Migraine: Functional impairment between attacks

The impact of migraine extends well beyond the acute pain phase of individual attacks.

Migraine is characterized by recurring, often frequent headache pain. The acute attack is usually accompanied by other symptoms, such as aversions to light (photophobia,) sound (phonophobia,) smells (osmophobia,) as well as nausea, vomiting and extreme tiredness.

Typical migraine lasts from 4 to 48 hours and for at least half those with migraine, results in near incapacitation and the need for bed rest. The associated symptoms of migraine headache explain the frequent need for the sufferer to retreat to a quiet, dark place during the acute attack.

That these attacks are disabling is immediately apparent. However, the impact of migraine is not limited to this acute pain phase. Each phase of migraine may be associated with significant impairment.

Premonitory phase:

Sometimes also referred to as the “prodrome” this phase can begin hours or days prior to the onset of the acute pain phase. It may be characterized by sleepiness, irritability, other change in mood or any number of diverse symptoms specific to the individual sufferer. Up to 80% of those with migraine can learn to recognize impending migraine, which may be advantageous in planning or in the administration of medication. However, this time frame represents a period of diminished function and adds to the negative impact of migraine.


While generally brief, and not specifically painful, many migraine patients who experience aura describe it as extremely unpleasant.

Post-headache Phase:

Also referred to as “postdrome,” this is a period of diminished functioning experienced by many migraine patients after the pain of migraine has resolved. Commonly, patients experience migraine-associated non-headache symptoms for an additional 24 to 48 hours. Frequent symptoms include fatigue, lethargy, muscle soreness, poor concentration and lack of appetite. Impaired functioning during this phase adds substantially to the burden of migraine.

Between Attacks:

Also referred to as “interictal,” this is the entire period between attacks of acute pain. While there may be differences in autonomic functioning, especially increased pain perception between attacks, the primary burden during this time period relates to the expectation (dread) of the next attack. Patients are unable to plan with confidence, which affects work, family and social interactions. Anxiety and depression are common and result, at least in part, from the perceived (and actual) loss of control that comes with recurring migraine attacks.

The publication briefly summarized below suggests that physicians need to become more aware of the extent to which migraine results in impaired function between attacks.

The publication:

December, 2009

Migraine and functional impairment.

Summary of the abstract

Migraine is a leading cause of disability worldwide; approximately half of those affected have such severe attacks that they cannot function normally in routine daily activities.

Research is starting to focus upon the burden of migraine between attacks, referred to as interictal burden. This burden encompasses worry and expectation of future attacks that consequently may be associated with limitations in social and family interactions, as well as work capacity.

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