Step-Headache: A Distinct Symptom of Migraine

Objectives  The diagnosis of migraine depends on various characteristics of headache with their associated constitutional symptoms such as nausea, vomiting, photophobia, and phonophobia. Relatively severe intensity, throbbing character, unilaterality, and aggravation with physical activity are the key features of migraine headache. We did this study to describe a new symptom (step-headache) in migraine in which some patients complained of uncomfortable or painful thump over the head with each footstep during walking or running. Materials and Methods  Self-designed proforma was filled in each clinically diagnosed patient of migraine or tension-type headache in an outpatient clinic setting. The symptom designated here as step-headache was evaluated in 150 patients of migraine including 26 patients with overlapping headache and 244 patients of tension-type headache. Binary logistic regression was used for association analysis of step-headache with subgroups of migraine and with other migraine features. Statistical Analysis  Frequency distributions were expressed as numbers (percentages) or mean ± standard deviation. Binary logistic regression was used for association analysis of step-headache with subgroups of migraine and with other migraine features. Results  Step-headache was experienced by 97 (64.67%) migraine patients with nearly equal distribution among the two clinical subtypes (61.5% for migraine with aura and 65.3% for migraine without aura) but with high prevalence among perimenopausal onset migraine. Of all the patients who had this symptom, 77.32% experienced it during all the migraine attacks. The step-headache was differentiable from throbs of migraine and their exacerbation during physical activity by its synchrony with footsteps and its presence during nonpulsatile headaches or nonheadache phases of migraine. Sensitivity of this symptom was 64.67% while specificity was 100%. Conclusion  Among primary headaches, step-headache is a less well-known but common and distinct symptom of migraine. It has good sensitivity and high specificity for migraine.