Migraine

MIGRAINE

Migraine is a complex disorder characterized by recurrent episodes of headache, most often unilateral, and in some cases associated with visual or sensory symptoms (collectively known as an aura). It is most commonly seen in females.

Causes

Migraine has a strong genetic background.

Migraine precipitants:

• Hormonal changes, such as those accompanying menstruation (common), pregnancy, and ovulation
• Stress
• Excessive or insufficient sleep
• Medications (e.g., vasodilators, oral contraceptives)
• Smoking
• Exposure to bright or fluorescent lighting
• Strong odors (e.g., perfumes, colognes, petroleum distillates)
• Head trauma
• Weather changes
• Motion sickness
• Cold stimulus (e.g., ice cream headaches)
• Fasting or skipping meals

Types

• Migraine without aura
• Migraine with aura
• Chronic migraine

Migraine without aura is a recurrent headache attack lasting 4 to 72 hours, moderate to severe in intensity, aggravated by physical activity, and associated with nausea and light and sound sensitivity (photophobia and phonophobia).

Migraine with aura has recurrent, fully reversible attacks lasting minutes, typically with one or more of these unilateral symptoms: visual, sensory, speech, and language.

Chronic migraine is a headache that occurs on 15 or more days a month for more than three months and has migraine features.

Phases

• Prodrome
• Aura
• Headache
• Postdrome

Prodrome – yawning, mood change, lethargy, light sensitivity, restlessness, feeling cold, thirst

Aura – Flashes of light, blind spots, zigzags, numbness, confusion, vertigo

Headache – nausea, vomiting, photophobia, phonophobia, lacrimation (tearing)

Postdrome – dizziness, difficulty concentrating, euphoria

Signs and symptoms

• Photophobia
• Phonophobia
• Sensitivity to smell
• Nausea and vomiting

Diagnosis

Headache lasting 4 hours to 3 days (untreated)

AT LEAST 2 OF:

• Unilateral pain (may become holocranial later in the attack)
• Throbbing type pain
• Moderate to severe intensity
• Motion sensitivity (headache made worse with head movement or physical activity)

AT LEAST 1 OF:

• Nausea & vomiting
• Photophobia & phonophobia
• Normal examination and no other cause of headache