Factors Associated with Migraine Attack Duration in Adults: A Cross-Sectional Study

INTRODUCTION: Migraine is a common neurological disorder with attacks lasting 4-72 hours (h). Although duration is a key diagnostic criterion, the clinical and demographic factors associated with its variability are not well defined. Identifying temporal phenotypes may improve diagnostic accuracy and inform individualized management. METHODS: In this cross-sectional observational study, we evaluated 694 patients fulfilling ICHD-3 migraine criteria. Patients were categorized by attack duration into short (4-12 h), medium (13- 24 h), and long (>24 h) groups. Sociodemographic features, migraine characteristics, associated symptoms, and disability measures were compared across groups. Multinomial logistic regression was performed using the short-duration group as the reference category to identify variables independently associated with medium- and long-duration attacks. RESULTS: Of 694 participants (84% female; mean age 36.66±12.20 years), 33.3% (n=231) experienced short, 28.2% (n=196) medium, and 38.5% (n=267) long attacks. Long-duration attacks were associated with older age (39.98±11.36 vs. 34.09±12.62 years, p < 0.001), higher female ratio (89.1% vs. 78.8%, p = 0.007), and lower educational level (p = 0.008). Patients with prolonged attacks had higher allodynia scores (median ASC 6 vs. 4, p < 0.001), greater pain intensity (VAS 9 vs. 8, p < 0.001), and more frequent nausea and vomiting (p = 0.002). Illness duration was longest in the long-attack group (median 120 vs. 60 months, p < 0.001). Other clinical characteristics, including aura, localization, and chronic migraine rates, showed no significant differences. In multivariable analysis, older age and higher pain intensity remained independently associated with long-duration attacks, while lower educational level and higher pain intensity were independently associated with medium-duration attacks. CONCLUSION: Migraine attack duration is associated with distinct demographic and clinical characteristics independent of attack frequency. In multivariable analysis, older age and higher pain intensity remained independently associated with long-duration attacks, while lower educational level and higher pain intensity were independently associated with medium-duration attacks. These findings suggest that attack duration could represent a meaningful clinical phenotype; therefore, frequency-based classification approaches might overlook patients with infrequent but prolonged and disabling attacks.