Yawning May Herald Migraine

Megan Brooks

February 21, 2018

For patients with migraine, repetitive yawning may accompany or precede a migraine attack, new research shows.

"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," say Bülent Güven, MD, and colleagues from Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital in Turkey.

Their study is published in the February issue of Headache.

In a cross-sectional study of 339 patients with long-standing migraine (mean age, 35 years; 301 women), 154 (45.4%) reported repetitive yawning during migraine attacks; 11.2%, in the premonitory phase, 24.2%, during headaches, and 10%, both in the premonitory phase and during headaches.

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.

Table. Clinical Factors in Patients With and Without Yawning

Clinical Factors Yawning (%) No Yawning (%) P Value
Migraine with aura 46.8 31.9 .005
Nausea 89.6 75.1 .001
Vomiting 48.7 37.8 .044
Osmophobia 66.7 52.3 .024
Cutaneous allodynia 58.2 46.0 .032
Other dopaminergic-hypothalamic premonitory symptoms 41.6 26.5 .003
Sleepiness 17.5 5.9 .001
Irritability/anxiety 21.4 11.4 .019
Nausea/vomiting 10.4 4.3 .030
Appetite changes 18.2 9.7 .024

 After adjustment for relevant cofactors, the likelihood of repetitive yawning was increased by the presence of nausea (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.45 - 5.73; P = .002) and migraine with aura (OR, 1.66; 95% CI, 1.04 - 2.67; P = .036).

Useful Warning Sign?

"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."

The study had no specific funding. The authors have disclosed no relevant financial relationships.

Headache. 2018;58:210-216. Abstract

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