prodrome

20 January 2020

Phases of Migraine (podcast)

In this podcast we discuss a new discussion on how we understand the various phases of a migraine attack, and why this understanding is important. (scroll down for podcast player)

Podcast: Play in new window | Download

After listening, I would like to hear your comments – what has your experience been? Do you agree with this study, or is your experience somewhat different?

For more information on measuring changes in the body during these phases, and the discussion in general about phases, you can read: Redefining migraine phases – a suggestion based on clinical, physiological, and functional imaging evidence from the journal of the International Headache Society, Cephalalgia.

Also mentioned in this podcast is The International Classification of Headache Disorders 3.

11 October 2018

Diagnosing Migraine with Aura – New Criteria

James Information 0

Following up on the report about the new International Classification of Headache Disorders 3rd edition (ICHD-3), one of the most interesting changes, though a little technical, was the change in the diagnostic criteria for migraine with aura. This is to say, new more precise ways of diagnosing migraine with aura (MA).

There are many types of migraine, of course, and also many types of migraine with aura. When the beta edition of ICHD-3 came out several years ago, there was concern that MA could be confused with transient ischaemic attacks, or mini-strokes. This is one reason why more specific details were added to the definition.

Migraine aura So let’s take a quick look.

First, in order to actually be diagnosed with MA, you need to have more than one attack. That hasn’t changed. Also, it’s still possible that you could fit the criteria below, but you better fit a different diagnosis.

Next, you obviously need to experience an “aura”. In migraine, aura is something temporary, or “reversible”. Possible aura types include:

visual (such as seeing flashing lights or patterns)
sensory (often a “tingling” sensation)
speech and/or language (such as slurred speech)
motor (weakness)
brainstem (various specific auras, including vertigo or impaired hearing)
retinal (for example, vision loss in one eye)

We won’t get into the details of all of these. Some of these will help doctors diagnose what type of MA you have – remember, there are several sub-types. All you need is one of these symptoms to receive the MA diagnosis.

It’s interesting that these symptoms usually come in a predictable order, as the migraine chain-reaction spreads.

Finally, to be diagnosed with MA you must have at least three of the following six characteristics:

At least one aura symptom spreads gradually over 5 minutes or more.
Two or more aura symptoms occur in succession (has this ever happened to you? It’s probably more common than you think. This was added for clarification since the beta version.)
Each individual aura symptom lasts 5-60 minutes (so, yes, auras could last several hours if there are several auras. Note that motor symptoms are an exception – they could last for 2-3 days.)
At least one aura symptom is unilateral – on only one side.
At least one aura symptom is positive (for example, seeing flashing lights is positive, partial blindness is negative.)
The aura is accompanied, or followed within 60 minutes, by headache (presumably the aura ends, and then within 60 minutes there’s a headache. Or they overlap.

Note that these are aura symptoms, not prodrome symptoms. The difference is that the prodrome may start hours or even a day or two before the attack. It’s often less defined, but may include feeling tired or “heavy”, or having neck stiffness, or having unusual trouble concentrating.

Many of the above symptoms are shared with transient ischaemic attack (TIA), but it’s hoped that the specific details will help rule out TIA. The key symptom of TIA is one-sided weakness or numbness, although other symptoms such as vertigo or vision loss are not uncommon. Learn more about transient ischaemic attack here.

Of course, in either case, it’s best to see a neurologist who can confirm a diagnosis for you, and help you avoid even more serious problems down the road.

For details about various types of migraine with aura, click through the list here.

5 October 2012

Aura, then Headache? What’s Your Sequence?

James Discoveries & Stats 2

When we talk about the different phases of migraine – we throw around words like prodrome, aura, headache, and so on – you might get the idea that the phases come in a sequence, one after another.

Well, there does tend to be a sequence – in other words, usually you don’t have aura and then headache. But the phases are not always clear-cut stages.

Dr. Jakob M. Hansen from Glostrup Hospital in Denmark, has done some work on auras and migraine. He gave a report about aura at the annual meeting of the American Headache Society.

His study suggested that the headache phase – and other symptoms – may start sooner in many patients.

This is what seemed to happen within 15 minutes of the start of migraine aura:

How does that compare with your experience?

Dr. Hansen, as quoted at Clinical Neurology News:

These results do not seem to be consistent with the current ICHD-2 [International Classification of Headache Disorders, second edition] classification that states that migraine headache usually follows the aura symptoms; that’s not the case here.

“Furthermore, we have already headache at the onset of aura, and that does seem to conflict with the idea that you have to have a [cortical] spreading depression to activate the trigeminovascular system to cause headache.

These data suggest that the phases of migraine attack may not be as discrete as originally believed. This is food for thought.

Dr. Hansen is not the only one who has seen this in real life. Dr. Alexander Mauskop has seen a few (though a minority) of patients report aura and headache starting at the same time. Dr. Werner Becker of the University of Calgary also reported seeing nausea, and sensitivity to light and sound, very early in the migraine chain-reaction.

This report is a change from what many migraine specialists have long believed. On the other hand, some like Dr. Mauskop intend to question their patients more closely regarding the sequence of events. Knowing what happens when gives us clues into what goes on in the brain, and helps us get the proper treatment sooner.

12 December 2011

The Gathering Storm: Predicting Migraine Attacks

James Information, Tips 1

This past summer at the annual conference of the American Headache Society, researchers and specialists discussed a something that we’ve known about for a long time – but still don’t take full advantage of. That is, the premonitory phase of a migraine attack (formerly called prodrome).

Some people call it the first part of a migraine attack – others talk about it as a "warning phase". But whatever you call it, it’s a time when there are symptoms before the full-blown symptoms at the height of an attack.

Researchers are especially interested in the premonitory phase because of the possibility of treating migraine before it gets out-of-hand.

What are some of these early-warning symptoms? Dr. R. Allan Purdy suggests that mood changes are common – sadness or euphoria, for example. Also, yawning, increased sensitivity to light and sound, trouble with concentration, paleness, and fatigue. Sometime patients just "know" that a migraine attack is coming.

Dr. Purdy says,"Migraine is for many people a lightning storm that starts hours or day similar to gathering clouds before the storm, followed by the thunderous pain of the migraine headache. The premonitory phase is well-documented but only recently have scientists considered if migraine can be treated before a patient is in full attack mode."

Some believe that, for example, taking triptans early in an attack can greatly increase your chances of successfully treating the symptoms.

What does Dr. Purdy advise? "Until we fully understand the neurobiology of this phenomenon, our advice to patients is to stay alert to the presence of these symptoms and slow down to allow the body to adjust to what maybe coming if a migraine occurs."

Be aware, slow down, and try treating the migraine early. Have you found that doing these things makes a difference in your symptoms?

via: Many migraine sufferers can predict their migraine attack — may create new treatment possibilities

More about premonitory symptoms and treating migraine

1 April 2010

1% Thursday: Warning Signs

James Tips 0

Make it a habit to watch for warning signs.

Even for those of us that try to keep track of migraine, cluster headache or whatever-kind-of-headache symptoms from day to day still miss these. It’s usually not hard to miss the main symptoms – headache, dizziness, nausea – whatever it is for you. And quite often we can point to one or two possible triggers in each attack (oh, it was that glass of wine – or I skipped breakfast).

Learning to recognize the warning signs are a little trickier, especially when they’re quickly overshadowed by a wave of incredible pain. But it’s worth paying attention.

In migraine, we call these premonitory symptoms (formerly prodrome). They can arrive right before the major part of the attack, or even a day or more earlier. Some common symptoms? You feel unusually tired. Your neck feels stiff. You have trouble focusing, even trouble speaking. You look pale. Or you start yawning a lot.

What’s the use of noticing these symptoms? First, it may help you correctly recognize your triggers, if you know when the migraine chain-of-events started. Second, it often helps to take medication earlier in the attack. The premonitory phase may be too early, but it will put you on the alert. Talk to your doctor about when to take your medication.

And we’re not just talking about medication – avoiding further triggers, perhaps getting hydrated, or going for a walk, or getting some rest – there may be things you can do to minimize your coming attack.

If you don’t have a migraine or headache diary, print one out and start watching for those early symptoms.

What is 1% Thursday?

Every Thursday at Headache and Migraine News (weather permitting) we’ll talk about one measurable, practical thing we can do to make our lives just 1% better. Usually it will be something very easy, sometimes it will be a challenge. Let us know if you try it, or share an idea of your own – and maybe a year from now we’ll see that things have really changed for the better!