E-diaries help migraine sufferers predict attacks

Early warning system’ may lead to treatments

A multicenter study of 97 patients found that 72% of those who reported premonitory (before the attack) symptoms (i.e., fatigue, difficulty concentrating, and a stiff neck) experienced a migraine headache within 72 hours at least half the time. This ability to predict migraines could one day lead to the development of preemptory treatment, says one of the lead researchers, and may even help improve the treatment being received by current sufferers.

The study’s results were published in the March 25, 2003, issue of Neurology, a publication of the American Academy of Neurology.

"The significance of the paper comes down to this: For years, there has been the perception that people with migraine could predict headaches based on premonitory symptoms. But some raised questions as to whether this was not so much prediction as patients recalling the symptoms as warnings when they looked back," notes Richard B. Lipton, MD, of the departments of neurology, epidemiology, and social medicine at Albert Einstein College of Medicine in Bronx, NY. "Our objective was to determine if the group could actually predict headaches, so we would know with certainty that the warning features were prospectively recorded. What we found was, those who thought they could predict migraines were actually very good at it," he explains.

Patients with recurring migraine were assigned a hand-held electronic diary and asked to record any nonheadache symptoms on a daily basis for three months. During that time, 97% of them recorded some type of symptom during the premonitory phase. The most common symptoms reported were tiredness (72%); difficulty with concentration (51%); and stiff neck (50%).

"We even asked them to estimate the likelihood they would get a migraine. Those who predicted an 80% chance, for example, actually got about that percentage," Lipton recalls.

The long-term clinical implication of these findings is that it might be possible to develop preemptory treatments, he adds. "Right now, there are two kinds of treatment: preventive treatment and acute treatment, which occurs after the attack begins."

Preventive treatments currently are taken every day, whether the patient feels a migraine coming on or not. "The problem is, most days you don’t really need it," Lipton says. "The problem with acute treatments is that they take a couple of hours to work, which means a couple of hours of acute suffering for the patient."

With preemptive treatment, he continues, you would get the benefits of both acute and preventive treatment.

"There are a number of candidate preemptive drugs that are either being developed or contemplated," Lipton observes. "This diary study says there really is a group of people who can predict migraine and might be good candidates for such drugs."

Does that mean things won’t improve for migraine sufferers until those new drugs are developed? Not necessarily, says Lipton.

"First, there are external trigger factors that vary from person to person, such as chocolate, red wine, soft cheeses, stressful events," he offers. "People can prevent some migraines themselves by avoiding triggers or by practicing a relaxation method."

Relaxation techniques such as meditation have been used for a long time and have worked "pretty well," Lipton says. "This study lends this approach support and creates opportunities for behavioral preemptive strategies," he says.

Most of the current preventive medicines have effects that only develop over a period of weeks, so they probably could not be used as preemptive treatments, says Lipton.

"There is one preemptive strategy that’s been used effectively," he adds. "Some women are very regular with their periods; if they have regular cycles, they can either take drugs like naproxen [Aleve], naratriptan [Amerge], or frovatriptan [frova]. The interesting thing about these drugs is that they are ordinarily acute treatments."

However, studies have shown them to be effective in pre-menstrual women, Lipton says. "If I had a patient who could predict migraine, I might try one of these as preemptive therapy, even though we do not have the science yet to support it."

In other words, "we are probably years away from new drugs, but not from new applications of approved drugs," he says.

Need More Information?

For more information, contact:

• Richard B. Lipton, MD, Professor, Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Ave., Bronx, NY 10461. Telephone: (718) 430-3886. E-mail: rlipton@acoem.yu.edu.