Warning symptoms in migraine: characteristics and therapeutic implications

The characteristics of warning symptoms preceding the migraine headache attack in 49 patients with complete migraine are described. These symptoms are divided into non-evolutive and evolutive warning symptoms, based on specific characteristics of each. Non-evolutive symptoms precede the attack by 8 to 48 h in 88% of our patients and have a constant and modest intensity. Evolutive warning symptoms appear within a few minutes up to 6 h before the attack. These symptoms become more and more pronounced towards the onset of the headache. There was no striking similarity between symptoms during the attack and the warning symptoms. In a number of patients with complete migraine, migraine attacks can be prevented by taking domperidone, a peripheral dopamine antagonist, at the time of the non-evolutive warning symptoms. These data suggest that the mechanism leading to a migraine attack can be operative 8-48 h before the headache begins and is possibly dopaminergically mediated.