive yawning or excess fatigue.

Among participants, 438 completed at least one diary entry during the run-in phase of the study. Participants experienced an average of 4.5 headache days and three migraine attacks during the run-in period.

The risk for migraine attack may increase with the presence of each premonitory symptom, including excessive yawning, mood changes and excessive fatigue, according to early results from a study presented at the American Headache Society Annual Meeting.

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Out of the total 4,423 subject-days recorded, excessive headache was reported during 526 (11.9%), mood changes during 403 (9.1%) and excessive fatigue during 950 (21.5%).

At least one premonitory symptom was reported by 311 (75.6%) participants, and 76 (17.4%) reported experiencing all three at once.

Among those who reported a premonitory symptom at least once, 47% had a migraine attack within 24 hours. Migraine attacks were experienced within 24 hours in 25% of those who reported excessive yawning, 20% of those who reported mood swings and 18% of those with excessive fatigue.

“There appears to be a possible dose-response relationship between these three premonitory symptoms and having a migraine attack within 24 hours, as each additional premonitory symptom incurred between a 2% to 7% increase of a migraine attack occurring within 24 hours, and the frequency following a report of all three premonitory symptoms was nearly double that following no report of premonitory symptoms,” Schmidt and colleagues wrote. – by Erin Michael

Reference:

Schmidt P, et al. Characteristics of headaches and premonitory symptoms during the run-in phase of a large migraine trial. Presented at: American Headache Society Annual Scientific Meeting; July 11-14, 2019; Philadelphia.

Disclosures: Schmidt is employed by Zosano Pharma.