Migraine headache

Clinic

• A migraine is a primary headache disorder characterized by recurrent headaches that are moderate to severe.
• Typically, the headaches affect one half of the head, are pulsating in nature, and last from a few hours to 3 days.
• Associated symptoms may include
  • Nausea, vomiting
  • Sensitivity to light, sound, or smell
  • Fatigue and irritability
• Pain is generally made worse by physical activity.
• Up to one-third of people have an aura: typically a short period of visual disturbance that signals that the headache will soon occur.

Sign / Symptoms

Migraine has three stages

• Aura phase

• Pain phase

• Postdrome

Aura phase

Symptoms can be visual, sensory or motor

• Visual effects occur most frequently; they occur in up to 99% of cases and in more than 50% of cases are not accompanied by sensory or motor effects.
  • Visual: Flickering animation a scintillating scotoma. The scintillations are of a zigzag pattern starting in the center of vision, surrounded by a somewhat larger area with distortion of shapes
  • Some people lose part of their field of vision known as hemianopsia while others experience blurring.
  • Sensory aura occur in 30–40% of people with auras. Feeling of pins-and-needles begins on one side in the hand and arm and spreads to the nose–mouth area on the same side.
  • Numbness usually occurs after the tingling has passed with a loss of position sense.
  • Aura phase can include speech or language disturbances, world spinning, and less commonly motor problems.
  • Motor symptoms indicate that this is a hemiplegic migraine, and weakness often lasts longer than one hour unlike other auras.
  • Auditory hallucinations or delusions have also been described.

Pain phase

• Classically the headache is unilateral, throbbing, and moderate to severe in intensity. It usually comes on gradually and is aggravated by physical activity.
• In more than 40% of cases, however, the pain may be bilateral and neck pain is commonly associated with it.
• Bilateral pain is particularly common in those who have migraines without an aura.
• Less commonly pain may occur primarily in the back or top of the head.

Basilar migraine

A migraine with neurological symptoms related to the brain stem or with neurological symptoms on both sides of the body, common effects include a

• Sense of the world spinning
• Light-headedness
• Confusion
• Nausea occurs in almost 90%, and vomiting occurs in 33%. Many thus seek a dark and quiet room.
• Other symptoms may include blurred vision, nasal stuffiness, diarrhea, frequent urination, pallor, or sweating.
• Swelling or tenderness of the scalp may occur as can neck stiffness.

Acephalgic migraine

• Rarely, an aura occurs without a subsequent headache.
• Also known as silent migraine; however, it is difficult to assess the frequency of such cases because people who do not experience symptoms severe enough to seek treatment may not realize that anything unusual is happening to them and dismiss it without reporting any problems.

Postdrome

The migraine postdrome could be defined as that constellation of symptoms occurring once the acute headache has settled. Many report a sore feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache has passed. The person may feel tired or "hung over" and have head pain, cognitive difficulties, gastrointestinal symptoms, mood changes, and weakness. According to one summary, "Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise." For some individuals this can vary each time.

Related disease

• Migraines are associated with MDD, bipolar disorder, anxiety disorders, and OCD. These psychiatric disorders are approximately
• 2–5 times more common in people without aura
• 3–10 times more common in people with aura

Migraine Miasms

Aura	Visual	Sensory	Speech	Motor	World spinning	Hallucinations Delusions
Entities Rubrics	Retinitis Visual field deficit	Paresthesia Hyperstasia	Aphasia	Hemiplegia Hemiparesis	Vertigo Dizziness	Auditory hallucination

Basilar migraine

	World spinning	Blurred vision	Nasal stuffiness	Diarrhea	Frequent urination	Pallor	Sweating
Entities Rubrics	Vertigo Dizziness