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HeadWay Issue #216 - Do You Get These Migraine Warnings?
October 21, 2022

In this issue:

Do You Get These Migraine Warning Symptoms?

Say what?! Autonomic Nervous System

Do You Get These Migraine Warning Symptoms?

A recent study out of the USA takes a look at possible migraine warning signs.

The other day I was talking with someone who had frequent headaches. I asked if they experienced any other symptoms - and they couldn't think of any. Until I started asking some more specific questions.

The fact of the matter is that we often don't recognize or remember our own symptoms, other than the big one - a headache. Which is why studies like this are so helpful.

This study, first published in May 2022, listed some of the most common symptoms that people considered as "migraine warnings". (Note that these were chosen from a list, so don't expect any of the more unusual ones.)

Here they are, in order of most to least common:
  • Neck pain/stiffness
  • Vision problems
  • Feeling dizzy/light-headed
  • Difficulty thinking/concentrating
  • Feeling irritable/moody
  • Feeling tired/weary

Neck Pain?

Maybe that first one surprised you, but we've been talking about it for a long time. In a 2010 study, researchers suggested that neck pain may be more common in migraine than nausea. The reasons for this connection are unclear, but in the end, this symptom is part of the reason why migraine is disabling.

Vision Problems?

"Vision problems" are more commonly recognized. These weren't necessarily visual aura (which usually comes more directly before a headache attack, though not always). In fact, only 48.8% of patients reporting vision symptoms also reported aura.

Warnings: A good thing?

As someone who has experienced migraine warning signs myself, I would consider them a good thing in a way. It is possible to prepare and even lessen migraine symptoms. However, the news is not all good.

Naturally, if you recognize more symptoms before the "headache phase", you also recognize a longer time when you're somewhat disabled.

Patients who recognized warnings also seemed likely to have higher levels or anxiety/depression, and more migraine problems between headache attacks. Warning signs were also somewhat more likely to be reported by those who had more monthly attacks (maybe just because they would tend to pay more attention!).

One more interesting note. Although most people reported these kinds of pre-headache symptoms (84.3%), only about 56.7% of those considered them warnings. Maybe they considered them part of the attack? Or hadn't really thought about how they could prepare for an attack?

For more about migraine symptoms, including these early warnings, take a look at What is Migraine? (the Story of Symptoms)

See the abstract of this study from the journal Neurology here: Characterizing Pre-headache (Prodrome) Features of Migraine Attacks

Say what?! Prodrome

The word "prodrome" actually has an interesting history. At first common, I began replacing it, in my own writing, with "premonitory symptoms". But prodrome is back.

Basically, "premonitory symptoms" referred specifically to migraine warning signs. But apparently it was used so vaguely that it was difficult as a medical term. It's also somewhat subjective.

For example, in the study above, people who thought they had migraine warnings had basically the same symptoms as those who didn't.

So, with the International Classification of Headache Disorders 3, prodrome is the preferred term.

Prodrome is something that comes first, though not necessarily a "warning" (pro=forward, dromos=running).

So the ICHD3 defines it as "a symptomatic phase, lasting up to 48 hours, occurring before the onset of pain in migraine without aura or before the aura in migraine with aura. Among the common prodromal symptoms are fatigue, elated or depressed mood, unusual hunger and cravings for certain foods."

Thanks for reading!  Remember, if you have feedback or ideas for future issues, visit the HeadWay MailRoom.  Your password is nomoache.
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