One hundred and eight migraine patients were enrolled. Patients were asked to recall retrospectively whether non-headache symptoms occurred during the prodrome, headache and postdrome phase of their migraine attacks. The Cochran’s Q test was performed to assess any significant differences in the frequency of non-headache symptoms across the three phases of the migraine attack. The co-occurrence of symptoms during the different phases was tested using Cohen’s and Fleiss’ kappa with 95% confidence intervals.

The frequency of most non-headache symptoms was significantly different throughout the three phases of the migraine attack, being higher during the headache phase than during the prodrome and postdrome phase. The rate of thirst and food craving did not significantly change over the migraine attack. The symptoms with the highest co-occurrence through all three phases were food craving, neck stiffness and thirst. If thirst occurs during the headache phase it is highly likely that it will persist during the postdrome phase, while if neck stiffness occurs during the prodrome phase it will probably occur also during the headache phase. We also found that if yawning is present during the prodrome phase it is highly likely that it will occur also during the postdrome phase.

Although cognitive, mood and homeostatic changes are characteristics of the prodrome and postdrome phase, migraine patients most often recall having these symptoms in association to the headache pain. Thirst, food craving and neck stiffness can be mediated by the hypothalamus. These symptoms occurred throughout all three phases, suggesting a constant involvement of the hypothalamus during the migraine attack.