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MIGRAINE HEADCHE

It is a complex disorder characterized by recurrent episodes of headache, most often unilateral and in some cases associated with visual or sensory symptoms(aura) that arise most often before the head pain but that may occur during or afterward. Migraine is most common in women and has a strong genetic component.

Symptoms

·         Throbbing or pulsatile headache, with moderate to severe pain that intensifies with movement or physical activity

·         Unilateral and localized pain in the frontotemporal and ocular area, but the pain may be felt anywhere around the head or neck

·         Headache lasts 4-72 hours

·         Pain builds up over a period of 1-2 hours, progressing posteriorly and becoming diffuse

·         Nausea (80%) and vomiting (50%), including anorexia and food intolerance, and light-headedness

·         Sensitivity to light and sound

 

Diagnosis

·         Unilateral location

·         Pulsating quality

·         Moderate or severe pain intensity

·         Aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)

In addition, during the headache the patient must have had at least 1 of the following:

·         Nausea and/or vomiting

·         Photophobia(difficulty to see in light) and phonophobia(difficulty to hear sound)

 

Treatment

  • Identification and avoidance of precipitants or exacerbating factors (such as the contraceptive pill) may prevent attacks.
  • Treatment of an acute attack consists of simple analgesia with aspirin or paracetamol, often combined with an antiemetic such as metoclopramide or domperidone.
  • Severe attacks can be treated with one of the ‘triptans’ (e.g. sumatriptan), 5-HT agonists that are potent vasoconstrictors of the extracranial arteries. These can be administered orally, sublingually, by subcutaneous injection or by nasal spray.