Characterizing the Patient Experience During the Prodrome Phase of Migraine: A Qualitative Study of Symptoms and Their Timing
Jonathan Stokes1, Richard B. Lipton2, Christopher Evans3, Elizabeth Hribal3, Kailee White3, Katelyn Keyloun1, Krutika Parikh1, Pranav Gandhi1, David W. Dodick4
1AbbVie, 2Albert Einstein College of Medicine, 3Endpoint Outcomes, 4Mayo Clinic
Objective:
To explore and document the patient experience of the prodrome phase of migraine.
Background:
Migraine can progress across four stages: prodrome, aura, headache, and postdrome. There is limited information on the percentage of people who experience the prodrome phase of migraine and the symptoms that characterize the experience. Prodrome may predict the onset of migraine headache hours in advance and can be key to help inform early treatment.
Design/Methods:
Eligible participants with clinician-confirmed diagnosis of migraine and at least one prodrome symptom were consented, screened, and participated in 60-minute concept elicitation interviews. The interview guide included open-ended questions to elicit spontaneous reports and specific probes about prodrome symptoms based on a clinician-established list.
Results:
Twenty interviews were completed and concept saturation was achieved. Participants reported 36 unique symptoms of prodrome. The most common (>50.0%) were nausea, fatigue/tiredness, sensitivity to light, neck pain/stiffness, and dizziness/vertigo/light-headedness. Of the symptoms reported by at least four participants, neck pain/stiffness was rated most bothersome (8.9 out of 10) and sensitivity to light was rated most severe (8.5 out of 10). Fourteen (38.9%) symptoms were reported as occurring less than two hours before the start of migraine headache. Of the commonly reported symptoms, nausea (0.8 hours), sensitivity to light (1.0 hour), and dizziness/vertigo/lightheadedness (2.0 hours) occurred closest to headache onset; fatigue/tiredness (4.0 hours) and neck pain/stiffness (4.8 hours) were the most remote from headache onset.
Conclusions:
This study identified frequently reported prodrome symptoms, with participants reporting confidence that migraine headache would imminently follow within 1-6 hours. Characterizing the prodrome experience may improve the measurement of the burden of migraine and create opportunities to treat during the prodromal phase to prevent the onset of moderate or severe headaches.