TY - JOUR

T1 - What proportion of people with migraine report postdromal symptoms?

T2 - A systematic review and meta-analysis of observational studies

AU - Christensen, Rune Häckert

AU - Eigenbrodt, Anna Kristina

AU - Ashina, Håkan

AU - Steiner, Timothy J.

AU - Ashina, Messoud

N1 - Publisher Copyright: © International Headache Society 2023.

PY - 2023

Y1 - 2023

N2 - Background: Postdromal symptoms, following headache resolution, are said to constitute a distinct phase of the migraine attack. We question the evidence for this, with regard both to the nature of such symptoms and to how often they are reported to occur. Methods: We searched the Pubmed and Embase databases for relevant articles from their inception until 25 May 2023. We included observational studies recording the proportions of participants with migraine reporting one or more postdromal symptoms or specific individual symptoms. Two reviewers independently screened studies for relevance (agreeing on those to be included), extracted data and assessed risk of bias. Data were analyzed using random-effects meta-analysis to establish the proportions of those with migraine reporting one or more postdromal symptoms, whether among the general population or patients in clinic-based samples. Results: Large majorities of participants in either case reported postdromal symptoms: 97% in the only population-based study, and a mean of 86% (95% CI: 71–94%) in four clinic-based studies. The most commonly reported specific symptoms were fatigue (52%; 95% CI: 44–60%), concentration difficulties (35%; 95% CI: 14–65%) and mood changes (29%; 95% CI: 9–64%), none of these being clearly described. These estimates could not be considered reliable: they were subject to substantial study heterogeneity, none of the studies applied International Classification of Headache Disorders definitions of postdromal symptoms, and all had high risk of bias. Conclusion: Postdromal symptoms in migraine appear to be very commonly reported, but the data are unreliable with regard both to their nature and to how often they occur. Further studies are needed to conclude that they constitute a distinct phase of migraine.

AB - Background: Postdromal symptoms, following headache resolution, are said to constitute a distinct phase of the migraine attack. We question the evidence for this, with regard both to the nature of such symptoms and to how often they are reported to occur. Methods: We searched the Pubmed and Embase databases for relevant articles from their inception until 25 May 2023. We included observational studies recording the proportions of participants with migraine reporting one or more postdromal symptoms or specific individual symptoms. Two reviewers independently screened studies for relevance (agreeing on those to be included), extracted data and assessed risk of bias. Data were analyzed using random-effects meta-analysis to establish the proportions of those with migraine reporting one or more postdromal symptoms, whether among the general population or patients in clinic-based samples. Results: Large majorities of participants in either case reported postdromal symptoms: 97% in the only population-based study, and a mean of 86% (95% CI: 71–94%) in four clinic-based studies. The most commonly reported specific symptoms were fatigue (52%; 95% CI: 44–60%), concentration difficulties (35%; 95% CI: 14–65%) and mood changes (29%; 95% CI: 9–64%), none of these being clearly described. These estimates could not be considered reliable: they were subject to substantial study heterogeneity, none of the studies applied International Classification of Headache Disorders definitions of postdromal symptoms, and all had high risk of bias. Conclusion: Postdromal symptoms in migraine appear to be very commonly reported, but the data are unreliable with regard both to their nature and to how often they occur. Further studies are needed to conclude that they constitute a distinct phase of migraine.

KW - headache disorders

KW - postdromal phase

KW - Postdrome

KW - prevalence

U2 - 10.1177/03331024231206376

DO - 10.1177/03331024231206376

M3 - Review

C2 - 37851650

AN - SCOPUS:85174748361

VL - 43

JO - Cephalalgia

JF - Cephalalgia

SN - 0800-1952

IS - 10

ER -