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The natural course of migraine attacks. A prospective analysis of untreated attacks compared with attacks treated with a triptan

Journal article
Authors Mattias Linde
Annsofie Mellberg
Carl Dahlöf
Published in Cephalalgia
Volume 26
Issue 6
Pages 712-21
Publication year 2006
Published at Institute of Neuroscience and Physiology, Department of Physiology
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Pages 712-21
Language en
Keywords Adult, Aged, Comorbidity, Cross-Over Studies, Disease Progression, Female, Humans, Hyperacusis/epidemiology/prevention &amp, control, Incidence, Male, Middle Aged, Migraine Disorders/diagnosis/ drug therapy/ epidemiology, Nausea/epidemiology/prevention &amp, control, Pain Measurement/drug effects/statistics &amp, numerical data, Prognosis, Prospective Studies, Risk Assessment/ methods, Risk Factors, Serotonin Agonists, Severity of Illness Index, Sumatriptan/ administration &amp, dosage, Sweden/epidemiology, Treatment Outcome, Tryptamines/ therapeutic use, Vasoconstrictor Agents/administration &amp, dosage, Vomiting/epidemiology/prevention &amp, control
Subject categories Physiology


This study was designed to document prospectively and explore scientifically the natural course of untreated migraine attacks in detail. A new, integrated, time-intensity method for self-assessment of the intensity of symptoms was tested on 18 adult International Headache Society migraineurs who volunteered to refrain from treatment during one attack. The area under the curves (AUC) during 72 h of untreated attacks was compared with attacks treated with a triptan. Migraine attacks are heterogeneous both inter- and intra-individually. In untreated attacks, the pain can stabilize and fluctuate around a plateau with a wavelength of hours. In general, the symptoms of each separate migraine attack follow a similar temporal course, with only moderate deviations. In some cases photo- and/or phonophobia (hyperexcitability) were not experienced at all, despite severe pain and nausea. Moreover, there was sometimes no nausea despite severe pain and hyperexcitability. Vomiting does not always correlate to the intensity of nausea and is not always followed by decreased headache intensity. Treatment with a triptan usually only temporarily distorts the basic pattern of attacks. Hyperexcitability can respond before pain to treatment. These genuine findings of the classic symptoms of migraine attacks support the notion of a mutual underlying pathophysiological mechanism.

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