PurposePremonitory symptoms (PSs) of migraine are those that precede pain in a migraine attack. Previous studies suggest that treatment during this phase may prevent the onset of pain; however, this approach requires that patients be able to recognize their PSs. Our objectives were to evaluate patients’ actual ability to predict migraine attacks based on their PSs and analyze whether good predictors meet any characteristic profile.Patients and methodsThis prospective, observational study included patients with migraine with and without aura. Patients’ baseline characteristics were recorded. During a 2-month follow-up period, patients used a mobile application to record what they believed to be PSs and later to record the onset of pain, if this occurred. When a migraine attack ended, patients had to complete a form on the characteristics of the episode (including the presence of PSs not identified prior to the attack).ResultsFifty patients were initially selected. A final total of 34 patients were analyzed, recording 229 attacks. Of whom, 158 (69%) were accompanied by PSs and were recorded prior to the pain onset in 63 (27.5%) cases. A total of 67.6% of the patients were able to predict at least one attack, but only 35.3% were good predictors (>50% of attacks). There were only 11 cases in which a patient erroneously reported their PSs (positive predictive value: 85.1%). Good predictors were not differentiated by any specific clinical characteristic. However, a range of symptoms were particularly predictive; these included photophobia, drowsiness, yawning, increased thirst, and blurred vision.ConclusionA large majority of patients with migraine experienced a PS and were able to predict at least one attack. Besides, only a small percentage of patients were considered as good predictors; however, they could not be characterized by any specific profile. Nonetheless, when patients with migraine believed that they were experiencing PSs, they were frequently correct.

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Employing Modeling and Simulation (M&S) extensively to analyze and develop complex systems is the norm today. The use of robust M&S formalisms and rigorous methodologies is essential to deal with complexity. Among them, the Discrete Event System Specification (DEVS) provides a solid framework for modeling structural, behavior and information aspects of any complex system.This gives several advantages to analyze and design complex systems: completeness, verifiability, extensibility, and maintainability. DEVS formalism has been implemented in many programming languages and executable on multiple platforms. In this paper, we describe the features of an M&S framework called xDEVS that builds upon the prevalent DEVS Application Programming Interface (API) for both modeling and simulation layers, promoting interoperability between the existing platform-specific (C++, Java, Python) DEVS implementations. Additionally, the framework can simulate the same model using sequential, parallel, or distributed architectures. The M&S engine has been reinforced with several strategies to improve performance, as well as tools to perform model analysis and verification. Finally, xDEVS also facilitates systems engineers to apply the vision of model-based systems engineering (MBSE), model-driven engineering (MDE), and model-driven systems engineering (MDSE) paradigms.We highlight the features of the proposed xDEVS framework with multiple examples and case studies illustrating the rigor and diversity of application domains it can support.