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