A Clinical Study of Migraine Evolution


  • William Pryse-Phillips MD,

  • Michel Aubé MD,

  • Peter Bailey MD,

  • Werner J. Becker MD,

  • Andre Bellavance MD,

  • Marek Gawel MD,

  • Rose Giammarco MD,

  • Gordon Mackie MD,

  • R. Allan Purdy MD,

  • Gordon Robinson MD,

  • Gary Shapero MD,

  • Keith Wilson MD, PhD

  • The study was supported by funding from GlaxoSmithKline Canada Inc.

  • Dr. Pryse-Phillips was Medical Advisor to GlaxoSmithKline Canada until May 2006 and previously had served on advisory boards and/or received speaker's honoraria from Merck, AstraZeneca, and Pfizer. During the last 5 years, Drs. Aubé, Bailey, Becker, Bellavance, Gawel, Giammarco, Mackie, Purdy, Robinson, and Shapero have served on advisory boards and/or received speaker's honoraria from GlaxoSmithKline, Merck, AstraZeneca, McNeil Consumer Healthcare, Proctor and Gamble, Jansen Ortho, Allergan, and/or Pfizer. Dr. Wilson has nothing to disclose.

  • From the Memorial University, St. John's, Newfoundland, Canada (Dr. Pryse-Phillips); McGill University, Montreal, Quebec, Canada (Dr. Aubé); University of New Brunswick, St. John, New Brunswick, Canada (Dr. Bailey); University of Calgary, Calgary, Alberta, Canada (Dr. Becker); Montréal South Shore Headache Clinic, Logueuil, Quebec, Ontario, Canada (Dr. Bellavance); University of Toronto, Toronto, Ontario, Canada (Dr. Gawel); McMaster University, Hamilton, Ontario, Canada (Dr. Giammarco); Richmond Hospital, Richmond, BC, Canada (Dr. Mackie); Dalhousie University, Halifax, Nova Scotia, Canada (Drs. Purdy and Wilson); Centennial Pavillion, Vancouver, BC, Canada (Dr. Robinson); The Markham Headache and Pain Treatment Centre, Unionville, Ontario, Canada (Dr. Shapero); and Healthnet Canada, St. John, New Brunswick, Canada (Dr. Wilson).

Address all correspondence to Dr. W. Pryse-Phillips, 7 Monkstown Rd., St. John's, NL A1C 3T1, Canada.


Background.—The buildup time of migraine headaches has not been well delineated in publications to date and we are aware of patients whose migraines last well over 72 hours. More concentration on these factors in the assessment of patients might lead to more appropriate therapeutic choices.

Method.—Prospective ascertainment of such data through a questionnaire completed by 253 informed and willing patients with IHS migraine with or without aura consulting Canadian headache specialists. Data were electronically sent to a central computer from each center, tabulated and analyzed using standard statistical parameters.

Results.—In 253 patients with migraine ascertained using applied IHS criteria, nausea was a feature in over 90% of cases, especially in those with aura. This inhibited the ingestion of oral medications in about a quarter of all subjects. The time to build from no pain to moderate/severe pain was shorter in subjects with auras and was less than 2 hours in 97% of those with and 86% of those without auras. However, we also identified a group of subjects with migraine (over 10% of all) in whom the build time to maximum pain is delayed for over 2 hours. Nausea was experienced by 91.7% of subjects, slightly but significantly later in those without auras. While most headaches in each group lasted from 4 to 72 hours, 24.3% of those with and 20.6% of those without aura expected to experience pain for more than 72 hours, while in untreated cases disability due to pain, nausea, or malaise usually persisted for over 3 days in 24.3% and 16.7% of those with and without aura, respectively. One-fifth of migraineurs may be in pain and/or disabled by accompanying symptoms for over 3 days in a typical migraine attack. Over half of our subjects reported that their medications worked well or excellently.

Conclusions.—Attacks of migraine in real-life clinical situations vary somewhat from the IHS criteria in that they are more often associated with nausea that interferes with oral therapy; can persist for over 72 hours; may have slow (>2 hours) buildup to maximum pain in 10% of cases; and may cause disability for over 3 days. Nevertheless, current therapeutic regimens (including prescribed medications) work well for a substantial majority.