Triggers, prodrome, aura, and headache interactions in migraine with typical aura: a prospective deep-phenotyping study

AIMS: This study aimed to prospectively and comprehensively phenotype migraine with typical aura (MwA) attacks, with a particular focus on the interaction between trigger factors and clinical features of the prodrome, aura, and headache phases. A secondary aim was to examine how characteristics of individual phases influence the subsequent course of an attack and to provide data-driven hypotheses relevant for future MwA classification. METHODOLOGY: This was a prospective, multicenter observational study conducted at two tertiary headache clinics. Participants recorded up to three MwA attacks over 12 months using an electronic questionnaire completed within one day after each attack. Data on potential triggers, prodromal symptoms, detailed aura features (visual, somatosensory, and higher cortical dysfunctions), and headache characteristics were collected. Associations between attack phases, including trigger factors, were analyzed. RESULTS: A total of 90 participants (74% female) reported 144 MwA attacks. Triggers were reported in 82% of attacks, with lack of sleep (36%) and the menstrual cycle (24%) being the most frequent. Prodromal symptoms occurred in 75% of attacks, most commonly neck stiffness (29%) and photophobia (28%). The number of triggers positively correlated with the number of prodromal symptoms (r=0.372, p