Below we reproduce a fragment of chapter 7 of the recently published book 'Goodbye to migraines' (Vergara) by Dr. Jesús Porta-Etessam. The author, a specialist in neurology and pathologies associated with the nervous system, works at the Hospital Clínico San Carlos in Madrid, in the Hospitalization, Headaches and Neuro-ophthalmology unit.
Although the most important and defining element of migraine is the headache, migraineurs can experience many symptoms that are not painful. Among them, photophobia, phonophobia, postdromic symptoms [after the headache] (...) and premonitory symptoms stand out. These appear before the headache and, from a medical point of view, they can warn us that the patient is going to suffer from it. Perhaps, in the future, drugs can be designed that, if taken now, will prevent the patient from developing a migraine headache later on. On the other hand, knowing these symptoms helps us understand why migraine occurs.
The premonitory symptoms will appear hours before the headache and must be distinguished from another different phenomenon, what we call 'the visual aura'. The aura is a phenomenon of cortical depolarization in which the patient sees lights, has sensory alterations or even problems speaking, and occurs immediately before the headache attack. However, the premonitory symptoms occur hours before and do not occur in the form of a neurological deficit, but are changes in attention, eating pattern or sleep.
Another important element is that the closer the premonitory symptoms are to the migraine attack, the more likely they are to predict it, in such a way that, if they occur six hours before, they can predict up to 70% of migraine attacks. However, if they appear before 24 hours, they will only predict it by 20%.
These symptoms are highly variable: fatigue -one of the most frequent-, hypersensitivity to noise or sounds, feeling dizzy, loss of activity or hyperactivity, yawning, paleness, blurred vision, skin hypersensitivity to touch, constipation, change in pattern urinary, nausea, and a feeling of stiffness in the neck.
The latter is very important, since, as many patients have this sensation before their headaches, they think that the migraine is caused by involvement of the neck. In addition, some will be in a bad mood or feel hungry.
It is especially interesting that many of them have a particular craving for sweets, in such a way that they eat chocolate and think that it is the trigger of the migraine attack, when what is really happening is that this prodromal symptom is an indication of migraine and, therefore, they take chocolate because they are going to have a seizure.
This point, which has been widely studied, is fundamental because it helps us understand migraine and also make decisions when it comes to making any dietary restrictions for patients who suffer from it.
Less commonly, there may be alterations in language or problems in concentration, reading or writing. These symptoms have been repeatedly analyzed using devices that can recognize this change in language and predict that the patient is going to have a seizure.
Many of the symptoms we are discussing lead us to a specific brain structure: the hypothalamus. There is currently much evidence that, in some patients, it could be the trigger or the beginning of migraine attacks, in such a way that external and internal influences would take place in the hypothalamus and subsequently the premonitory symptoms would develop so that, at a later stage, the headache itself appears. Currently, different devices are being investigated to recognize prodromal symptoms and, possibly, in the future a treatment can be applied to patients with migraine to prevent them from developing attacks.
