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The objective was to define the overall treatment expectations of migraineurs. Many studies have defined the expectations of patients regarding their acute migraine treatment but little information is available regarding overall expectations. During routine first visits to the author’s headache clinic patients were asked about their expectations of treatment as well as demographics and headache characteristics. Demographics were recorded and expectations were compared between different forms of migraine and between females and males. One thousand seven hundreds and fifty patients were diagnosed with ICHD-II 1.1, 1.2, 1.5.1 and 1.6, 1207 with migraine and 543 with probable migraine. A percentage of 27.8 expected a cure from their treatment, 79.7% to be symptomfree, 95.2% a reduction in frequency of headaches, 95.6% a reduction in severity of headaches and 95.5% an improved quality of life. Males had greater expectations for reduction in severity of migraines than females. Patients with migraine were more likely to expect a cure and a reduction in headache severity than patients with probable migraine. Patients with aura with every headache were more likely to expect reduced frequency of headache than patients with no aura. Some patients did expect a cure for their headaches and knowing patients’ expectations may facilitate headache management and education, and achieve more realistic outcomes. [ABSTRACT FROM AUTHOR]

This study was performed to document the frequency, duration and types of symptoms of postdrome in migraine patients. Eight hundred and twenty-seven consecutive headache clinic patients (IHS 1.1, 1.2 and 1.5.1) were evaluated at first visit. Postdrome frequency, duration and characteristics were analysed. Sixty-eight per cent of 827 patients reported postdrome (69.1% females; 56.8% males, P < 0.007). The average duration of the postdrome was 25.2 h. Fifty-six per cent had postdrome for ≤ 12 h, 32% for 12–24 h, 88% for ≤ 24 h, and 12% for > 24 h. The commonest symptoms were tiredness (71.8%), head pain (33.1%), cognitive difficulties (11.7%), ‘hangover’ (10.7%), gastrointestinal symptoms (8.4%), mood change (6.8%), and weakness (6.2%). Patients with postdrome compared with patients without postdrome have more characteristic and more frequent migraine features. This study demonstrated postdrome in 68% of patients, duration ≤ 24 h in most patients, more often associated with a full-blown migraine attack, more common in females, and with commonest symptoms being tiredness and low-grade headache. [ABSTRACT FROM AUTHOR]

Objective.—To document the frequency and types of symptoms of migraine in a large group of female migraineurs in tertiary care. Background.—Hormonal changes remain a significant accompaniment in the life cycle of the female migraineur. Little is documented on the relationship of women's issues to other features of migraine or to the lives of patients with migraine. Successful management of migraine mandates attention to women's issues from menarche to beyond menopause. The more information available to this end, the more confidently the clinician can prognosticate, guide, and treat the female patient. Methods.—Women's issues were evaluated in 504 women with migraine diagnosed according to the criteria of the International Headache Society (codes 1.1 and 1.2). The variables graded on a scale of 0 to 3 at the initial visit included premenstrual syndrome, menopausal symptoms, use of birth control pills, use of hormone replacement therapy, hormonal triggering of headaches, worsening of headaches with birth control pills or hormone replacement therapy, headaches with menses only, headaches with menses and at other times, headaches in pregnancy, headaches unchanged in pregnancy, headaches worse in pregnancy, and headaches better in pregnancy. These variables were stratified by age and headache diagnosis. Results.—Premenstrual syndrome was reported in 68.7% of patients, menopausal symptoms in 29.0%, and headaches attributed to birth control pills or hormone replacement therapy in 24.4% of patients. Sixty-four point nine percent of women had headaches with menses as well as at other times, while 3.4% of women had headaches exclusively with menses. A pregnancy was reported in 61.3% of the women; 20.4% did not experience headache in pregnancy. Of the 79.6% who did experience headache, 17.8% reported that headaches improved in pregnancy, 27.8% reported headaches to be unchanged, and 34% reported a worsening of headaches. Hormone replacement therapy or birth control pills triggered headaches in 64% of the study group. Patients with 100% aura were significantly different from patients with 0% aura, being less likely to have headaches worsening with birth control pills or hormone replacement therapy ( P < .01) and more likely to have headaches occurring during pregnancy ( P < .05). When patients with 100% aura were matched for age, headache frequency, use of birth control pills or hormone replacement therapy, and use of prophylactic medications with patients having 0% aura, the former were significantly less likely to have menopausal symptoms ( P < .05), less likely to have headaches worsening with birth control pills or hormone replacement therapy ( P < .01), and more likely to have headaches occurring only during pregnancy ( P < .05). Conclusions.—This study provides a documentation of women's issues in a large cohort of patients. Stratification by headache type, presence of aura, and age refine the study. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about the author's response to the comments made to his study related to the characterization of the premonitory symptoms (prodrome) in migraine, with particular reference to ICHD- 2, 1.1-1.5.