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Early Detection of Migraine Episodes

September 9, 2022

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Episodic migraine is a prevalent condition associated with a large burden of suffering. The effectiveness of medical and nonpharmacologic interventions depends on the detection of a migraine episode during the prodromal phase, which is often difficult for patients to recognize. Few tools are available to help patients know when best to apply a migraine abortive treatment. The best tool developed to-date is a forecasting survey that does not incorporate biometric data. We believe that the Cardiogram app can be tailored to serve as the world’s most accurate, real-time predictor of impending migraine episodes, thereby helping to reduce the burden of suffering associated with migraine. 

Definition of Migraine

A migraine is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. A migraine is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.  
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Pathophysiology

The pathophysiology of migraine is not completely understood. The neurovascular theory posits that migraine pain originates from the trigeminovascular system, the activation of which triggers the release of vasoactive neuropeptides, which in turn triggers vasodilation and dural plasma extravasation, leading to neurogenic inflammation.  

Another way to say this is that the trigeminovascular system can go awry and cause inflammation as well the enlargement of blood vessels in the brain, thereby leading to pain in the head. 

Prevalence and Burden of Disease

Among Americans between the ages of 15 and 64 years, 18% report having experienced either severe headaches or migraines in the past three months. Migraine was ranked as the sixth cause of years lost to disability globally in 2013. 

Episodic Migraine

The vast majority of migraineurs experience episodic migraines, defined as fewer than 15 headaches per month. 

Four Phases of a Migraine

4 Stage of a Migraine

Most (and possibly all) migraine episodes are preceded by a prodrome that lasts for a few to many hours. Common prodromal symptoms include irritability, food cravings, sensitivity to light or sound, or difficulty concentrating. Approximately 20% of migraineurs experience an aura for 5-60 minutes, during  which time they may experience visual disturbances, temporary loss of sight, or numbness and tingling in parts of the body. The headache phase follows either the prodrome or the aura. This phase typically lasts 4-72 hours. Headache is often the predominant symptom, but associated symptoms such as nausea, vomiting, anxiety, sensitivity to light, smell, and/or sound, or neck pain/stiffness are almost always present and can be temporarily debilitating in and of themselves. After the headache phase has run its course, the postdrome phase sets in. This phase typically lasts 24-48 hours and can manifest in a variety of ways, including fatigue, depressed mood, or euphoric mood. 

Prevention

Episodic migraine is considered by many to be a largely preventable condition. The pharmaceutical industry focuses primarily on the treatment of acute migraine (the global migraine drugs market was valued at $1.7B in 2017, according to Allied Market Research), but the public health impact of effective prevention is likely to be far greater than effective migraine abortive treatment. 

Treatment

Interventions designed to minimize symptoms once a migraine episode has begun are called abortive treatments. Abortive medications, if taken early enough during a migraine episode, are generally effective, but so are a wide variety of nonpharmacological abortive treatments, including stress reduction techniques, meditation, biofeedback, taking a nap, and acupuncture. The effectiveness of all abortive treatment is nearly always a function of timing, such that the sooner a treatment is applied, the more likely the developing migraine episode is stopped. 

Early Detection

The Holy Grail of migraine treatment (as opposed to prevention) lies in the earliest possible detection of a developing migraine episode, well before the onset of headache. Little research has been published to-date on this topic. One study used sleep time data from the wrist-worn Empatica E4 wearable sensors, but their findings were inconclusive (Siirtola, 2018). A systematic review of computerized migraine diagnostic tools identified 41 eligible studies, all of which focused on migraine diagnosis but not early detection (Woldeamanual, 2022). 

The most relevant published study reported the findings of a longitudinal cohort of 100 participants with episodic migraine (Houle, 2017). The authors created a generalized mixed-effects forecast model that demonstrated predictive utility with an area under the curve (AUC) of 0.73 in the training sample and an AUC of 0.65 in a validation sample. The inputs to this model comprised only survey respondent data; no data from wearable devices were used in this study. 


 Siirtola P, Koskimäki H, Mönttinen H, Röning J. Using Sleep Time Data from Wearable Sensors for Early Detection of Migraine Attacks. Sensors (Basel). 2018 Apr 28;18(5):1374. doi: 10.3390/s18051374. PMID: 29710791; PMCID: PMC5981434. 

https://www.alliedmarketresearch.com/migraine-drugs-market 

Woldeamanuel YW, Cowan RP. Computerized migraine diagnostic tools: a systematic review. Ther Adv Chronic Dis. 2022 Jan 24;13:20406223211065235. doi: 10.1177/20406223211065235. PMID: 35096362; PMCID: PMC8793115. 

Houle TT, Turner DP, Golding AN, Porter JAH, Martin VT, Penzien DB, Tegeler CH. Forecasting Individual Headache Attacks Using Perceived Stress: Development of a Multivariable Prediction Model for Persons With Episodic Migraine. Headache. 2017 Jul;57(7):1041-1050. doi: 10.1111/head.13137. PMID: 28699328; PMCID: PMC5950708. 

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