A systematic review published in the Journal of Headache and Pain reports that overall, there is insufficient evidence to support reliable prevalence estimation or characterization of premonitory symptoms in patients with migraine.
], 45% of symptoms lasted less than one hour and only 13% more than 12 h. These data, indicating a generally much shorter-lasting premonitory phase than 48 h, do not support the ICHD-3 definition.The strength of this study lies in the systematic literature review and meta-analyses following standard methodological guidelines. The limitations were not in the study itself but in the data.
First, research must address the methodological shortcomings that are evident in the literature, and promote standardisation to make future studies more comparable. Above all, the field needs an operational consensus definition of the premonitory phase. Ultimately, ICHD should be the source of this definition, but our findings suggest that the current definition [] needs revision and perhaps further specification. Revision requires more and better empirical data than currently exist.
Secondly, studies should be conducted in the population of interest. Clinic-based studies are feasible and of interest to clinicians. Generalizability from speciality care to primary care or from diagnosed patients in primary care to the general migraine population is hazardous. If the goal is to characterize premonitory features in unselected people with migraine, population studies are required.
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