Migraine phases and treatment response: a post hoc analysis of participants with migraine with aura from the TEAM study
Abstract
Background: Migraine is a phased neurological disorder progressing through prodrome, aura (in approximately one-third of patients), headache, and postdrome. Migraine with aura (MA) and migraine without aura (MO) are pathophysiologically distinct subtypes with potentially different treatment responses. Some acute therapies, including triptans, show reduced efficacy when administered during the aura phase. Whether this extends to neuromodulation remains unclear. This study examined whether the presence of migraine aura-a phase reflecting cortical spreading depolarization-modifies the therapeutic response to acute external trigeminal nerve stimulation (eTNS), using data from the TEAM (Trial of eTNS for the Acute Treatment of Migraine) study.
Methods: This was a post hoc, non-pre-specified analysis from a prospective, multicenter, randomized, double-blind, sham-controlled trial (N = 538). Participants were randomized 1:1 to verum (N = 259) or sham (N = 279) eTNS for 2 h during an active migraine. We compared treatment outcomes between MA (N = 224) and MO (N = 314) participants using logistic regression with interaction terms to test whether aura status modified treatment effect. Models were adjusted for age, sex, and baseline headache severity.
Results: The MA group had more male participants and higher rates of severe baseline headache pain compared to the MO group. No significant treatment-by-aura interactions were found for any endpoint, including 2-h pain freedom, most…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 538 participants or records.
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