Migraine can progress through several phases: prodrome, aura, attack and postdrome.

Participants were administered electronic daily headache diary to document migraine days and associated symptoms before and after treatment for 3 months. Detailed questionnaires/interviews were used to document changes in premonitory symptoms followed by headache, and  incidence of triggers that initiate a headache.

Of the 64 participants,  we found that after treatment: (a) incidence of prodromes followed by headache decreased 48% in responders vs. 28% in non-responders, and 50% in super-responders vs. 12% in super non-responders; (b) incidence of visual and sensory auras followed by headache reduced among all groups, except the super non-responder group; (c) the number of triggers followed by headache decreased by 38% in responders vs. 13% in non-responders, and 31% in super-responders vs. 4% in super non-responders; (d) premonitory symptoms: incidence of headache following cognitive impairment and irritability reduced in responders and super-responders only, whereas incidence of headache after fatigue, nausea and vertigo reduced in all groups except among the super non-responders; and (e) triggers: incidence of headache following not drinking enough and being too hot reduced in responders and super-responders, whereas incidence of headache after stress, sleep and light reduced in all groups except the super non-responders.

These findings suggest that even a mild decrease in migraine frequency is sufficient to partially reverse pain impact on the excitability and responsivity of neurons involved in the generation of certain migraine prodromes and triggers. Clinically, these findings provide further justification for lowering the definition threshold of responders from >50 to >30% reduction in migraine day/month.