Migraine

Migraine
Migraine
Classification & external resources
ICD-10
G43.0
ICD-9
346
OMIM
157300
DiseasesDB
8207
MedlinePlus
000709
eMedicine
neuro/218  neuro/517 emerg/230 neuro/529
MeSH
D008881
This article is about migraine disease<1>. For the Finnish melodic death metal group, see myGRAIN.
Migraine (pronounced "Mee-grain" but also, and especially in American English, "My-grain") is a neurological disease<2>, of which the most common symptom is an intense and disabling episodic headache. Migraine headaches are usually characterized by severe pain on one or both sides of the head. Absent serious head injuries, stroke, and tumors, the recurring severity of the pain indicates a vascular headache rather than a tension headache. Migraines are often accompanied by photophobia (hypersensitivity to light), phonophobia (hypersensitivity to sound) and nausea.
The word migraine is French in origin and comes from the Greek hemicrania, as does the Old English term megrim. Literally, hemicrania means "only half the head".
Migraines are a frustrating chronic illness which is widespread in the population (10% diagnosed, 5% undiagnosed),<3> with seriousness varying from a rare annoyance to a life-threatening daily experience. Treatments are typically expensive. Periodic or unpredictable disability can cause impoverishment due to patients'' inability to work enough or to hold a job at all.
Migraines'' secondary characteristics are inconsistent. Triggers precipitating a particular episode of migraine vary widely. The efficacy of the simplest treatment, applying warmth or coolness to the affected area of the head, varies between persons, sometimes worsening the migraine.<4> A particular migraine rescue drug may sometimes work and sometimes not work in the same patient. Some migraine types don''t have pain or may manifest symptoms in parts of the body other than the head.
Available evidence suggests that migraine pain is one symptom of several to many disorders of the serotonergic control system, a dual hormone-neurotransmitter with numerous types of receptors. Two disorders — classic migraine with aura (MA, STG) and common migraine without aura (MO, STG) — have been shown to have a genetic factor.<5> Studies on twins show that genes have a 60 to 65% influence on the development of migraine (PMID 10496258 and PMID 10204850 ). Additional migraine types are suspected and could be proved to be genetic. Migraine understood as several or many disorders could explain the inconsistencies, especially if a single patient has more than one genetic type.
However, still other migraine types might be functionally acquired due to hormone organ disease or injury. Three quarters of adult migraine patients are female, although pre-pubertal migraine affects approximately equal numbers of boys and girls. This reveals the strong correlation to hormonal cycling and hormonal-related causes or triggers. Hormonal migraine is a likely consequence of periodically falling hormone levels causing reduction in protein biosynthesis of metabolic components including intestinal tract serotonin.
Contents
1 Signs and symptoms
1.1 Prodrome phase
1.2 Aura phase
1.3 Pain phase
1.4 Postdrome phase
2 Pathophysiology
3 Types
3.1 Migraine without aura
3.2 Migraine with aura
3.3 Basilar type migraine
3.4 Familial hemiplegic migraine
3.5 Abdominal migraine
3.6 Acephalgic migraine
4 Epidemiology
5 Triggers
5.1 Food
5.2 Weather
5.3 Hair Wash Headache
6 Treatment
6.1 Trigger avoidance
6.2 Abortive treatment
6.2.1 Acetaminophen or NSAIDs
6.2.2 Serotonin Agonists
6.2.3 Ergot alkaloids
6.2.4 Other agents
6.2.5 Comparative studies
6.3 Preventive drugs <44>
6.3.1 Physical therapy
6.3.2 Prism eyeglasses
6.3.3 Herbal and nutritional supplements
6.3.4 Non-drug medical treatments
6.her alternatives
7 History
8 Economic impact
9 Migraine and cardiovascular risks
10 References
10.1 Migraine triggers
10.2 Treatment
10.2.1 Triptans
10.3 General
10.4 Economic impact
10.5 Clinical picture
11 Footnotes
12 External links
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Signs and symptoms
The signs and symptoms of migraine vary among patients. Therefore, what a patient experiences before, during and after an attack cannot be defined exactly. The four phases of a migraine attack listed below are common among patients but are not necessarily experienced by all migraine sufferers. Additionally, the phases experienced and the symptoms experienced during them can vary from one migraine attack to another in the same migraineur:
The prodrome, which occurs hours or days before the headache.
The aura, which immediately precedes the headache.
The pain phase, also known as headache phase.
The postdrome.
Prodrome phase
Prodromal symptoms occur in 40% to 60% of migraineurs. This phase may consist of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food (e.g., chocolate), stiff muscles (especially in the neck), constipation or diarrhea, increased urination, and other vegetative symptoms. These symptoms usually precede the headache phase of the migraine attack by several hours or days, and experience teaches the patient or observant family how to detect that a migraine attack is near. The headache could range from mild to moderate or intolerable.<1>
Aura phase
For the 20-30%<6><7> of migraineurs who suffer migraine with aura, the migraine aura comprises focal neurological phenomena that precede or accompany the attack. They appear gradually over 5 to 20 minutes and generally last less than 60 minutes. The headache phase of the migraine attack usually begins within 60 minutes of the end of the aura phase, but it is sometimes delayed up to several hours, and it can be missing entirely. Symptoms of migraine aura can be visual, sensory, or motor in nature.<8>
Visual aura is the most common of the neurological events. There is a disturbance of vision consisting usually of unformed flashes of white and/or black or rarely of multicolored lights (photopsia) or forma­tions of dazzling zigzag lines (scintillating scotoma; often arranged like the battlements of a castle, hence the alternative terms "fortification spectra" or "teichopsia"). Some patients complain of blurred or shimmering or cloudy vision, as though they were look­ing through thick or smoked glass, or, in some cases, tunnel vision. The somatosensory aura of migraine consists of digitolingual or cheiro-oral paresthesias, a feeling of pins-and-needles experienced in the hand and arm as well as in the ipsilateral nose-mouth area. Paresthesia migrate up the arm and then extend to involve the face, lips and tongue.
Other symptoms of the aura phase can include auditory or olfactory hallucinations, aphasia, vertigo, tingling or numbness of the face and extremities, and hypersensitivity to touch.
The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria":
5 or more attacks
4 hours to 3 days in duration
2 or more of - unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity
1 or more accompanying symptoms - nausea and/or vomiting, photophobia, phonophobia
For migraine with aura, only two attacks are required to justify the diagnosis.
Pain phase
The typical migraine headache is unilateral, throbbing, moderate to severe and can be aggravated by physical activity. Not all of these features are necessary. The pain may be bilateral at the onset or start on one side and become generalized, usually alternates sides from one attack to the next. The onset is usually gradual. The pain peaks and t