Prodromal Functioning of Migraine Patients Relative to Their Interictal State - An Ecological Momentary Assessment Study

Abstract

Smartphones were used in an online Ecological Momentary Assessment (EMA) design to test prodromal functioning relative to the interictal state in migraine patients. Eighty-seven participants completed an electronic diary 4 times daily during 3-6 weeks to monitor their migraine attacks. Twice daily the diary additionally included 16 multi-answer questions covering physical symptoms (30 items), cognitive-affective functioning (25 items) and external factors (25 items). Eight clustered prodromal features were identified in the current study: sensory sensitivity, pain/stiffness, fatigue, cognitive functioning, positive affect, negative affect, effort spent and stressors encountered. Per feature, individual change scores with interictal control days - excluding 24-hour post-attack recovery - were computed for six 12-hour pre-attack time windows covering three prodromal days. Linear mixed model (fixed-effect) analysis established significant increases in sensory sensitivity, pain/stiffness and fatigue, and a tendency for increased negative affect, in the 12 hours prior to the attack. Positive affect and cognitive functioning were impaired both in the 25-36 hour and - more strongly - in the 12-hour time window before the attack. No effects were found for effort spent and stressors encountered. Exploratory (random effect) analysis revealed significant individual differences in the change scores in sensory sensitivity, pain/stiffness, fatigue and negative affect. It is concluded that the prodromal change in migraine - relative to interictal functioning - predominantly exists within the last 12 hours before attack onset. Individual diversity is large, however. Future research should zoom in to identify prodrome development within the 12 pre-attack hours as well as to isolate individual patterns.

Unraveling the Relationship between Motor Symptoms, Affective States and Contextual Factors in Parkinson’s Disease: A Feasibility Study of the Experience Sampling Method

“…The ESM approach is gaining terrain in the study of psychopathology, [ 5 , 6 , 9 , 10 ] and is previously used among others, in studies on depression [ 11 ], asthma [ 12 ], irritable bowel syndrome [ 13 ] and migraine [ 14 ]. To date, this approach had not yet been used in a PD population.…”

To what extent are patients with migraine able to predict attacks?

“…This period was established at 72 hours, in line with the limit set by the majority of researchers conducting prospective studies on PSs. 15 , 19 …”

“…A large majority of studies about PSs in the literature followed a retrospective approach; 7 – 13 it is not possible with this design to assess patients’ ability to predict attacks, 14 which is fundamental if we intend to administer treatment during this phase. The few prospective studies that do exist 15 – 19 are mainly descriptive, with the exception of the articles by Giffin et al 15 and Houtveen and Sorbi, 19 which used electronic diaries to evaluate patients’ ability to predict migraine attacks. The advantage of using these diaries is that data can be collected in real time, increasing prediction reliability.…”

“…As opposed to the methodology of Giffin et al and Hout-veen and Sorbi, 15 , 19 our research does not ask the patients about their symptoms (reactively), but it allows them to spontaneously register their symptoms as soon as they appear (proactively), providing a set of potential symptoms to select from. Our aim is hence to exploit the capability of the patients to recognize their own symptoms in order to drive a potential early intake of the drugs.…”

Tryptophan Catabolites and Migraine

“…Premonitory phase can be present with diverse symptoms including fatigue, mood changes, food cravings, concentration problems, sleep disturbances, gastrointestinal disturbances and yawning [48,49].…”