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MIGRAINE HEADACHE

Migraine headache without aura has at least 5 attacks of any 2 symptoms of unilateral headache that is throbbing or pulsating in nature, moderate to severe in pain and activity aggravates pain. It is accompanied with either nausea and vomiting or photophobia and/or phonophobia. The symptoms last for 4-72 hours without signs of secondary headache.
Migraine headache with aura has at least 2 attacks with any of the fully reversible symptoms of flickering lights, spots or lines and/or vision loss, sensory symptoms of pins and needles and/or numbness and dysphasic speech disturbance but without motor weakness. Accompanied by at least 2 of the following symptoms of homonymous visual symptoms and/or unilateral sensory symptoms or at least 1 aura symptom develops gradually over ≥5 minutes and/or different aura symptoms that occur in succession over ≥5 minutes.

Migraine%20headache Signs and Symptoms

Signs and Symptoms

Definition

Migraine Headache

A common episodic primary headache that is disabling with associated nausea and/or light and sound sensitivity

Phases of migraine attack

Prodrome - appears 24-48 hours before headache occurs
Aura - occurs in 25% of individuals with migraine which is often visual but can be sensory, verbal or motor disturbances
Headache - usually unilateral with throbbing or pulsatile quality and accompanying nausea, vomiting, photophobia or phonophobia
Postdrome

Epidemiology

Based on the 2015 data from the World Health Organization (WHO), 50%-75% of adults aged 18-65 years old in the world have had headache and ≥30% of them have reported having migraine headache
Ranked as the 3rd most prevalent disorder in the world based on the Global Burden of Disease Survey 2010 (GBD 2010) and ranked as the 3rd-highest cause of disability in the world among males and females <50 years old based on GBD 2015
According to the United Nations, there are 350 million individuals that have migraine headache in the Asia-Pacific region

Pathophysiology

It is hypothesized that cortical spreading depression causes the aura of migraine, activates trigeminal nerve afferents and alter blood-brain barrier permeability by matrix metalloproteinase activation and upregulation
- Activation of trigeminal nerve afferents causes inflammatory changes in the pain-sensitive meninges that generates the headache that occur in migraine through central and peripheral reflex mechanisms
Pathophysiology of migraine includes activation of the trigeminovascular system and the pain of migraine is linked to the onset of neurogenic inflammation
Clinical symptoms of migraine is due to the process called sensitization in which neurons become increasingly responsive to nociceptive and non-nociceptive stimulation

Signs and Symptoms

Premonitory and resolution symptoms include

Hyperactivity
Hypoactivity
Depression
Cravings for particular foods
Repetitive yawning
Fatigue
Neck stiffness and/or pain

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Shifting paradigms in MS management: Early, optimized interventions improve patient outcomes

04 May 2018

Multiple sclerosis (MS) is one of the most common neurological disorders – affecting over 2.3 million people globally – and it is the leading cause of nontraumatic disability in young adults. However,the availability of supportive resources and services for people with MS is scarce in many regions of the world. In Malaysia, the prevalence of MS is estimated at 2-3/100,000; the current Malaysian clinical practice guidelines on the management of MS recommend disease modifying agents, such as interferon-β and teriflunomide, as first-line therapeutic agents. In this article, Dr Singer - in partnership with Sanofi and the Malaysian Society of Neurosciences - shares his insights into managing MS dynamically, highlighting the importance of early intervention in improving patient outcomes.