Premonitory symptoms in glyceryl trinitrate triggered migraine attacks: a case-control study.

Area of Science:

• Neurology
• Neuroscience
• Clinical Medicine

Background:

• Migraine attacks are often preceded by premonitory symptoms.
• These symptoms can occur spontaneously or be provoked by certain triggers.
• Understanding these early warning signs is crucial for migraine management.

Purpose of the Study:

• To systematically evaluate premonitory symptoms in migraine patients and healthy controls following glyceryl trinitrate (GTN) infusion.
• To identify specific premonitory symptoms associated with GTN-induced migraine-like headaches.
• To assess the potential of these symptoms as early warning signals in clinical practice.

Main Methods:

• A semistructured interview was used to assess 21 potential premonitory symptoms in women with migraine without aura and age-matched healthy controls.
• Interviews were conducted every 15 minutes for 5 hours after GTN infusion (0.5 µg/kg/min over 20 minutes).
• Migraineurs were categorized as GTN responders (developed migraine-like headache) or nonresponders.

Main Results:

• Migraine-like headaches occurred in 82.4% of migraineurs (GTN responders).
• At least one premonitory symptom was reported by 92.9% of responders, 100% of nonresponders, and 54.2% of controls.
• Concentration difficulties, yawning, nausea, and photophobia were more frequent in migraineurs who developed a migraine-like attack compared to controls.
• Concentration difficulties were exclusively reported by migraineurs who developed a migraine-like attack.

Conclusions:

• Glyceryl trinitrate (GTN) effectively provokes naturally occurring premonitory symptoms in migraine patients.
• Yawning, nausea, photophobia, and concentration difficulties are highly specific for impending GTN-induced migraine-like headaches.
• These identified symptoms, particularly concentration difficulties, may serve as valuable early warning signals in clinical settings for migraine attacks.