Overlap between perceived triggers, premonitory symptoms and symptom persistence across migraine phases: A REFORM study

Aim
To evaluate the overlap between commonly reported trigger factors and corresponding premonitory symptoms in individuals with migraine.
Methods
This cross-sectional study analyzed data based on participant recall obtained through semi-structured interviews. Individuals diagnosed with migraine were enrolled from September 2020 to June 2022. Participants underwent semi-structured interviews to record their usual trigger factors, premonitory symptoms, non-headache symptoms during the headache and postdromal symptoms. The primary outcome was to assess whether reporting specific trigger factors increased the likelihood of experiencing corresponding premonitory symptoms. Furthermore, the presence of non-headache symptoms across migraine phases was examined.
Results
Among the 632 participants (mean age 44.6 ± 12.0 years; 89% female), the most frequent triggers were sleep disturbances (70.1%), stress (67.7%) and alcohol consumption (59.0%). Common premonitory symptoms included tiredness (39.9%), concentration difficulties (35.0%) and neck pain (33.2%). Significant associations were found between specific triggers and premonitory symptoms: bright light with premonitory photophobia (odd ratio (OR)  = 2.79; 95% confidence interval (CI) = 1.90–4.12; p < 0.001), loud noise with premonitory phonophobia (OR = 4.26; 95% CI = 2.77–6.59; p < 0.001) and sleep disturbances with premonitory tiredness (OR = 1.74; 95% CI = 1.15–2.64; p = 0.009).
Conclusions
Our results reveal a notable overlap between specific migraine triggers and corresponding premonitory symptoms, implicating that some perceived triggers could be early signs of an impending attack. Moreover, the continuation of most premonitory symptoms into the postdromal phase suggest that migraine-related symptoms extend across a broader temporal continuum than previously recognized.