Recurrent headache disorder manifesting in attacks lasting 4 to 72 hours. Typically: unilateral location, pulsating quality, moderate to severe intensity, and associated nausea and/or photophobia and phonophobia (1)
- Most frequent subtypes of migraine (1):
- Without aura: defines >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 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: debilitating migraine lasting >72 hours
- Prolonged aura: aura symptoms >60 minutes (can last up to 7 days), should prompt consideration of secondary causes
- Ocular: repeated attacks of monocular visual disturbance, including 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
- Female > male (3:1)
- Affects >28 million Americans
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
>80% of patients have a family history
- Female sex (menstrual cycle)
- 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
- Lifestyle modifications are the cornerstone: sleep hygiene, stress management, healthy diet, adequate hydration, and regular exercise.
- Prophylactic medication for frequent attacks
Commonly Associated Conditions
- Depression, anxiety, PTSD
- Sleep disturbance (e.g., sleep apnea)
- Cerebral vascular disease
- Seizure disorders
- Irritable bowel syndrome
- Medication overuse headache (MOH)
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Domino, Frank J., et al., editors. "Headache, Migraine." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688666/all/Headache__Migraine.
Headache, Migraine. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688666/all/Headache__Migraine. Accessed June 7, 2023.
Headache, Migraine. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688666/all/Headache__Migraine
Headache, Migraine [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 07]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688666/all/Headache__Migraine.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Headache, Migraine ID - 1688666 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688666/all/Headache__Migraine PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -