Associations between premonitory symptoms and triggers in migraine: An exploratory study

Background The hypothalamus has been posited to play a role in premonitory symptomatology in migraine. Many patients also report particular triggers for their migraine attacks. Identifying the relationship between these may provide insights into the potential role of hypothalamic dysfunction in migraine pathophysiology. Methods A single centre cross-sectional study was performed. Data was collected on the presence of premonitory symptoms and triggers from patients who attended a tertiary headache clinic from February 2024 to December 2024 and entered into a Headache Database. Statistical analysis with multivariate binomial logistic regression was performed to identify relationships between premonitory symptoms and triggers. Results Of the100 patients who were identified as fulfilling a diagnosis of migraine as per ICHD-3 criteria, 96% reported at least one premonitory symptom. Women reported a greater number of premonitory symptoms (6 [IQR 4–9] vs 4 [IQR2–7], P = 0.005) and triggers (4 [IQR 3–7] vs 3 [IQR 2–5], P = 0.046) compared to men. Linear regression showed that patients with more triggers were likely to report more premonitory symptoms (R 2 = 0.466). Statistically significant correlations were found between certain triggers and premonitory symptoms such as poor sleep and photophobia ( P = 0.001) and overcast weather and drowsiness ( P = 0.003). Independent correlations were also found between certain premonitory symptoms, allowing for groupings of certain symptoms with each other. Conclusions The study demonstrated that patients who reported more triggers were likely to report more premonitory symptoms, and that women reported more premonitory symptoms compared to men. Certain triggers were also associated with the presence of certain premonitory symptoms, for example poor sleep and photophobia as well as overcast weather and drowsiness. The presence of independent associations between certain triggers and premonitory symptoms may suggest specific network dysfunctions in different networks that may account for interindividual variability in migraine triggers and symptomatology.