Insights from triggers and prodromal symptoms on how migraine attacks start: The threshold hypothesis, 2024, Sebastianelli et al

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

Authors:
Sebastianelli G, Atalar AÇ, Cetta I, et al.

Abstract

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.

LINK | pdf
doi:10.1177/03331024241287224

 

Interesting considering the conversation around PEM triggers

 

Also that stress, hormones, sleep deprivation act as a catalyst. I’m used to them being framed more as “me making the wrong choices/failing to look after myself”

I never believed the food trigger theory, that was always clear to me that I craved these because it was underway already.

 

I have very clear food triggers. I can reliably give myself a migraine by eating certain things. I really wish I couldn't!

 

If chocolate coffee and orange caused my migraines I’d be in a permanent migraine!

 

I've never been able to identify any triggers for mine (they aren't frequent). Wish I knew!

 

Me too.

 

I have clear food triggers with a predictable time lapse between consumption and the headache onset. But also migraine type headaches are a symptom of my PEM. I only now get food triggered migraines if I eat something that contains the trigger foods unbeknownst to me. Also though restricting my diet drastically reduces migraines they can still emerge as part of PEM.

When I was still working, though only half time, before I had not identified the food triggers, taking medication designed to stop migraines happening, I found delayed but did not ultimately block the headache phase. However they did get me through the work days but then the headache, etc came on with a vengeance along with PEM at the end of the week.

 

I have a few lead suspects and a few that I have realised are actually symptoms of the early phase