migraine%20headache
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

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
Editor's Recommendations
Most Read Articles
Pearl Toh, 29 Jun 2020
Having migraine during midlife appears to be associated with a higher risk of developing dementia in later life, according to a large population-based longitudinal Danish study presented at the AHS* 2020 Virtual Meeting, indicating that migraine may be a risk factor for dementia.
Pearl Toh, 4 days ago
After treatment with fremanezumab, a difficult-to-treat patient population with treatment-resistant episodic or chronic migraine saw sustained benefits across a broad range of measures, according to multiple analyses of the FOCUS study released during the AHS 2020 Virtual Meeting.
Pearl Toh, 24 Jun 2020
While aducanumab significantly reduced clinical decline in individuals with early Alzheimer's disease (AD) in one randomized trial, no changes were seen in another identical study — rendering the role of aducanumab in AD inconclusive.
Roshini Claire Anthony, 13 Aug 2019

An active lifestyle, regardless of vascular risk, may delay the progression of Alzheimer’s disease (AD) by slowing down cognitive decline and neurodegeneration, according to a study presented at the Alzheimer’s Association International Conference (AAIC 2019).