We conclude that trigger factors and premonitory symptoms are very common, but that the frequency estimates vary widely based on the study approach and population. We recommend that multimodal approaches are necessary for the comprehensive study of predictive biophenotypes as determined by triggers and premonitory symptoms, including retrospective and prospective cohort studies and case-crossover studies.

The Global Campaign against Headache, directed by the non-governmental organization Lifting The Burden (LTB) in official relations with the World Health Organization (WHO), aspires to reduce the global burden of headache. Ultimately this calls for improvements in headache management, largely in primary care, where most people with headache receive medical care. In support, LTB is developing a range of headache management aids for primary care. Presently, no single instrument covers the range of assessment and decision-making necessary for successful headache management, and few make the important link between assessment and clinical advice. Expressly to fill this gap, LTB has developed a new instrument: the Headache Under-Response to Treatment (HURT) Questionnaire, an eight-item, self-administered questionnaire addressing headache frequency, disability, medication use and effect, perceptions of headache "control" and knowledge of diagnosis. This instrument is intended not only to evaluate current headache outcomes and assess the need for and response to treatment, but also to provide guidance on appropriate actions towards treatment optimization. The first draft of the HURT was created by an expert consensus group, meeting at WHO headquarters in Geneva, Switzerland. The final version came about through multiple refinements following psychometric testing. Assessment of clinical utility is ongoing in multiple countries.

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The relationship between migraine and a large number of other diseases has been studied to varying degrees. Both clinical and population-based studies, cross-sectional and longitudinal, have been performed, indicating a relationship of migraine with ischaemic stroke, epilepsy, vertigo, psychiatric disorders, sleep disorders, pain disorders, and others. The association of migraine with depression is one of the most extensively studied comorbidities. The bidirectional nature of this comorbidity indicates possible shared genetic factors. Furthermore, the risk of migraine chronification is increased in migraine patients with a depression. Also, anxiety and bipolar disorder show clear associations with migraine. Sleep disorders have been reported to occur more often in migraineurs than in persons without migraine. A clear association was found for restless legs syndrome and familial advanced sleep phase syndrome. Furthermore, associations have been described with insomnia, daytime sleepiness, sleep apnoea, and narcolepsy. Among pain disorders associated with migraine are low back pain, fibromyalgia, and abdominal pain. The magnitude and the background of these comorbidities remain unclear, and should be further investigated. Other described comorbidities of migraine include syncope, movement disorders, asthma and allergies, gynaecological disturbances, obesity, diabetes, multiple sclerosis, and cancer.

Background and objectives We aimed to gather data regarding knowledge, attitudes, and clinical practices related to behavioral treatments for migraine and psychological issues among healthcare professionals (HCPs), an area about which little is currently known.

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