Canine Responses to Impending Migraines

Abstract

Dear Editor:

Service dogs (also called assistance dogs in Europe) are trained and certified to help individuals with visual/hearing/motor impairments, post-traumatic stress disorder, autism, and a wide range of other disabling conditions by providing specific skills that help improve human independence. Some service dogs are also trained as medical detection dogs (for example, alerting their humans with epilepsy to impending seizures,¹ patients with diabetes to hypoglycemia,² and individuals with Addison disease to low cortisol levels). Wells and colleagues previously published data from a survey of 212 patients with type 1 diabetes who were also dog owners.³ In this series, 32% of respondents reported >10 incidents where their dog's behavior changed in relation to hypoglycemia, with 36% identifying a consistent link between the dog's behavior and hypoglycemia and 34% reporting that the dog's behavioral change preceded the patient's clinical awareness of hypoglycemia. Typically, the dogs' behavior changes, including vocalizing, licking, nuzzling, jumping onto the person, and intent staring, elicited increased attention from their owner.

Similar to hypoglycemia, migraine is an episodic disorder with attacks often preceded by subtle changes called the migraine prodrome. In January 2011, a blog about migraine prodrome posted on a new, educational website (Migraine.com) mentioned a woman whose dog alerted her to migraines so that she could treat before disabling symptoms occurred. Following this post, a number of people commented about how their dogs alerted them to their migraines, with 8 individuals agreeing to provide detailed information about migraine-alerting behaviors. Similar to the report by Wells for hypoglycemia-alerting dogs, the migraine-alerting behaviors likewise involved behaviors designed to attract the attention of the migraine sufferer in the very early stages of a migraine before painful symptoms occurred (Table 1). A wide range of breeds was included, with most female dogs (bitches). Interestingly, new alerting behaviors were recognized in puppies as well as adult dogs, typically within months of the dog first starting to live with the migraine sufferer.

Table 1.

Case Series of Individuals Reporting Migraine-Alerting Behavior in Dogs

Case	Dog breed and gender	Age when alerting behavior first recognized	Alerting behavior	Duration between dog alerting and development of migraine	Consistency of alert linked with migraine
1	Doberman bitch	Dog acquired as puppy. Alerting behavior recognized after 6 months of age. Currently 2.5 years old	Persistent and unique vocalization that sounds like grumbling and muttering. Different from vocalizations dog uses for food or to go outside	Alerting behavior immediately followed by patient developing aura; painful part of migraine generally begins 2 hours later	Consistent link between alerting behavior and development of aura. Patient typically treats during aura to prevent migraine progression. Patient also experiences nonmigraine headaches, which have never been associated with alerting behavior from dog
2	Bull terrier male dog	Dog acquired as puppy. Alerting behavior recognized after 6 months of age. Dog currently 11 months	Persistently attentive, refusing to leave patient's side or allow her children or other dogs in the home to approach the patient. If patient is standing, dog scratches at patient's feet. If patient is sitting, dog sits on patient's lap and refuses to leave	Migraine typically begins within 30 minutes of onset of dog's behavior or sooner when attacks are more severe	Migraines have consistently occurred after dog's alerting behavior. When patient successfully treats her migraines, she still experiences unilateral tingling and mild migraine symptom severity. Instances where she has treated before symptoms after recognizing alert have resulted in continuing to experience the unilateral tingling and mild symptoms that typically occur after her successfully treated attacks
3	Border Collie bitch	Dog acquired at 6 weeks of age. Alerting behavior recognized at 12-13 weeks. Dog is currently 2 years old	Dog becomes anxious, whines, stands over or lies on patient. If on a walk, will uncharacteristically pull on leash to end walk more quickly	Migraine escalation begins within minutes of alerting behavior	Behavior consistently linked with migraine and does not occur at other times
4	German Shepherd-mix bitch	Dog rescued from shelter at approximate age 1.5 years. Alerting behavior recognized after 6 months with new owner. Dog is currently 8 years old	Persistently paws at patient	For daytime migraines, pawing occurs minutes in advance of characteristic visual migraine aura	For daytime migraines, consistent link between pawing and subsequent development of aura, when patient treats to prevent progression. Patient often has migraine on waking in the morning. On these days, dog paws patient awake early; patient never woken early when migraine has not been present. Consistency resulted in dog becoming certified as a medical alert dog
5	Australian Cattle Dog bitch	Patient was caring for friend's 8-year-old dog during friend's illness. Alerting behavior began after dog had been with patient for 6 weeks	Excessively attentive to patient, refusing to leave her side, pawing at patient, and sitting or lying on patient	Behavior began about 24 hours before painful part of migraine and ended once migraine symptoms began	Consistent relationship between behavior and migraine attacks
6	German Shepherd-mix bitch	Acquired as 2-year-old dog	Change in normal behavior to get owner's attention	Alerting 10–20 minutes before migraine	Certified as medical alert dog
7	Shih-Tzu male dog	Acquired as 3-year-old dog. Behavior began within a few months of getting dog. Dog is currently 7 years old	Patient has fairly constant headaches that intensify to become severe migraines. Dog is typically not attentive or overly affectionate to patient. Before escalation to severe migraine, dog stays very close to patient, climbs onto her, and licks her hands	Patient has chronic migraine and dog's behavior begins about 1 hour before severity escalates	Alerting behavior consistently linked with developing severe attacks, with no cases of behavior occurring when migraine did not progress to severe
8	West Highland White terrier male dog	Acquired dog at 3 months of age; alerting noticed about 1 year after acquiring dog. Dog is currently 2 years old	Dog whines, sits on patient's lap, and refuses to leave patient. Also, dog ignores other stimuli that would normally excite him to bark	Alerting 20–30 minutes prior to migraine aura	Alerting behavior consistently linked with migraine attacks, occurring with about 90% of attacks. Does not display similar behavior when patient has other pain problems, like bad flare of back pain

Similarities noted within these cases support the theory that certain dogs may indeed be able to successfully alert their owners to impending migraine, which might be used as a time to pre-emptively treat migraines. A more complete survey of a large group of migraineurs, similar to the Wells study, may be warranted.

Footnotes

Disclosure Statement

No competing financial interests exist.

References

Dalziel

, Uthman

, Mcgorray

, Reep

. Seizure-alert dogs: A review and preliminary study. Seizure, 2003; 12:115–120.

Rosenthal

. Diabetes alert dogs. Diabetes Self Manag, 2010; 27:23–26.

Wells

, Lawson

, Siriwardena

. Canine responses to hypoglycemia in patients with type 1 diabetes. J Altern Complement Med, 2008; 14:1235–1241.