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

Optimal protection in geriatric patients with atrial fibrillation: An expert’s perspective

Prof. Olivier Hanon, 01 Apr 2022

Geriatric patients with atrial fibrillation (AF) are at increased risk of blood clots that can lodge in the brain and cause fatal strokes. At a recent webinar, Professor Olivier Hanon, Head of Geriatrics Department in Broca Hospital, Paris, France, shared insights on how to optimally protect geriatric patients with AF, with a special focus on direct oral anticoagulants (DOACs), particularly rivaroxaban, for stroke prevention in AF.

Addressing the unmet needs and challenges in managing older AF patients

Dr. Tan Vern Hsen, Dr. Barbara Helen Rosario, 01 Apr 2022

A key focus in the management of atrial fibrillation (AF) in older patients is stroke prevention through oral anticoagulation. However, a significant proportion of older AF patients remain undercoagulated due to the perceived bleeding risk of oral anticoagulants (OACs). Dr Tan Vern Hsen, Senior Consultant, Department of Cardiology, Changi General Hospital, Singapore, and Dr Barbara Helen Rosario, Senior Consultant, Department of Geriatric Medicine, Changi General Hospital, Singapore, shared their respective insights into managing older AF patients for an integrated approach.

Updates on migraine management with rimegepant

03 Sep 2023

Migraine is a debilitating neurological condition that affects millions of people worldwide, causing intense headaches, sensory disturbances, and a significant decline in quality of life. Approximately one-third of patients encounter aura, which encompasses transient focal neurological disturbances that precede the attack. [Lancet 2017;390:1211-1259; Headache 2021;61:1021-1039]