Classification of the pain curve and semiology of a migraine crisis

Abstract text (incl. figure legends and references)

Objective: Previous studies have identified clinical characteristics of a migraine crisis; however, the evolution of the pain has been little studied. Our objective was to evaluate the semiology of a migraine crisis according to the type of pain curve.

Methods: We analyzed the pain curve of patients with episodic migraine according to the current criteria (ICHD-III) included in a prospective real time study using a smartphone application. The follow-up period was one month, the patient marked start/end and evolution of the pain in at least 5 points depending on the intensity. Symptomatic treatment was allowed. At the end of the crisis, the patient completed the characteristics of the episode in the smartphone application. To generate the model K-means and a supervised validation technique using a logistic model tree was used.

Results: A total of 344 migraine crisis from 51 patients (mean age 39 years, 90.2% women) were analyzed. Using the maximum pain intensity, time to achieve the maximum pain intensity, the relationship between both parameters and the total duration, all episodes were categorized in four types according to the main characteristics: 1(high intensity), 2(acute onset), 3(prolonged and intense) y 4(low intensity). Univariate analysis found statistically significant differences in the type of curve regarding the presence of nauseas (p<0.001), sonophobia(p<0.001), osmophobia(p<0.03) and the number of simultaneous symptoms (p<0.001); there were also differences in prodromic symptoms such as speech difficulties (p=0.029), dizziness (p=0.015), and postdrom symptoms such as appetite (p=0.029), whim (p=0.031), cognitive (p=0.019) and sleepiness (p=0.013).

Conclusion: The evolution of the pain crisis can be successfully categorized in 4 types of curves, which represent different semiology characteristics of a migraine crisis