Headache, Migraine
BASICS
BASICS

BASICS
DESCRIPTION
DESCRIPTION
DESCRIPTION
Recurrent headache disorder manifesting in attacks lasting 4 to 72 hours; typically: unilateral, pulsating, moderate to severe intensity, and associated nausea and/or photophobia or phonophobia (1).
- Most frequent subtypes of migraine (1):
- Without aura: >80% of migraines; vomiting, photophobia, and/or phonophobia
- With aura: visual or other (motor, sensory or brainstem symptoms, including previously known as basilar or hemiplegic migraine); fully reversible neurologic phenomenon, develop gradually over 5 minutes and last up to 60 minutes
- Chronic migraine: >15 migraine days/month, >4 hours/attack, for ≥3 months
- Menstrual migraine: Migraine attacks in a menstruating person, onset of 1 to 2 days prior to menses or up to day 3 of menstruation, occurring in 2 of 3 menstrual cycles and at no other time during cycle
- Menstrually related migraine: menstrual migraine plus migraine attacks at other times during cycle
- Rare but important subtypes (1):
- Status migrainosus: migraine lasting >72 hours
- Prolonged aura: aura symptoms of >60 minutes (can last up to 7 days); should consider secondary causes
- Ocular: repeated attacks of monocular visual disturbance, scintillations, scotomata, or blindness, with migraine
- Vertiginous: migraine with vertigo or dizziness
- Acephalgic migraine (migraine aura without headache): typical aura symptoms not followed by a migraine headache
EPIDEMIOLOGY
EPIDEMIOLOGY
EPIDEMIOLOGY
- Female > male (3:1)
- Affects >28 million Americans
ETIOLOGY AND PATHOPHYSIOLOGY
ETIOLOGY AND PATHOPHYSIOLOGY
ETIOLOGY AND PATHOPHYSIOLOGY
- Trigeminovascular hypothesis: Hyperexcitable trigeminal brainstem sensory neurons are stimulated and release neuropeptides (substance P and CGRP), leading to vasodilation and neurogenic inflammation.
- Cortical spreading depression: main hypotheses for migraine with aura; change in electrical activity with reduced blood flow, leading to aura
Genetics
Genetics
Genetics
>80% of patients have family history.
RISK FACTORS
RISK FACTORS
RISK FACTORS
- Female sex (menstrual cycle)
- Family history of migraine
- Triggers:
- Sleep pattern disruption
- Diet: skipped meals (48%), alcohol (32%), chocolate (20%), cheese (13%), caffeine overuse (14%), monosodium glutamate (MSG) (12%), and artificial sweeteners
- Medications: estrogens, vasodilators
GENERAL PREVENTION
GENERAL PREVENTION
GENERAL PREVENTION
- Lifestyle modifications are cornerstone: sleep hygiene, stress management, healthy diet, adequate hydration, and regular exercise.
- Prophylactic medication for frequent attacks
COMMONLY ASSOCIATED CONDITIONS
COMMONLY ASSOCIATED CONDITIONS
COMMONLY ASSOCIATED CONDITIONS
- Depression, anxiety, PTSD
- Sleep disturbance (sleep apnea)
- Cerebral vascular disease
- IBS
- Other pain syndromes (cervical spine disease, endometriosis)
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