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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.

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 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 World Health Organization (WHO), 0.5-0.75 of adults aged 18-65 years old in the world have had headache in 2015 and ≥30% of them have reported having migraine headache
  • Headache was ranked as the 3rd most prevalent disorder and migraine headache is the 6th highest specific cause of disability worldwide based on the Global Burden of Disease Survey 2013
  • 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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