Variability of the characteristics of a migraine attack within patients.
BACKGROUND
Migraine attacks may present different features in different patients and also within the same patient. The percentage of patients reporting stereotyped attacks and those reporting attacks with different phenotypes has not been the object of specific investigations.


OBJECTIVE
The objective of this article is to evaluate the percentage of migraine patients reporting the same characteristics, in terms of phenotype and response to symptomatic medications on three consecutive migraine 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 as the two hours pain-free status.


RESULTS
None of the patients presented identical characteristics on the three studied attacks. This was still the case if we reduced the number of variables evaluated from 11 to seven of the eight core features indicated by the ICHD. Considering just six variables: unilaterality and quality of pain, presence/absence of nausea, vomiting, photophobia and phonophobia, only two patients (6%) had identical features on three consecutive attacks.With respect to the response to frovatriptan, 39% of patients had the same response, either positive (i.e. pain free after two hours) or negative (i.e. not pain free after two hours) on three consecutive attacks.


CONCLUSIONS
Migraine attacks show a high variability not just among patients, but also within the same patient. Our data indicate that stereotypy of attacks is uncommon, and reinforces the underlying logic of the current operational classification system.
Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy michele.viana@ymail.com.
M
M
Viana
Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy.
G
G
Sances
Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy.
N
N
Ghiotto
Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy.
E
E
Guaschino
Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy.
M
M
Allena
Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy.
G
G
Nappi
Headache Group - NIHR-Wellcome Trust Clinical Research Facility, King's College London, UK.
P J
PJ
Goadsby
Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy Dept. of Brain and Behavioral Sciences, University of Pavia, Italy.
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C
Tassorelli
D000328:Adult; D002227:Carbazoles / Q000627:therapeutic use; D005260:Female; D006801:Humans; D012001:Hyperacusis / Q000209:etiology; D006930:Hyperalgesia / Q000209:etiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000188:drug therapy; D010641:Phenotype; D020795:Photophobia / Q000209:etiology; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D016896:Treatment Outcome; D014363:Tryptamines / Q000627:therapeutic use; D014839:Vomiting / Q000209:etiology; D055815:Young Adult
D002227:Carbazoles; D017366:Serotonin Receptor Agonists; D014363:Tryptamines; C108128:frovatriptan
Migraine; characteristics; differences; features; phenotype; variability