Characterizing the patient experience during the prodrome phase of migraine: A qualitative study of symptoms and their timing

Abstract Objective This study explores and documents the patient experience during the prodrome phase of migraine. Background Migraine attacks can be divided into four stages: the prodrome (or premonitory phase), the aura, the headache phase, and postdrome. Qualitative data on the range of symptoms during the prodrome and their timing relative to headache onset are sparse. Prodromal symptoms may predict the onset of migraine headache pain and provide a clinically useful benchmark for initiation of treatment early in an attack before pain begins. Design/Methods Eligible participants with a clinician‐confirmed diagnosis of migraine and at least one prodromal symptom were consented, screened, and then participated in 60‐min interviews. The interview guide included open‐ended questions to elicit spontaneous reports and specific probes about prodromal symptoms based on a clinician‐established list. A theory approach was used to analyze the qualitative data collected in interviews to identify key themes and gather insights; data were analyzed using ATLAS.ti. Results Data collection for this study occurred from March 8, 2022, to May 16, 2022. Twenty interviews were conducted, and analyses demonstrated that concept saturation was achieved. Participants reported 36 unique prodromal symptoms, and each participant experienced a mean of 13 symptoms (standard deviation SD = 6.6) and a median of 11 symptoms (interquartile range IQR = 7.8–17.0) during the prodrome phase. The most commonly reported prodromal symptoms were nausea ( n = 17/20, 85%), fatigue/tiredness ( n = 16/20, 80%), sensitivity to light ( n = 13/20, 65%), neck pain/stiffness ( n = 12/20, 60%), and dizziness/vertigo/light‐headedness ( n = 10/20, 50%). Of the symptoms reported by at least four participants ( n ≥ 4/20, 20%), 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). Almost 40% of all symptoms reported occurred less than 2 h before the start of migraine headache. Of the commonly reported symptoms, nausea (0.8h), sensitivity to light (1.0 h), and dizziness/vertigo/lightheadedness (2.0 h) began closest to headache onset; fatigue/tiredness (4.0 h) and neck pain/stiffness (4.8 h) were the most remote from headache onset. Conclusion This study identified frequently reported prodromal symptoms, with participants commonly reporting that a migraine headache would follow their experience of prodrome within a 1‐ to 6‐h window. Characterizing the prodrome experience may improve measurement strategies for the burden of migraine and create opportunities to treat during the prodromal phase to prevent the onset of moderate or severe headaches.