Migraine index

Review of Migraine

An inherited disorder

? an autosomal dominant trait with incomplete penetrance.

Sex distribution is approximately equal in childhood

May represent a broad clinical continuum

	On one end: an occasional migraine with aura
	On the other end: daily persistent pain similar to tension headache.

Events known to precipitate an attack

	hormonal alteration
	emotional phenomena
	sleeping disturbances
	weather changes
	certain types of drugs and food
	smoke

Transformed migraine

	Excessive use of symptomatic medications, including analgesics and ergotamine tartrate
	When used more than 2 days a week may lead to a constant headache.
	This phenomenon, called rebound, renders appropriate treatment ineffective until the offending drug has been entirely withdrawn and a period of physiologic stabilization occurs.

Diagnosis Criteria recommended by IHS Headache Classification Committee

Migraine without aura

At least 5 attacks fulfilling the following criteria

Each attack, untreated or unsuccessfully treated, lasts 2 to 72 hours.

The attack has at least 2 of the following characteristic

Unilateral location:

	bilateral in 30%40% of cases
	pain may begin on one side and spread

Pulsating quality:

	over 50% of people who suffer migraines report nonthrobbing pain during some attacks
	30% of patients with tension-type headaches may report pulsating pain
	Headache quality may vary over the duration of the attack.
	If the pain is throbbing at any phase of the attack, it is considered as throbbing overall.

Moderate or severe intensity: inhibits or prohibits daily activity.

Pain is aggravated by walking up and down stairs or similar routine physical activity.

During an attack at least 1 of the following symptoms.

	Nausea or vomiting: differentiate from anorexia, common among patients with anxiety or tension headaches.
	Presence of Photophobia or phonophobia.

No evidence from the history or physical examination of any other disease that might cause headaches.

Criteria for diagnosing migraine with aura

	Same as above
	But include symptoms of neurological dysfunction (including visual disturbance) occurring before or during the attack.

American Academy of Neurology: practice parameters for diagnostic procedures for headaches.

EEG: not useful in the routine evaluation of patients with headache

CT and MRI: Neither CT scans nor MRI scans are warranted in the following adult patients

Headaches fit a broad definition of recurrent migraine

Have NOT demonstrated any of the following

	recent substantial change in headache pattern
	a history of seizures
	presence of focal neurological symptoms or signs

More information on headache & imaging

Lumbar puncture: may have potential value in the following clinical situations

	the first or worst in patient's life
	a severe, recurrent headache of rapid onset
	a progressive headache without signs of raised intracranial pressure
	an atypical, chronic and intractable headache
	headache associated with fever.

Further reading

	Guideline for the diagnosis and treatment of migraine - CMAJ 97
	Tfelt-Hansen, P. Prophylactic Pharmacotherapy Of Migraine. Some Practical Guidelines. Neurologic Clinics Vol 15. 1 Feb 1997