Migraine history and symptoms
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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 but 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 patient: (1) the prodrome, which occurs hours or days before the headache, (2) the aura, which immediately precedes the headache, (3) the pain phase, also known as headache phase and (4) the postdrome phase.
History and Symptoms
Prodromal symptoms occur in 40 to 60% of migraineurs. This phase is characterized by the occurrence of vegetative or affective symptoms as early as 24 to 48 hours prior the beginning of the migraine attacks. The typical symptoms include altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food (e.g., chocolate), muscle stiffness (especially in the neck), constipation, diarrhea or increased urination. The prodrome phase helps the patient or observant family to predict the occurrence of a new migraine episode.
For the 20-30% of migraineurs who suffer migraine with aura, this aura comprises focal neurological phenomena that precede or accompany the attack. They appear gradually over 5 to 20 minutes and generally last fewer than 60 minutes. Some prospective data suggest that some of patients headache’s are present during the aura phase of the migraine attack. The pain 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. The auras are most often visual, but can also be sensory, verbal or motor disturbances. 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 and hemianopsia.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, temporary dysphasia, vertigo, tingling or numbness of the face and extremities, and hypersensitivity to touch.
Shown below are images depicting some visual abnormalities that may occur as part of the aura.
The headache of migraine is often but not always unilateral and tends to have a throbbing or pulsatile quality, especially as the intensity increases. Not all of these features are necessary. The pain may be bilateral at the onset or may start on one side then becomes generalized. The headache usually alternates sides from one attack to the next. The onset is usually gradual. The pain peaks and then subsides, and usually lasts between 4 and 72 hours in adults and 1 and 48 hours in children. The frequency of attacks is extremely variable, from a few in a lifetime to several times a week, and the average migraineur experiences from one to three headaches a month. The head pain varies greatly in intensity. The pain of migraine is invariably accompanied by other features. Nausea occurs in almost 90 percent of patients, while vomiting occurs in about one third of patients. Many patients experience sensory hyperexcitability manifested by photophobia, phonophobia, osmophobia and seek a dark and quiet room. Blurred vision, nasal stuffiness, diarrhea, polyuria, pallor or sweating may be noted during the headache phase. There may be localized edema of the scalp or face, scalp tenderness, prominence of a vein or artery in the temple, or stiffness and tenderness of the neck. Impairment of concentration and mood are common. Lightheadedness, rather than true vertigo and a feeling of faintness may occur. The extremities tend to be cold and moist.
The effects of migraine may persist for some days after the main headache has ended; this is called the migraine postdrome. Many report a sore feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache has passed. The patient may feel tired or "hung over" and have head pain, cognitive difficulties, gastrointestinal symptoms, mood changes, and weakness. According to one summary, "Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise."
Severity of Pain
The International Headache Society defines intensity of pain according to the following:
- 0 no pain
- 1 mild pain 'does not interfere with usual activities'
- 2 moderate pain 'inhibits, but does not wholly prevent usual activities'
- 3 severe pain 'prevents all activities'
- ↑ Kelman L (2004). "The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs". Headache. 44 (9): 865–72. doi:10.1111/j.1526-4610.2004.04168.x. PMID 15447695.
- ↑ Young, William B. and Silberstein, Stephen D., Migraine and Other Headaches. St. Paul, Minn: AAN Press, 2004.
- ↑ Evans, Randolph W., MD, and Matthew, Ninan T., MD. Handbook of Headache, Second Edition. Philadelphia: Lippincott Williams & Wilkins. 2005.
- ↑ name="pmid23115208">Hansen JM, Lipton RB, Dodick DW, Silberstein SD, Saper JR, Aurora SK; et al. (2012). "Migraine headache is present in the aura phase: a prospective study". Neurology. 79 (20): 2044–9. doi:10.1212/WNL.0b013e3182749eed. PMID 23115208.
- ↑ name="pmid17495755">Cutrer FM, Huerter K (2007). dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17495755 "Migraine aura" Check
|url=value (help). Neurologist. 13 (3): 118–25. doi:10.1097/01.nrl.0000252943.82792.38. PMID 17495755.
- ↑ Kelman L (February 2006). "The postdrome of the acute migraine attack". Cephalalgia. 26 (2): 214–20. doi:10.1111/j.1468-2982.2005.01026.x. PMID 16426278.
- ↑ Halpern, Audrey L.; Silberstein, Stephen D. (2005). "Ch. 9: The Migraine Attack—A Clinical Description". In Kaplan PW, Fisher RS. Imitators of Epilepsy (2 ed.). New York: Demos Medical. ISBN 1-888799-83-8. NBK7326.
- ↑ Headache Classification Subcommittee of the International Headache Society (2004). "The International Classification of Headache Disorders: 2nd edition". Cephalalgia : an international journal of headache. 24 Suppl 1: 150. doi:10.1111/j.1468-2982.2004.00653.x. PMID 14979299. Complete supplement online (see page 150)