Headache, Migraine
To view the entire topic, please log in or purchase a subscription.
5-Minute Clinical Consult (5MCC) app and website powered by Unbound Medicine helps you diagnose and manage 900+ medical conditions. Exclusive bonus features include Diagnosaurus DDx, 200 pediatrics topics, and medical news feeds. Explore these free sample topics:
-- The first section of this topic is shown below --
Basics
Description
Recurrent headache disorder manifesting in attacks lasting 4 to 72 hours. Typical characteristics are unilateral location, pulsating quality, moderate to severe intensity, aggravation by physical activity, and association with nausea and/or photophobia and phonophobia (1).
- Most frequent subtypes of migraine (1):
- Without aura (common migraine): defining >80% of attacks, often associated with nausea, vomiting, photophobia, and/or phonophobia
- With aura (classic migraine): visual or other types (motor, sensory or brainstem symptoms, including previously known as basilar or hemiplegic migraine) of fully reversible neurologic phenomenon develops gradually over 5 minutes and lasts up to 60 minutes
- Chronic migraine: Migraine attacks are >15 headache days/month, >4 hours/day, for at least 3 months.
- Menstrual-related migraine: associated with onset of menstrual period
- Rare but important subtypes (1):
- Status migrainosus: debilitating migraine lasting >72 hours
- Prolonged aura: aura symptoms lasting more than 60 minutes (can last up to 7 days)
- Retinal: repeated attacks of monocular visual disturbance, including scintillations, scotomata, or blindness, associated with migraine headache
- Acephalagic migraine (migraine aura without headache): typical aura symptoms not followed by a migraine headache
Epidemiology
Female > male (3:1)
Prevalence- Affects >28 million Americans
- Adults: women 18%; men 6%
Etiology and Pathophysiology
- Trigeminovascular hypothesis: Hyperexcitable trigeminal sensory neurons in brainstem are stimulated and release neuropeptides, such as substance P and calcitonin gene-related peptide (CGRP), leading to vasodilation and neurogenic inflammation.
- Cortical spreading depression: Mainly accepted hypotheses for migraine with aura; change in electrical activity with reduction of blood flow, leading to aura
Genetics
- >80% of patients have a positive family history.
- Familial hemiplegic migraine has been shown to be linked to chromosomes 1, 2, and 19 (1).
Risk Factors
- Family history of migraine
- Female gender
- Stress
- Menstrual cycle, hormones
- Sleep pattern disruption
- Diet: skipped meals (48%), alcohol (32%), chocolate (20%), cheese (13%), caffeine overuse (14%), monosodium glutamate (MSG) (12%), and artificial sweeteners (e.g., aspartame, sucralose)
- Medications: estrogens, vasodilators
General Prevention
- Avoid precipitants of attacks.
- Lifestyle modifications are the cornerstone of prevention: sleep hygiene, stress management, healthy diet, adequate hydration, and regular exercise.
- Biofeedback, education, and psychological intervention
- Prophylactic medication if attacks are frequent, severely debilitating, or not controlled by acute interventions
Commonly Associated Conditions
- Depression, anxiety, posttraumatic stress disorder
- Sleep disturbance (e.g., sleep apnea)
- Cerebral vascular disease
- Seizure disorders
- Irritable bowel syndrome
- Obesity
- Medication overuse headache (MOH)
- Childhood trauma
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
Recurrent headache disorder manifesting in attacks lasting 4 to 72 hours. Typical characteristics are unilateral location, pulsating quality, moderate to severe intensity, aggravation by physical activity, and association with nausea and/or photophobia and phonophobia (1).
- Most frequent subtypes of migraine (1):
- Without aura (common migraine): defining >80% of attacks, often associated with nausea, vomiting, photophobia, and/or phonophobia
- With aura (classic migraine): visual or other types (motor, sensory or brainstem symptoms, including previously known as basilar or hemiplegic migraine) of fully reversible neurologic phenomenon develops gradually over 5 minutes and lasts up to 60 minutes
- Chronic migraine: Migraine attacks are >15 headache days/month, >4 hours/day, for at least 3 months.
- Menstrual-related migraine: associated with onset of menstrual period
- Rare but important subtypes (1):
- Status migrainosus: debilitating migraine lasting >72 hours
- Prolonged aura: aura symptoms lasting more than 60 minutes (can last up to 7 days)
- Retinal: repeated attacks of monocular visual disturbance, including scintillations, scotomata, or blindness, associated with migraine headache
- Acephalagic migraine (migraine aura without headache): typical aura symptoms not followed by a migraine headache
Epidemiology
Female > male (3:1)
Prevalence- Affects >28 million Americans
- Adults: women 18%; men 6%
Etiology and Pathophysiology
- Trigeminovascular hypothesis: Hyperexcitable trigeminal sensory neurons in brainstem are stimulated and release neuropeptides, such as substance P and calcitonin gene-related peptide (CGRP), leading to vasodilation and neurogenic inflammation.
- Cortical spreading depression: Mainly accepted hypotheses for migraine with aura; change in electrical activity with reduction of blood flow, leading to aura
Genetics
- >80% of patients have a positive family history.
- Familial hemiplegic migraine has been shown to be linked to chromosomes 1, 2, and 19 (1).
Risk Factors
- Family history of migraine
- Female gender
- Stress
- Menstrual cycle, hormones
- Sleep pattern disruption
- Diet: skipped meals (48%), alcohol (32%), chocolate (20%), cheese (13%), caffeine overuse (14%), monosodium glutamate (MSG) (12%), and artificial sweeteners (e.g., aspartame, sucralose)
- Medications: estrogens, vasodilators
General Prevention
- Avoid precipitants of attacks.
- Lifestyle modifications are the cornerstone of prevention: sleep hygiene, stress management, healthy diet, adequate hydration, and regular exercise.
- Biofeedback, education, and psychological intervention
- Prophylactic medication if attacks are frequent, severely debilitating, or not controlled by acute interventions
Commonly Associated Conditions
- Depression, anxiety, posttraumatic stress disorder
- Sleep disturbance (e.g., sleep apnea)
- Cerebral vascular disease
- Seizure disorders
- Irritable bowel syndrome
- Obesity
- Medication overuse headache (MOH)
- Childhood trauma
There's more to see -- the rest of this entry is available only to subscribers.