Often the first signs of a migraine are visual disturbances such as blind spots, tingling in the hands and face, weakness and changes in speech – known as the ‘aura’ stage.
But there is also a lesser-known period, the premonitory, or prodromal phase, with its own set of debilitating symptoms – including brain fog and fatigue, mood changes (irritability and anxiety), neck pain, dizziness, passing more urine and yawning.
It can also cause thirst and food cravings (which the sufferer may then mistakenly think is the ‘trigger’ for the migraine itself).
This prodomal stage can occur hours or even days before the headache – but while the symptoms come on before the aura, they can also overlap.
Now scientists at King’s College London have found that a drug already known to relieve migraine pain can also stop these early symptoms, which may affect up to 80 per cent of migraine sufferers.
The drug, called ubrogepant, is the first to be shown to help patients in this stage.
For the study, published in the journal Nature Medicine, 438 participants aged 18 to 75 who had had migraines for at least a year were randomly assigned into one of two groups.
They took either a single 100mg dose of ubrogepant or a placebo when their premonitory symptoms struck. They were then asked to repeat this process by using the other treatment at least seven days later.
Around 10million in the UK suffer from migraines and they are more common for women than men (picture posed by model)
The participants endured fewer symptoms when they used ubrogepant. They were twice as likely to be free of neck pain and fatigue two or three hours after taking ubrogepant, for instance.
They also reported being able to concentrate only an hour later, and experienced less sensitivity to light.
There were some side-effects, such as nausea, drowsiness and dizziness, but these were relatively uncommon and not deemed to be severe.
Ubrogepant works by blocking calcitonin gene-related peptide (CGRP), a chemical messenger released by certain nerves during a migraine that is involved in the transmission of pain signals.
Around 10million in the UK suffer from migraines and they are more common in women than men.
A study by Umea University in Sweden, published in 2015 in the journal Cephalalgia, found that 77 per cent of those with migraines experienced premonitory symptoms – with women having more than men (other studies have put the prevalence at between 30 to 80 per cent of migraine sufferers).
King’s College London researchers have found that the drug ubrogepant, which is already known to relieve migraine pain, can stop brain fog
‘As the issue is increasingly discussed, it seems clear the vast majority [of migraine sufferers] have some form of premonitory phase,’ said Professor Peter Goadsby, a world-renowned authority on migraines and lead author of the King’s College London study. ‘In my experience, it is 90 per cent.’
But as Rob Music, chief executive of charity The Migraine Trust, told Good Health: ‘People do not always recognise prodrome symptoms as being part of a migraine attack.
‘There can also be confusion between these symptoms and migraine triggers, for example mistaking mood changes or tiredness for triggers when actually they may be prodrome symptoms.’
Chocolate, when eaten in this stage to satisfy food cravings, is often wrongly labelled as a trigger.
Dr Nicholas Silver, a consultant neurologist at The Walton Centre in Liverpool, said: ‘This is a really interesting and useful study – the prodromal stage of migraine is important as these symptoms are often relatively invisible but can be highly disabling.
‘They also allow a person to be able to detect when a migraine is starting.
‘This study provides good evidence that treatment with CGRP antagonist therapy early in a migraine attack, indeed before the headache, has good utility in reducing these symptoms.’
He adds that this type of drug ‘is probably the first acute attack treatment class unlikely to cause rebound or medication-overuse headache’. (Scientists aren’t sure exactly why, but some painkillers, when used frequently, can start causing more pain.)
Rob Music, chief executive of charity The Migraine Trust
This understanding would mean these drugs could be prescribed more widely and not just kept for severe attacks.
While ubrogepant is available in several countries, including the US and Canada, the manufacturer AbbVie (which funded and partly designed the latest study) has no plans to bring the treatment to the UK at the moment.
However there is another type of CGRP receptor antagonist, rimegepant, available here.
‘Although not as proven as ubrogepant in this study, we believe it may be safely used in aura or in the prodromal phase,’ says Dr Silver.
‘Under NICE [National Institute for Health and Care Excellence] guidelines it is potentially available to those who are contraindicated to take triptans [one of the first-line medicines for treating migraine] or if they have failed two triptans.’
There are other treatments coming along – for example, scientists in the US have developed a skin patch that could be more effective than migraine pills.
A team from Mercer University in Atlanta, Georgia, packed two migraine medicines – sumatriptan (used to combat pain) and metoclopramide ( which reduces nausea and vomiting) – into a stick-on patch and tested it on pig skin.
Taking them as tablets is often ineffective if the patient then vomits due to the migraine.
Results from the test, published earlier this month in the Drug Delivery and Translational Research journal, showed the required amount of both drugs seeped through the skin and into the blood within a few hours of the patch being applied – ensuring the medicine stayed in the body.
