Insights from triggers and prodromal symptoms on how migraine attacks start: The threshold hypothesis.

Autor: Sebastianelli G; Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy., Atalar AÇ; Neurology Department, Health Sciences University, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Istanbul, Turkey., Cetta I; Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy., Farham F; Department of Headache, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medicine Sciences, Tehran, Iran., Fitzek M; Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany., Karatas-Kursun H; Institute of Neurological Sciences and Psychiatry, Hacettepe University, Ankara, Turkiye., Kholodova M; Department of Neurology and Neurosurgery, Medical Center 'Dobrobut-Clinic' LLC, Kyiv, Ukraine., Kukumägi KH; University of Tartu, Tartu University Hospital, Tartu, Estonia., Montisano DA; Headache Center, Neuroalgology Dpt - Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy., Onan D; Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Yozgat Bozok University, Yozgat, Türkiye., Pantovic A; Neurology Clinic, Military Medical Academy, University of Defence, Belgrade, Serbia., Skarlet J; Western Tallinn Central Hospital, Tallinn, Estonia., Sotnikov D; Department Neurosurgery and Neurology, Sumy State University, Medical Center 'Neuromed', Sumy, Ukraine., Caronna E; Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.; Headache Research Group, Departament de Medicina, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain., Pozo-Rosich P; Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.; Headache Research Group, Departament de Medicina, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain.
Jazyk: angličtina
Zdroj: Cephalalgia : an international journal of headache [Cephalalgia] 2024 Oct; Vol. 44 (10), pp. 3331024241287224.
DOI: 10.1177/03331024241287224
Abstrakt: Background: The prodrome or premonitory phase is the initial phase of a migraine attack, and it is considered as a symptomatic phase in which prodromal symptoms may occur. There is evidence that attacks start 24-48 hours before the headache phase. Individuals with migraine also report several potential triggers for their attacks, which may be mistaken for premonitory symptoms and hinder migraine research.
Methods: This review aims to summarize published studies that describe contributions to understanding the fine difference between prodromal/premonitory symptoms and triggers, give insights for research, and propose a way forward to study these phenomena. We finally aim to formulate a theory to unify migraine triggers and prodromal symptoms. For this purpose, a comprehensive narrative review of the published literature on clinical, neurophysiological and imaging evidence on migraine prodromal symptoms and triggers was conducted using the PubMed database.
Results: Brain activity and network connectivity changes occur during the prodromal phase. These changes give rise to prodromal/premonitory symptoms in some individuals, which may be falsely interpreted as triggers at the same time as representing the early manifestation of the beginning of the attack. By contrast, certain migraine triggers, such as stress, hormone changes or sleep deprivation, acting as a catalyst in reducing the migraine threshold, might facilitate these changes and increase the chances of a migraine attack. Migraine triggers and prodromal/premonitory symptoms can be confused and have an intertwined relationship with the hypothalamus as the central hub for integrating external and internal body signals.
Conclusions: Differentiating migraine triggers and prodromal symptoms is crucial for shedding light on migraine pathophysiology and improve migraine management.
Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: GS received personal fees from AbbVie. KHK received travel grant from AbbVie and honoraria for participation in advisory board from Medison Pharma. MF received personal fees from Novartis and Teva. AÇA, IC, FF, HK, MK, DO, DAM, AP, DS and JS declared no conflict of interest. EC has received honoraria from Novartis, Chiesi, Lundbeck, TEVA, Lilly, Medscape. PPR reports that within the prior 36 months, having received honoraria as a consultant and speaker for: AbbVie, Amgen, Biohaven, Chiesi, Eli Lilly, Lundbeck, Medscape, Novartis, Pfizer and Teva. Her research group has received research grants from Novartis, Teva, AbbVie, EraNET Neuron, RIS3CAT FEDER, AGAUR, ISCIII and International Headache Society, and has received funding for clinical trials from Alder, Amgen, Biohaven, Eli Lilly, Lundbeck, Novartis and Teva. She is the Honorary Secretary of the International Headache Society. She is a member of the Clinical Trials Guideline Committee of the International Headache Society. She serves as an associate editor for Cephalalgia, Headache, The Journal of Headache and Pain, Neurologia and Revista de Neurologia. She is the founder of www.midolordecabeza.org. PP-R does not own stocks from any pharmaceutical company.
Databáze: MEDLINE
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