Headache‐related disability as a function of migraine aura: A daily diary study

Abstract Objective To examine the unique role of migraine aura in predicting day‐to‐day levels of headache‐related disability. Background Migraine symptoms and psychological variables contribute to headache‐related disability. Migraine aura may be associated with more severe symptom profiles and increased risk of psychiatric comorbidities, but the impact of aura on daily functioning is unknown. The present study sought to evaluate the role of migraine aura in predicting same‐day and subsequent‐day migraine‐related disability while accounting for demographic, headache, and psychological variables. Methods This was an observational prospective cohort study among 554 adults with migraine. For each participant, data on migraine symptoms and psychological variables were collected daily for 90 days using the N‐1 Headache™ digital app ( N = 11,156 total migraine days). Analyses assessed whether the presence of aura predicted daily ratings of migraine‐related disability independently of other headache and psychological variables. Given the number of predictors examined, statistical significance was set at p < 0.01. Results The mean (standard deviation, range) patient‐level Migraine Disability Assessment questionnaire score across days of the migraine episode was 1.18 (1.03, 0–3). Aura was significantly associated with higher disability ratings on all days of the migraine episode (odds ratio OR 1.40, 99% confidence interval CI 1.13–1.74; p < 0.001). This relationship remained unchanged after adjusting for patient‐level variables (OR 1.40, 99% CI 1.13–1.73; p < 0.001) and day‐level psychological variables (OR 1.39, 99% CI 1.12–1.73; p < 0.001) but was fully negated after controlling for day‐level headache variables (OR 1.19, 99% CI 0.95–1.49; p = 0.039). Aura on the first day of the episode was associated with increased odds of allodynia (OR 1.87, 99% CI 1.22–2.86; p < 0.001), phonophobia (OR 1.62, 99% CI 1.17–2.25; p < 0.001), photophobia (OR 1.89, 99% CI 1.37–2.59; p < 0.001), and nausea/vomiting (OR 1.54, 99% CI 1.17–2.02; p < 0.001) on all days of the episode, but not episode duration ( p = 0.171), peak severity ( p = 0.098), or any examined psychological variables (sleep duration p = 0.733, sleep quality p = 0.186, stress p = 0.110, anxiety p = 0.102, or sadness p = 0.743). Conclusion The presence of aura is predictive of increased headache‐related disability during migraine episodes, but this effect is attributable to associated non‐pain symptoms of migraine.