A comprehensive approach to migraine requires an understanding of the entire range
of mechanisms and resultant symptoms that occur throughout the evolution of an attack. The understanding of migraine pathophysiology continues to advance rapidly, bringing fresh opportunities for the development of novel acute and preventive therapies. It is convenient to describe the phases of a migraine attack (premonitory, aura, headache, postdrome) relative to the headache phase because headache is the most easily recognizable, Rapamycin stereotyped, and quantifiable feature of an attack. But for a significant number of patients, the other phases of a migraine attack can be more prolonged and even more disabling click here than headache. Growing evidence indicates that the phases of migraine do not occur in a discrete and linear fashion but rather reflect overlapping
chemical, physiological, and anatomical mechanisms. It is well known that for many migraine patients, the first symptoms of an attack are “premonitory” that occur up to hours before aura or headache.[1-7] The reliable occurrence of these symptoms in a significant majority of patients indicates that complex brain events are taking place well before the events associated with aura and headache. A better understanding of the mechanisms underlying premonitory symptoms is critical to a complete understanding of how a migraine attack begins. This understanding is particularly important because the “premonitory phase” of an attack may represent an important window of opportunity for novel acute therapies. The most commonly reported symptoms preceding headache are fatigue, irritability, difficulty concentrating, mood change, yawning, stiff neck, phonophobia, and nausea.[1-7] Other symptoms that have been reported MCE include change in appetite, food cravings, bloating, piloerection, and change in facial expression or body perception among others. Both retrospective and prospective studies indicate that more than 80% of adults[6,
7] and a slightly lower percentage of children experience some type of premonitory symptoms, and electronic diary studies indicate that some patients can reliably predict the occurrence of migraine headache up to 12 hours before its onset based on awareness of premonitory symptoms. Some symptoms may come and go before the headache phase, whereas others may build in intensity leading up to the headache, occur during the headache, and persist well beyond the resolution of headache. Indeed, several of the symptoms that have been described as part of the migraine “postdrome” are the same as those occurring in the premonitory phase.[8, 9] Some of the premonitory symptoms also raise questions regarding the nature of migraine triggers.