Photo-, osmo- and phonophobia in the premonitory phase of migraine: mistaking symptoms for triggers?

Abstract

BackgroundCertain environmental stimuli are frequently reported as typical triggers of migraine pain. Whether these so-called triggers are independent precipitators of migraine pain or mere symptoms of the premonitory phase of migraine remains to be elucidated.MethodsIn this retrospective cohort study of 1010 migraine patients of a tertiary headache center we assessed the frequency of common trigger factors, premonitory symptoms and accompanying symptoms as well as basic headache characteristics and demographic data.ResultsPremonitory symptoms with an onset of 2 or more hours prior to the headache were present in 38.9% of migraine patients, the most frequent being a tense neck, phonophobia and difficulty concentrating. There was a clear overlap of certain trigger factors and the presence of corresponding premonitory symptoms: flickering or bright light as a trigger was associated with higher frequency of photophobia in the premonitory phase. The same applied to the presence of food craving and osmophobia in the premonitory phase and certain foods or odours as trigger factors.ConclusionsOur data thus support the view that commonly reported trigger factors of migraine are not so much independent precipitators of migraine pain, but that they are most likely just misinterpreted results of enhanced attention to certain stimuli mediated by typical premonitory symptoms of migraine pain.

Longitudinal Neuroimaging over 30 Days: Temporal Characteristics of Migraine

“…T he premonitory phase of migraine is characterized by a well-described complex of symptoms, such as excessive tiredness, yawning, food cravings, mood swings, and others. [1][2][3][4][5][6] It is not clear, however, when the premonitory phase starts in relation to the pain phase. Premonitory symptoms have been reported to be present up to 72 hours before the beginning of the headache, but it seems that in most cases it is actually shorter, with patients reporting a symptom onset within the last 12 hours and in some patients in the last 48 hours preceding the pain phase.…”

“…Because migraine is more than just headache, 8 only investigating the headache phase will not tell us how migraine starts; the beginning of the migraine happens before the actual onset of the headache. 5,8,9 However, if we do not have a clear concept of how long the premonitory phase actually is, we do not know when to look. Continuous surveillance over the migraine cycle could help solve this problem.…”

Abdominal migraine

“…Sometimes, triggers may be confused with premonitory symptoms (symptoms preceding or forewarning of a migraine episode) 7. For example, bright light or low mood may seem to trigger an episode, when, in fact, photophobia and mood change are recognised premonitory symptoms 18. Relieving factors for abdominal migraine, as for other migraines, are rest (in 88% of patients), sleep (in 64%), and analgesia (in 38%) 2…”

Premonitory-like Symptomatology in Migraine

“…6,7 Therefore, there is an increasing need to understand the mediation of such symptoms, and their differentiation from migraine triggers, to allow patients to understand their condition better and effectively manage their lifestyles accordingly.…”

“…6 Increasingly, the evidence suggests that many of the triggers reported by patients are not reproducible in experimental research, and may actually represent the manifestation of premonitory-like symptomatology. 6,7 Therefore, there is an increasing need to understand the mediation of such symptoms, and their differentiation from migraine triggers, to allow patients to understand their condition better and effectively manage their lifestyles accordingly.…”