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Literature highlights
Evolution of a migraine attacks
The build-up time of migraine attacks has not yet been well described in the literature. Based on clinical experience, we know that, in some patients, attacks may last over 72 hours – the upper duration limit set by the International Classification of Headache Disorders, 2nd Edition (ICHD-II). A better knowledge of how migraine attacks evolve could be helpful in choosing more appropriate symptomatic treatments. This prospective study was conducted in Canada by administering a specially designed questionnaire to 253 informed and willing patients with migraine with or without aura consulting headache specialists. The data were electronically sent to a central computer from each specialist. Data analysis showed that nausea was present in 90% of cases, especially in those with aura. This gastrointestinal symptom inhibited the ingestion of oral medications in about a quarter of patients. The time to build up from no pain at onset of the attack to moderate/severe pain was shorter in patients with aura and was less than 2 hours in 97% of those with and 86% of those without aura. However, a group of subjects with migraine (about 10% of all) was identified, in whom onset of the attack was more gradual and the build-up time to maximum pain was delayed for over 2 hours. Nausea, experienced by 91.7% of patients, occurred significantly later in those without than in those with aura. While most headaches lasted from 4 to 72 hours, 24.3% of those with and 20.6% of those without aura experienced pain for more than 72 hours. In patients who were not taking symptomatic medications, disability due to pain, nausea or malaise usually persisted for over 3 days in 24.3% and in 16.7% of cases with and without aura, respectively. One-fifth of migraine sufferers might be in pain and/or disabled by accompanying symptoms for over 3 days in a typical migraine attack. In about half the cases, patients themselves reported that their medications had a good or excellent efficacy. The authors concluded that, in real-life clinical situations, migraine attacks may be variable and do not always fulfil the International Headache Society classification criteria. Attacks are often accompanied by nausea, which interferes with oral therapy. They may last for over 72 hours, have a slow build-up time to maximum pain (over 2 hours) in about 10% of cases, and may cause disability for over 3 days. Nevertheless, current symptomatic treatments are effective in a considerable proportion of cases.
A clinical study of migraine evolution.
Pryse-Phillips W, Aube M, Bailey P, Becker WJ, Bellavance A, Gawel M, Giammarco R, Mackie G, Purdy RA, Robinson G, Shapero G, Wilson K.
Headache 2006;46:1480-6.
This page last modified: 30/10/2007