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O012. Intra-variability of the characteristics of migraine attacks

  • Michele Viana
  • Grazia Sances
  • Natascia Ghiotto
  • Elena Guaschino
  • Marta Allena
  • Giuseppe Nappi
  • Peter J Goadsby
  • Cristina Tassorelli
Open Access
Oral presentation

Keywords

Migraine Classification System High Variability Pain Intensity Operational Classification 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Background

Migraine attacks may have different features with respect to different patients and also within the same patient. The percentage of patients reporting attacks as stereotyped and those reporting attacks with different phenotypes has not been the object of specific investigations. Here we wanted to evaluate the percentage of migraine patients reporting attacks with the same characteristics, in terms of phenotype and response to symptomatic medications, on three consecutive attacks.

Methods

Thirty patients with migraine without aura prospectively recorded the features of three consecutive attacks in a headache diary. Characteristics recorded were: pain intensity, presence of nausea, vomiting, photophobia, phonophophia, osmophobia, allodynia, cranial autonomic symptoms (at least one), and premonitory symptoms. Patients were allowed to take frovatriptan as symptomatic medication, whose efficacy was evaluated at the two hours pain-free rate.

Results

None of the patients presented identical characteristics on the three studied attacks (Table 1). This was still the case if we reduced the number of variables evaluated from eleven to seven of the eight core features indicated by the ICHD. Considering just six variables: unilaterality, quality of pain, presence/absence of nausea, vomiting, photophobia and phonophobia, only two patients (6%) had identical features on three consecutive attacks.
Table 1

Migraine attack features and intrapatient variability.

Unilateral location

Pulsating quality

Pain intensity (4 point scale)

N

V

PT

PN

O

A

CAS

PS

Number (%) of patients with three identical attacks with respect to some of the features recorded at the moment of symptomatic medication intake

x

x

x

x

x

x

x

x

x

x

x

0 (0%)

x

x

x

x

x

x

x

    

0 (0%)

x

x

 

x

x

x

x

    

2 (6%)

   

x

x

x

x

    

9 (30%)

x

x

         

10 (33%)

N: nausea, V: vomiting, PT: photophobia, PN: phonophobia; O: osmophobia; A: allodynia; CAS: cranial autonomic symptoms (at least one); PS: premonitory symptoms (at least one).

With respect to the response to frovatriptan, 39% of patients had the same outcome (positive or negative pain-free in 2 hours) on three consecutive attacks.

Conclusions

To the best of our knowledge this is the first study that systematically assessed the percentage of patients reporting migraine attacks with identical features in a given period. Our results demonstrate that migraine attacks show a high variability not just among patients, but also within the same patient. Our findings indicate that stereotype of attacks is uncommon, and reinforces the underlying logic of the current operational classification system.

Written informed consent to publication was obtained from the patient(s).

Conflict of interest

None.

Notes

Acknowledgements

This study was carried out in collaboration with UCADH (University Consortium for Adaptive Disorders and Head pain), University of Pavia, Italy. This work was supported by grants of the Italian Ministry of Health to RC 2013-2015.

Copyright information

© Viana et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Michele Viana
    • 1
  • Grazia Sances
    • 1
  • Natascia Ghiotto
    • 1
  • Elena Guaschino
    • 1
  • Marta Allena
    • 1
  • Giuseppe Nappi
    • 1
  • Peter J Goadsby
    • 2
  • Cristina Tassorelli
    • 1
    • 3
  1. 1.Headache Science CentreC. Mondino National Neurological InstitutePaviaItaly
  2. 2.Headache Group, NIHR-Wellcome Trust Clinical Research FacilityKing's College, LondonLondonUK
  3. 3.Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly

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