Migraine is a chronic illness that has been hypothesized to be caused by perturbation in the blood flow to the brain. It has a strong genetic component. It can be precipitated by stress, hunger, lack of sleep, menstrual cycle etc. It's usually preceded by an aura, which is a combination of signs and symptoms that tell the patient that a migraine attack is eminent. Typical symptoms: Throbbing or pulsatile (with the heart beat) headache, with moderate to severe pain that intensifies with movement or physical activity. One-sided and localized pain on the sides or in the back of the head, but the pain may be felt anywhere around the head or neck. Pain grows worse over 1-2 hours, progressing to the back of the head and then the entire head. Headache lasts 4-72 hours. Nausea and vomiting, and food intolerance, and light-headedness are experienced. Sensitivity to light and sound.
Features of migraine aura are as follows:
May precede or accompany the headache phase or may occur independent of it. Usually develops over 5-20 minutes and lasts <60 minutes. Most commonly visual in nature (seeing bands of light).
For the diagnosis of migraine to be made, patients must have had at least 5 headache attacks that lasted 4-72 hours and the headache must have had at least 2 of the following characteristics:
Unilateral (one sided) location. Pulsating quality. Moderate or severe pain intensity. Made worse by or causing avoidance of 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 (irritation from light; patient usually seeks a dark place) and phonophobia (irritation from sounds; patient avoids noisy places). Treatment has 2 components: prophylactic (maintenance) which aims to keep a level of symptom free period, and abortive, which aims to abort (stop) an acute attack of pain. In addition to avoidance of causative agents (daily diary helps identify those).
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