The term of prodrome was first mentioned in the International Classification of headache disorders, 2nd edition (ICHD-2) in 2004 ( 10). Even experimentally triggered migraine attacks seem to follow a similar chronological sequence of symptom development: First the prodromal symptoms, then the headache attack ( 7 – 9). in the preictal phase) leading to hypersensitivity to incoming stimuli and subsequently the migraine attack ( 2, 3). Accumulating evidence suggests the activation of the hypothalamus prior to the ictal phase (i.e.

Over the last few years the understanding of a migraine attack has been improved. The definition of prodromes may be traced back to John Fordyce in 1758 in his De Hemicrania where he observed polyuria and mood changes before the headache ( 6). Therefore, when a migraine attack starts, it comprises three different phases: i) preictal – the time before the headache starts, when the patient may develop prodromes, including appetite changes, thirst, yawning, or others ii) ictal – when the patient experiences headache, which lasts by definition 4–72 hours ( 4) iii) postictal – the time following the cessation of the headache, characterized by non-headache symptoms such as cognitive deficits, fatigue, and others ( 5). Functional imaging evidence suggests certain regional activation in the brain even before the headache starts ( 2, 3). The transition between the interictal phase and the migraine attack is poorly understood. During the interictal phase – the interval between two migraine attacks – patients are usually relatively symptom free. Migraine is defined by its periodicity and specific phases ( 1).

Premonitory aura definition