Photo-, osmo- and phonophobia in the premonitory phase of migraine: mistaking symptoms for triggers?

Laura H Schulte,Tim P Jürgens,Arne May

doi:10.1186/s10194-015-0495-7

Laura H Schulte, Tim P Jürgens + Show 1 more

Open Access

https://doi.org/10.1186/s10194-015-0495-7

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Abstract

BackgroundCertain environmental stimuli are frequently reported as typical triggers of migraine pain. Whether these so-called triggers are independent precipitators of migraine pain or mere symptoms of the premonitory phase of migraine remains to be elucidated.MethodsIn this retrospective cohort study of 1010 migraine patients of a tertiary headache center we assessed the frequency of common trigger factors, premonitory symptoms and accompanying symptoms as well as basic headache characteristics and demographic data.ResultsPremonitory symptoms with an onset of 2 or more hours prior to the headache were present in 38.9% of migraine patients, the most frequent being a tense neck, phonophobia and difficulty concentrating. There was a clear overlap of certain trigger factors and the presence of corresponding premonitory symptoms: flickering or bright light as a trigger was associated with higher frequency of photophobia in the premonitory phase. The same applied to the presence of food craving and osmophobia in the premonitory phase and certain foods or odours as trigger factors.ConclusionsOur data thus support the view that commonly reported trigger factors of migraine are not so much independent precipitators of migraine pain, but that they are most likely just misinterpreted results of enhanced attention to certain stimuli mediated by typical premonitory symptoms of migraine pain.

Highlights

Certain environmental stimuli are frequently reported as typical triggers of migraine pain
Empirical evidence that these factors can provoke migraine attacks is scarce [12,13], and it is currently not clear whether these factors are actual independent triggers of migraine pain, i.e. factors that at any given moment reliably precipitate migraine pain, or whether the increased intake of certain foods, the pronounced perception of e.g. certain lights or odours as adverse and even pain inducing might rather be a result of a slight photo- or osmophobia or food craving already present in the premonitory phase
699 had migraine without aura and 311 had migraine with aura. 389 migraine patients reported premonitory symptoms starting at least 2 hours before the pain phase of migraine with no significant difference between MwoA and MwA (269 MwoA (38.5%) and 120 MwA (38.6%))

Summary

Introduction

Certain environmental stimuli are frequently reported as typical triggers of migraine pain. Whether these so-called triggers are independent precipitators of migraine pain or mere symptoms of the premonitory phase of migraine remains to be elucidated. Flickering light, bright sunlight, certain odours or certain foods are - among others - frequently reported as typical triggers of migraine pain [1,2,3,4,5,6,7,8,9,10,11]. Empirical evidence that these factors can provoke migraine attacks is scarce [12,13], and it is currently not clear whether these factors are actual independent triggers of migraine pain, i.e. factors that at any given moment reliably precipitate migraine pain, or whether the increased intake of certain foods, the pronounced perception of e.g. certain lights or odours as adverse and even pain inducing might rather be a result of a slight photo- or osmophobia or food craving already present in the premonitory phase

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