Saturday, February 24, 2018

Migraine and yawning

Güven B, Güven H, Çomoğlu SS. Migraine and Yawning. Headache. 2018 Feb;58(2):210-216.


Yawning is considered to be a symptom that reflects dopaminergic activity, although its pathophysiological mechanism is not yet fully understood. Interestingly, repetitive yawning is seen in some patients during migraine attacks. The aim of this cross-sectional study is to investigate the frequency of yawning during migraine attacks and its association with different characteristics of migraine.

Patients with migraine with or without aura were evaluated using questionnaires and diaries to determine the characteristics of headache and accompanying symptoms. Repetitive yawning in the premonitory phase and/or during headache were determined.

Three hundred and thirty-nine patients were included in the study. One hundred and fifty-four patients reported repetitive yawning (45.4%) during migraine attacks. Repetitive yawning was reported in the 11.2% of the patients in the premonitory phase, 24.2% during headaches, and 10% both in the premonitory phase and during headaches. Migraine with aura (46.8 vs 31.9%; P = .005), accompanying nausea (89.6 vs 75.1%; P = .001), vomiting (48.7 vs 37.8%; P = .044), osmophobia (66.7 vs 52.3%; P = .024), and cutaneous allodynia (58.2 vs 46%; P = .032) were more common in patients with yawning than without. Other dopaminergic-hypothalamic premonitory symptoms (41.6 vs 26.5%; P = .003), especially sleepiness (17.5 vs 5.9%; P = .001), irritability/anxiety (21.4% vs 11.4%; P = .019), nausea/vomiting (10.4 vs 4.3%; P = .03), and changes in appetite (18.2 vs 9.7%; P = .024), were also more frequent in patients with yawning than without. After being adjusted for all other relevant covariates, the odds of repetitive yawning were increased by the presence of nausea (OR 2.88; 95% CI 1.453-5.726; P = .002) and migraine with aura (OR 1.66; 95% CI 1.035-2.671; P = .036).

Our results demonstrated that yawning is a common self-reported symptom leading or accompanying migraine attacks and is associated with aura, nausea and/or vomiting, osmophobia, and cutaneous allodynia in patients with migraine. Although yawning is a rather frequently seen behavior, it is a unique and reliable symptom in patients with migraine that may offer an opportunity for early treatment of migraine attacks.
Migraine with aura, accompanying nausea, vomiting, osmophobia, and cutaneous allodynia and other symptoms were more common in migraine patients with yawning than without yawning. Other dopaminergic-hypothalamic premonitory symptoms, especially sleepiness, irritability/anxiety, nausea/vomiting, and changes in appetite, were also more frequent in patients with yawning…

"This is a valuable study in helping illustrate that migraine is more than just a headache disorder," Juliana H. VanderPluym, MD, Department of Neurology, Mayo Clinic, Phoenix, Arizona, told Medscape Medical News.

"There are a number of symptoms, including yawning, that may accompany and precede a migraine attack. Nonheadache symptoms in migraine, like yawning, may be subtle and/or overshadowed by the other symptoms.

"In addition, patients may misattribute symptoms like yawning to other causes, for example too little sleep or too little caffeine," said VanderPluym, who wasn't involved in the study.

"If patients can be educated about these symptoms it will help empower patients by providing a better understanding of what they are experiencing and perhaps can be used to identify an impending attack so that patients may take appropriate actions to treat their migraine early," VanderPluym said.

Commenting on the findings for Medscape Medical News, Noah Rosen, MD, director, Northwell Health's Headache Center in Great Neck, New York, said clinicians have known for some time that yawning can be a prodrome for migraine.

"It's commonly seen in association with other prodromal symptoms, oftentimes with changes in level of energy, levels of hunger, sometimes irritability. These are other subtle changes that some people can be attuned to that herald the start of a migraine.  Yawning does have utility, I think, because people are not always very good judges of when they are going to have a migraine attack," said Rosen.

His advice to patients: "If you find yourself tired at odd times, or yawning excessively, you should take note of that because it's possible that a headache is oncoming and you may want to be prepared with your medication or anticipate maybe changing your environment."

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