Premonitory symptom burden and questionnaire-based cutaneous allodynia in episodic migraine: A cross-sectional study

Aim Premonitory symptoms (PSs) precede migraine headache, but the clinical significance of overall symptom burden is uncertain. We examined associations of retrospectively defined PS burden with questionnaire-based cutaneous allodynia and headache impact. Methods This single-center cross-sectional study included 425 adults with episodic migraine and at least one monthly attack during the previous 6 months. A 22-entry PS questionnaire yielded a 20-item analytic score; participants also completed a 19-item Allodynia questionnaire and the Headache Impact Test-6 (HIT-6). Participants were classified into four burden groups based on symptoms reported in ≥30% of attacks. Adjusted models examined cephalic and extracephalic allodynia counts (coprimary outcomes) and HIT-6 (secondary outcome). Results At least one qualifying PS was reported by 372 of 425 patients (87.5%). The adjusted incidence rate ratio per one-category increase in PS burden was 1.25 (95% confidence interval [CI] 1.13–1.38) for cephalic allodynia and 1.32 (95% CI 1.14–1.52) for extracephalic allodynia. The association with HIT-6 was statistically significant but not clinically meaningful ( B = 0.72, 95% CI 0.08–1.36; estimated adjusted difference between the highest- and lowest-burden groups, 2.2 points). These associations remained significant after false discovery rate correction in the sensory-item-removal analysis. Conclusion In this single-center Japanese specialist-clinic cohort, higher retrospective PS burden was associated with greater questionnaire-based cephalic and extracephalic allodynia, whereas the HIT-6 association was not clinically meaningful. Findings are cohort-specific and hypothesis-generating; prospective multicenter validation with attack-level recording and objective sensory assessment is needed.