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The Postdrome Phase of Migraine

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Amy Gelfand, MD Reviewing Giffin NJ et al., Neurology 2016 Jul 19; 87:309

A descriptive study of this underappreciated contributor to migraine symptomatology

To describe the frequency of postdrome symptoms among patients with migraine, researchers recruited 120 patients from four centers who endorsed having nonheadache symptoms with their attacks. Participants completed daily electronic symptom diaries for 3 months. The electronic diaries alarmed randomly once daily during waking hours to survey patients about their symptoms before, during, and after migraine headache. The postdrome phase was defined as “the time between headache resolution and feeling completely back to normal.” Participants had to provide data on at least three migraine attacks during the study period. The study was funded by a manufacturer of medications used to treat migraine.

Ninety-seven patients were included; 873 migraine attacks were recorded, and 773 (89%) of these had postdrome symptoms. The most common prospectively measured postdrome symptom was being tired or weary, reported in 88% of postdromes. Difficulty concentrating was seen in 56%, and stiff neck in 42%. The majority (54%) of postdrome phases resolved within 6 hours; 7% lasted more than 24 hours. Treatment type and attack severity did not influence the duration of the postdrome.

Comment

Migraine attacks are more than just a headache. Disability from migraine is substantial: It is estimated to be the sixth most disabling condition worldwide (Lancet2015; 386:743). The extent of disability that comes from the premonitory and postdrome phases is probably underappreciated. These findings demonstrate that postdrome symptoms — particularly fatigue and cognitive disability — are very common among migraineurs who have nonheadache attack symptoms. Even after the head pain has passed, patients probably are not able to perform optimally at work, school, or in other activities for at least several hours. As the authors acknowledge, research on population-based samples of migraineurs is needed for a true prevalence estimate. We also need to understand how best to treat these postdrome symptoms.

Dr. Gelfand is Assistant Professor, Department of Neurology, Division of Child Neurology, University of California, San Francisco.

 

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