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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 &/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 &/or vision loss, sensory symptoms of pins & needles &/or numbness and dysphasic speech disturbance but without motor weakness. Accompanied by at least 2 of the following symptoms of homonymous visual symptoms &/or unilateral sensory symptoms or at least 1 aura symptoms develop gradually over ≥5 minutes &/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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