The not so hidden impact of interictal burden in migraine: A narrative review

Abstract

Migraine is a highly prevalent neurological disease of varying attack frequency. Headache attacks that are accompanied by a combination of impact on daily activities, photophobia and/or nausea are most commonly migraine. The headache phase of a migraine attack has attracted more research, assessment tools and treatment goals than any other feature, characteristic, or phase of migraine. However, the migraine attack may encompass up to 4 phases: the prodrome, aura, headache phase and postdrome. There is growing recognition that the burden of migraine, including symptoms associated with the headache phase of the attack, may persist between migraine attacks, sometimes referred to as the “interictal phase.” These include allodynia, hypersensitivity, photophobia, phonophobia, osmophobia, visual/vestibular disturbances and motion sickness. Subtle interictal clinical manifestations and a patient's trepidation to make plans or commitments due to the unpredictability of migraine attacks may contribute to poorer quality of life. However, there are only a few tools available to assess the interictal burden. Herein, we examine the recent advances in the recognition, description, and assessment of the interictal burden of migraine. We also highlight the value in patients feeling comfortable discussing the symptoms and overall burden of migraine when discussing migraine treatment needs with their provider.

Real-world experience with calcitonin gene-related peptide-targeted antibodies for migraine prevention: a retrospective observational cohort study at two Japanese headache centers

“…This headache disorder is characterized by recurrent headache attacks of moderate to severe intensity, which interfere with daily activity. The interictal symptoms of migraine include allodynia, hypersensitivity, photophobia, phonophobia, osmophobia, visual/vestibular disturbances, and motion sickness [ 2 ]. The Eurolight project revealed that interictal symptoms, reported in 26.0% of patients with episodic migraine (EM), caused loss of productivity [ 3 ].…”

Approach to the Patient With Headache

“…Functional imaging studies corroborate changes in the brain during this interictal phase 39 . In addition to the aforementioned symptoms, the interictal burden of migraine is associated with photophobia, anxiety (fear of the next attack), depression (inability to make plans because of the possibility of having a migraine episode), motion sickness, fear of upcoming events, stigma (reluctance to tell others about their headaches), and worse interpersonal interactions with others 37,40 . Individuals experiencing interictal impact from migraine report having to alter their lifestyle to avoid triggers or in response to an impending attack 41 .…”

Postdromal symptoms in migraine: a REFORM study

“…Multiple studies have found that the migraine postdrome has negative effects on patients’ daily functioning and overall quality of life [ 3 , 9 , 15 , 22 ]. Our study revealed a weak positive correlation between the number of postdromal symptoms reported prompted and both HIT-6 and WHODAS scores.…”