Episodic Migraine Pain Curves: Real-Time Smartphone-Based Analysis and Clinical Implications.

Purpose: Migraine involves a wide range of symptoms, with pain being one of the most prominent and disabling. While the ICHD-3 provides a well-established classification framework, exploring pain dynamics such as onset, duration, and intensity may offer additional insights to support the development of more personalized treatment strategies. Patients and Methods: A previous study categorized episodic migraine patients based on pain curve dynamics (onset, duration, and intensity). This study analyzes socio-demographic and clinical characteristics across the previously identified subgroups. Patients met ICHD-3 criteria and used a smartphone app for real-time data collection on migraine parameters, including onset, pain duration and intensity, symptoms, triggers, and treatment responses. The aim was to identify differences across subgroups in these variables. Results: The study included 51 participants, mostly women, with a mean age of 39.1 years. Four distinct migraine patterns emerged based on pain dynamics: Type 1 (High intensity), Type 2 (Acute onset and intense), Type 3 (Prolonged and intense), and Type 4 (Low intensity). Significant associations were found between curve types and demographic factors such as sex, aura presence, and cardiovascular risk. Although food-related triggers were common across groups, their distribution did not significantly differ. However, prolonged migraines posed unique challenges regarding treatment timing and effectiveness. Conclusion: Pain curve-based classification reveals clinically relevant migraine subtypes. Significant differences were observed across curve types in sex distribution, aura prevalence, associated symptoms such as nausea and phonophobia, and treatment response profiles. This approach, supported by real-time data, may advance personalized migraine management.