As many as one-third of sufferers of migraine with aura experience forewarning symptoms even the day before an attack that might create an opportunity for intervention and prevention. Later during the actual migraine episode then a significant number of migraine sufferers experience aura prior to an attack, which is characterized by visual disturbances, illusions, zigzag lines, blind spots, speech disturbances, and tingling or numbness on one side of the body.
Migraine scientists meeting this week are considering this subject, among others, at the annual scientific conference of the American Headache Society.
"Migraine is for many people a lightning storm that starts hours or day similar to gathering clouds before the storm, followed by the thunderous pain of the migraine headache," Dr. Purdy said. "The premonitory phase is well-documented but only recently have scientists considered if migraine can be treated before a patient is in full attack mode."
Symptoms are often easily recognized by patients, he said, and can include mood changes - a sense of sadness or euphoria - fatigue, problems with concentration, yawning and pallor, increasing sensitivity to light and sound and a general feeling that the attack is about to begin." In some ways, it's very much like the PMS that many women report before their menstrual period."
Dr. Purdy stressed that the premonition is biologic, not psychological. "Until we fully understand the neurobiology of this phenomenon, our advice to patients is to stay alert to the presence of these symptoms and slow down to allow the body to adjust to what maybe coming if a migraine occurs."
The session "Premonitory Phase of Migraine," Chaired by Andrew Charles, MD and Joel R. Saper, MD at 8:30 am, Saturday, June 4 in the Grand Hyatt Washington. Dr. Charles is Professor and Director, Headache Research and Treatment Program, Department of Neurology at the David Geffen School of Medicine at UCLA. Dr. Saper is Founder and Director of the Michigan Headache and Neurological Institute in Ann Arbor, Michigan. Top scientists will discuss the mechanisms of the premonitory phase and recent imaging research and treatment.
Treatment during this phase of an attack, especially with triptans, has been shown to be effective with some patients. Werner J. Becker, MD, says in his work with medications administered in the premonitory phase of attack.
"We found that headache prevention is possible when a triptan is administered during the premonitory period," Dr. Becker said. "And those that did occur appeared to be milder." Triptans are a class of drugs that constrict blood vessels in the brain and relieve swelling that is associated with migraine pain.
About 500 migraine researchers and clinical specialists are expected to attend the four-day conference.