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{{Migraine}}
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==Classification==
==Overview==
Migraines have been classified by the [[International Headache Society]] which periodically revises their classification.<ref name="pmid14979299">{{cite journal |author=Headache Classification Subcommittee of the International Headache Society |title=The International Classification of Headache Disorders: 2nd edition |journal=Cephalalgia : an international journal of headache |volume=24 Suppl 1 |issue= |pages=9–160 |year=2004 |pmid=14979299 |doi=10.1111/j.1468-2982.2004.00653.x|}} [http://www.i-h-s.org/upload/ct_clas/ihc_II_main_no_print.pdf Complete supplement online]</ref>
Migraines can be divided in three different types: migraine without [[aura]], typical migraine with [[aura]] and probable migraine without [[aura]]. Migraines are often underdiagnosed and misdiagnosed.<ref name="pmid1599358">{{cite journal |author=Lipton RB, Stewart WF, Celentano DD, Reed ML |title=Undiagnosed migraine headaches. A comparison of symptom-based and reported physician diagnosis |journal=Arch. Intern. Med. |volume=152 |issue=6 |pages=1273–8 |year=1992 |pmid=1599358 |doi=}}</ref><ref name="pmid15364670">{{cite journal |author=Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C |title=Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache |journal=Arch. Intern. Med. |volume=164 |issue=16 |pages=1769–72 |year=2004 |pmid=15364670 |doi=10.1001/archinte.164.16.1769}}</ref> The diagnostic criteria for migraine include recurrent headache disorder manifesting in attacks that fulfill typical characteristics in a context of normal clinical examination that rules out other diagnoses. Migraine with aura is a recurrent disorder manifesting in attacks of reversible focal neurological symptoms that usually develop gradually over 5–20 minutes and last for less than 60 minutes.


===Defining Severity of Pain===
==The International Classification of Headache Disorders (ICHD)==
In addition to classifying the type of headache, the [[International Headache Society]] defines intensity of [[pain]] on a verbal 4 point scale:<ref name="pmid14979299p150">{{cite journal |author=Headache Classification Subcommittee of the International Headache Society |title=The International Classification of Headache Disorders: 2nd edition |journal=Cephalalgia : an international journal of headache |volume=24 Suppl 1 |issue= |pages=150 |year=2004 |pmid=14979299 |doi=10.1111/j.1468-2982.2004.00653.x|}} [http://www.i-h-s.org/upload/ct_clas/ihc_II_main_no_print.pdf Complete supplement online] (see page 150)</ref>


* '''0 no pain'''
===Migraine without Aura===
* '''1 mild pain''' 'does not interfere with usual activities'
The diagnosis of migraine without [[aura]], according to the [[International Headache Society]], can be made according to the following criteria:<ref name="pmid23771276">{{cite journal| author=Headache Classification Committee of the International Headache Society (IHS)| title=The International Classification of Headache Disorders, 3rd edition (beta version). | journal=Cephalalgia | year= 2013 | volume= 33 | issue= 9 | pages= 629-808 | pmid=23771276 | doi=10.1177/0333102413485658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23771276  }} </ref>
* '''2 moderate pain''' 'inhibits, but does not wholly prevent usual activities'
*A - ≥ 5 attacks characterized by the symptoms presented in the criteria B through D
* '''3 severe pain''' 'prevents all activities'
*B - [[Headache]]s can last form 4 to 72 hours.
*C - [[Headache]]s must contain at least one of the following:
**Unilateral location
**Pulsating quality
**Moderate to severe [[pain]]
**Aggravation or causing of the pain from normal [[physical activity]]
*D - Presence of one of the following:
**[[Nausea]] and/or [[vomit]]
**[[Photophobia]] and/or [[phonophobia]]
*E - The symptoms can not be better accounted for by any other diagnosis.
The mnemonic POUNDing ('''P'''ulsating, duration of 4-72 h'''O'''urs, '''U'''nilateral, [[Nausea|'''N'''ausea]], '''D'''isabling) can help diagnose migraine. If 4 of the 5 criteria are met, then the positive [[likelihood-ratio test| likelihood ratio]] for diagnosing migraine is 24.<ref name="pmid16968852">{{cite journal |author=Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM |title=Does this patient with headache have a migraine or need neuroimaging? |journal=JAMA |volume=296 |issue=10 |pages=1274–83 |year=2006 |pmid=16968852 |doi=10.1001/jama.296.10.1274}}</ref>. The presence of either disability, nausea or sensitivity, can diagnose migraine with<ref name="pmid12913201">{{cite journal |author=Lipton RB, Dodick D, Sadovsky R, ''et al'' |title=A self-administered screener for migraine in primary care: The ID Migraine validation study |journal=Neurology |volume=61 |issue=3 |pages=375-82 |year=2003 |pmid=12913201 |doi=}}</ref> [[sensitivity (tests)|sensitivity]] of 81% and [[specificity (tests)|specificity]] of 75%.  Patients that meet the criterai for Migraine without [[aura]], but have fewer than 5 attacks, are classified as '''Probable''' Migraine without [[aura]].


===Migraine with Aura===
===Migraine Without Aura===  
The diagnosis of migraine with [[aura]], according to the [[International Headache Society]], can be made according to the following criteria:<ref name="pmid23771276">{{cite journal| author=Headache Classification Committee of the International Headache Society (IHS)| title=The International Classification of Headache Disorders, 3rd edition (beta version). | journal=Cephalalgia | year= 2013 | volume= 33 | issue= 9 | pages= 629-808 | pmid=23771276 | doi=10.1177/0333102413485658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23771276  }} </ref>
Aslo known as common migraine or hemicrania simplex is a recurrent [[headache]] that lasts 4-72 hours. It is characterized by unilateral location, pulsating quality, moderate to severe intensity, worsens with physical activity and can be associated to [[Nausea and Vomiting|nauseas]], [[Nausea and Vomiting|vomiting]] and [[photophobia]].  In order to diagnose migraine without aura, there must have been at least five attacks not attributable to another cause that fulfill the following criteria 
*A - ≥ 2 attacks characterized by the symptoms presented in the criteria B through D
*B - At least 1 of the following reversible symptoms:
**[[Visual]]
**[[Motor skill]]
**[[Sensory]]
**[[Developmental dyspraxia#Developmental profiles|Speech/language]]
**[[Retinal]]
*C - At least two of the following:
**At least one [[aura]] symptom spreading gradually over >5 minutes and/or two or more [[aura]] symptoms occur in succession over >5 minutes
**Each individual symptom lasting between 5 to 60 minutes
**The [[aura]] is accompanied or followed by 60 minutes of headache.
*D - The symptoms can not be better accounted for by any other diagnosis.


1. Headache attacks lasting 4-72 hours
Where these criteria are not fully met, a diagnosis of "probable migraine with aura" may be considered, although other neurological causes must also be excluded.


2. At least two of the following characteristics
If the picture complies with the criteria but includes one-sided muscular weakness or paralysis, a diagnosis of "sporadic hemiplegic migraine" or "familial hemiplegic migraine" should be considered.
* Unilateral location
* Pulsating quality
* Moderate or severe pain intensity
* Aggravation by or causing avoidance of routine physical activity 


3. During the [[headache]] there must be at least one of the following associated symptom clusters 
* [[Nausea and Vomiting|Nausea]] and/or [[Nausea and Vomiting|vomiting]]
* Photophobia and phonophobia


When these criteria are not fully met, the problem may be classified as "probable migraine without aura" but other diagnoses such as "[[Tension headache|episodic tension type headache]]" must also be excluded.  
{| class="wikitable"
|-
| '''Typical aura With migraine headache'''
|Typical aura with migraine headache consists of a typical [[aura]] involving [[visual]] and/or [[sensory]] and/or [[Developmental dyspraxia|speech]] symptoms, lasting no more than 60 minutes. The [[aura]] is characterized by complete reversibility of the symptoms and is associated with [[headache]] fulfilling the criteria for migraine without [[aura]].  It begins during the aura or follow the [[aura]] within 60 minutes and is not attributed to another disorder.
|-
| '''Typical aura with non-migraine headache'''
| Is a typical [[aura]] involving [[visual]] and/or [[sensory]] and/or [[Developmental dyspraxia|speech]] symptoms, lasting no more than 60 minutes. The [[aura]] is characterized by complete reversibility of the symptoms, which is associated with [[headache]] that does not fulfil the criteria for migraine without [[aura]].
|-
| '''Typical aura without headache'''
|Is a typical [[aura]] involving [[visual]] and/or [[sensory]] and/or [[Developmental dyspraxia|speech]] symptoms, lasting no more than 60 minutes. The [[aura]] is characterized by complete reversibility of the symptoms, which is not associated with [[headache]].
|-
| '''Familial hemiplegic migraine (FHM)'''
| Familial hemiplegic migraine (FHM) is a type of migraine with a possible [[Biological inheritance|polygenetic]] component.  These migraine attacks may last 4-72 hours<ref name="pmid14979299">{{cite journal |author= |title=The International Classification of Headache Disorders: 2nd edition |journal=[[Cephalalgia : an International Journal of Headache]] |volume=24 Suppl 1 |issue= |pages=9–160 |year=2004 |pmid=14979299 |doi= |url=http://cep.sagepub.com/cgi/pmidlookup?view=long&pmid=14979299 |accessdate=2012-08-30}}</ref> and are apparently caused by [[Ion channel|ion channel]] [[Mutation|mutations]], three types of which have been identified to date.  Patients who experience this syndrome have relatively typical migraine headaches preceded and/or accompanied by reversible [[limb]] [[Muscle weakness|weakness]] on one side as well as [[Visual system|visual]], [[Sensory system|sensory]] or [[Developmental dyspraxia#Developmental profiles|speech]] difficulties.
|-
| '''Sporadic hemiplegic migraine'''
| Sporadic hemiplegic migraine (SHM) have migraine attacks that may last 4-72 hours<ref name="pmid14979299">{{cite journal|author= |title=The International Classification of Headache Disorders: 2nd edition |journal=[[Cephalalgia : an International Journal of Headache]] |volume=24 Suppl 1 |issue= |pages=9–160 |year=2004|pmid=14979299 |doi= |url=http://cep.sagepub.com/cgi/pmidlookup?view=long&pmid=14979299 |accessdate=2012-08-30}}</ref>. Patients who experience this syndrome have relatively typical migraine headaches preceded and/or accompanied by reversible [[limb]] [[Muscle weakness|weakness]] on one side as well as [[Visual system|visual]], [[Sensory system|sensory]] or [[Developmental dyspraxia#Developmental profiles|speech]] difficulties without a first or second relative with hemiplegic migraine.
|-
| '''Basilar-type migraine'''
| Basilar type migraine (BTM), formerly known as [[basilar artery]] migraine (BAM) or basilar migraine (BM), is an uncommon type of complicated migraine with [[aura]].  In the majority of migraineurs the [[aura]] progress gradually for 5 minutes or more, lasting 5 - 120 minutes and the [[headache]] starts after the onset of the aura.<ref> name="pmid23771276">{{cite journal| author=Headache Classification Committee of the International Headache Society (IHS)| title=The International Classification of Headache Disorders, 3rd edition (beta version). | journal=Cephalalgia | year= 2013 | volume= 33 | issue= 9 | pages= 629-808 | pmid=23771276 | doi=10.1177/0333102413485658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23771276  }} </ref>  The symptoms are originated from the [[brain stem]] and/or from both [[Cerebral hemisphere|hemispheres]] simultaniously attacked, without [[Muscle weakness|weakness]].<ref> name="pmid3537212">{{cite journal| author=Pearce JM| title=Historical aspects of migraine. | journal=J Neurol Neurosurg Psychiatry | year= 1986 | volume= 49 | issue= 10 | pages= 1097-103 | pmid=3537212 | doi= | pmc=PMC1029040 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3537212  }} </ref> It always present 2 or more [[brain stem]] related [[aura]] symptoms (eg. [[Dysarthria]], [[vertigo]], [[Hearing impairment|hypoacusis]], [[diplopia]], [[ataxia]], [[Unconsciousness|decreased level of consciousness]]) .<ref> name="pmid23771276">{{cite journal| author=Headache Classification Committee of the International Headache Society (IHS)| title=The International Classification of Headache Disorders, 3rd edition (beta version). | journal=Cephalalgia | year= 2013 | volume= 33 | issue= 9 | pages= 629-808 |pmid=23771276 | doi=10.1177/0333102413485658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23771276  }} </ref> Serious episodes of BTM can lead to [[stroke]], [[coma]], or even [[death]]. The use of [[triptan]]s and other [[vasoconstrictor]]s as abortive treatments in BTM is [[Contraindication|contraindicated]]. Abortive treatments for BTM often focus on [[Vasodilator| vasodilation]] and restoration of normal [[blood flow]] to the vertebrobasilar territory and subsequent return of normal [[brain stem]] function.
|}


===Migraine With Aura===
===Childhood Periodic Syndromes That Are Commonly Precursors Of Migraine===
Also known as classic migraine, is the second most commonly seen form of migraine: patients who primarily suffer from migraine with aura may also have attacks of migraine without aura. Migraine with aura is a recurrent condition in which the attacks are manifested as reversible [[focal neurologic signs]] that progress over 5-20 minutes, lasting for less than 60 minutes.  After the [[aura]] symptoms the headache with the same description as the [[headache]] in migraine without aura starts. Less commonly, the [[aura]] may occur without a subsequent [[headache]] or the [[headache]] may be non-migrainous in type.  In order to diagnose migraine with aura, there must have been at least two attacks not attributable to another cause that fulfill the following criteria.


====Cyclical Vomiting====
Are recurrent episodic attacks that last from 1 hour to 5 days of [[nausea and vomiting]] at least 4 times per hour, free of symptoms between attacks and it is not attributed to another disorder.


1. Aura consisting of at least one of the following, but no [[muscle weakness]] or [[paralysis]]
====Abdominal migraine====


* Fully reversible [[Visual system| visual]] symptoms (e.g. flickering lights, spots, lines, [[Vision loss|loss of vision]])
Is a recurrent disorder of unknown origin which occurs mainly in children. It is characterised by episodes of moderate to severe central [[abdominal pain]] lasting 1-72 hours. There is usually associated [[nausea and vomiting]] but the child is entirely well between attacks. In order to diagnose abdominal migraine, there must be at least five attacks, not attributable to another cause, fulfilling the following criteria


* Fully reversible [[Sensory system|sensory]] symptoms (e.g. pins and needles, [[Paresthesia|numbness]])
1. Attacks lasting 1-72 hours when untreated


* Fully reversible [[dysphasia]]
2. Pain must have ALL of the following characteristics


2. [[Aura]] has at least two of the following characteristics
*Location in the midline, around the umbilicus or poorly localised


* [[Visual system|Visual]] symptoms affecting just one side of the field of vision and/or [[Sensory system|sensory]] symptoms affecting just one side of the body
*Dull or 'just sore' quality


* At least one [[aura]] symptom develops gradually over more than 5 minutes and/or different aura symptoms occur one after the other over more than 5 minutes
*Moderate or severe intensity


* Each symptom lasts from 5-60 minutes
3. During an attack there must be at least two of the following


Where these criteria are not fully met, a diagnosis of "probable migraine with aura" may be considered, although other neurological causes must also be excluded.
*[[Anorexia (symptom)|Loss of appetite]]


If the picture complies with the criteria but includes one-sided muscular weakness or paralysis, a diagnosis of "sporadic hemiplegic migraine" or "familial hemiplegic migraine" should be considered.
* [[Nausea and vomiting|Nausea]]


 
*[[Nausea and vomiting|Vomiting]]


*[[Pallor]]


====Typical Aura With Migraine Headache====
Most children with abdominal migraine will develop migraine headache later in life and the two may co-exist during [[adolescence]].
Is a typical [[aura]] involving [[visual]] and/or [[sensory]] and/or [[Developmental dyspraxia|speech]] symptoms, lasting no more than 60 minutes. The [[aura]] is characterized by complete reversibility of the symptoms, which is associated with [[headache]] fulfilling the criteria for migraine without [[aura]].  It begins during the aura or follow the [[aura]] within 60 minutes and is not attributed to another disorder.
 
====Typical Aura with non-Migraine headache====
Is a typical [[aura]] involving [[visual]] and/or [[sensory]] and/or [[Developmental dyspraxia|speech]] symptoms, lasting no more than 60 minutes. The [[aura]] is characterized by complete reversibility of the symptoms, which is associated with [[headache]] that does not fulfil the criteria for migraine without [[aura]].
 
====Typical Aura without headache====
Is a typical [[aura]] involving [[visual]] and/or [[sensory]] and/or [[Developmental dyspraxia|speech]] symptoms, lasting no more than 60 minutes. The [[aura]] is characterized by complete reversibility of the symptoms, which is not associated with [[headache]].
 
====Familial Hemiplejic Migraine (FHM)====
                Normal  0      21      false  false  false    ES-TRAD  JA  X-NONE
 
Familial hemiplegic migraine 'FHM' is a type of migraine with a possible [[Biological inheritance|polygenetic]] component.  These migraine attacks may last 4-72 hours<ref name="pmid14979299">{{cite journal |author= |title=The International Classification of Headache Disorders: 2nd edition |journal=[[Cephalalgia : an International Journal of Headache]] |volume=24 Suppl 1 |issue= |pages=9–160 |year=2004 |pmid=14979299 |doi= |url=http://cep.sagepub.com/cgi/pmidlookup?view=long&pmid=14979299 |accessdate=2012-08-30}}</ref> and are apparently caused by ion channel mutations, three types of which have been identified to date.  Patients who experience this syndrome have relatively typical migraine headaches preceded and/or accompanied by reversible limb weakness on one side as well as visual, sensory or speech difficulties.
 
====Sporadic Hemiplejic Migraine====
 
====Basilar-Type Migraine====
 
===Childhood Periodic Syndromes That Are Commonly Precursors Of Migraine===
 
====Cyclical Vomiting====
 
====Abdominal migraine====


====Bening paroxysmal Vertigo Of Childhood====
====Bening paroxysmal Vertigo Of Childhood====
Are recurrent brief episodic attacks of [[vertigo]]. In order to diagnose benign paroxysmal vertigo of childhood there must have been at least 5 attacks of multiple episodes with severe [[vertigo]], starting without warning and resolving spontaneously. The patient must have a normal [[Neurology#Testing examinations|neurological]], [[Audiometry|audiometric]] and [[Vestibular system|vestibular]] functions between attacks and a normal [[electroencephalogram]].


===Retinal Migraine===
===Retinal Migraine===
Also called ocular migraine is a rare condition described as multiples attacks of monocular [[scotoma]] or [[blindness]]. In order to diagnose retinal migraine there must have been at least 2 attacks with reversible monocular (positive and/or negative) [[Visual system|visual]] phenomena (eg, [[scotoma]] or [[blindness]]) and a [[headache]] fulfilling criteria for Migraine without aura begins during the visual symptoms or follows them within 60 minutes. The patient should have normal ophthalmological examination between attacks and is not attributed to another disorder.


==References==
==References==
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[[Category:Needs overview]]
[[Category:Needs overview]]
[[Category:Migraine]]
[[Category:Migraine]]
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[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Signs and symptoms]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Headaches]]
[[Category:Headaches]]
[[Category:Head and neck]]
[[Category:Head and neck]]

Latest revision as of 22:43, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Migraines can be divided in three different types: migraine without aura, typical migraine with aura and probable migraine without aura. Migraines are often underdiagnosed and misdiagnosed.[1][2] The diagnostic criteria for migraine include recurrent headache disorder manifesting in attacks that fulfill typical characteristics in a context of normal clinical examination that rules out other diagnoses. Migraine with aura is a recurrent disorder manifesting in attacks of reversible focal neurological symptoms that usually develop gradually over 5–20 minutes and last for less than 60 minutes.

The International Classification of Headache Disorders (ICHD)

Migraine without Aura

The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria:[3]

  • A - ≥ 5 attacks characterized by the symptoms presented in the criteria B through D
  • B - Headaches can last form 4 to 72 hours.
  • C - Headaches must contain at least one of the following:
    • Unilateral location
    • Pulsating quality
    • Moderate to severe pain
    • Aggravation or causing of the pain from normal physical activity
  • D - Presence of one of the following:
  • E - The symptoms can not be better accounted for by any other diagnosis.

The mnemonic POUNDing (Pulsating, duration of 4-72 hOurs, Unilateral, Nausea, Disabling) can help diagnose migraine. If 4 of the 5 criteria are met, then the positive likelihood ratio for diagnosing migraine is 24.[4]. The presence of either disability, nausea or sensitivity, can diagnose migraine with[5] sensitivity of 81% and specificity of 75%. Patients that meet the criterai for Migraine without aura, but have fewer than 5 attacks, are classified as Probable Migraine without aura.

Migraine with Aura

The diagnosis of migraine with aura, according to the International Headache Society, can be made according to the following criteria:[3]

  • A - ≥ 2 attacks characterized by the symptoms presented in the criteria B through D
  • B - At least 1 of the following reversible symptoms:
  • C - At least two of the following:
    • At least one aura symptom spreading gradually over >5 minutes and/or two or more aura symptoms occur in succession over >5 minutes
    • Each individual symptom lasting between 5 to 60 minutes
    • The aura is accompanied or followed by 60 minutes of headache.
  • D - The symptoms can not be better accounted for by any other diagnosis.

Where these criteria are not fully met, a diagnosis of "probable migraine with aura" may be considered, although other neurological causes must also be excluded.

If the picture complies with the criteria but includes one-sided muscular weakness or paralysis, a diagnosis of "sporadic hemiplegic migraine" or "familial hemiplegic migraine" should be considered.


Typical aura With migraine headache Typical aura with migraine headache consists of a typical aura involving visual and/or sensory and/or speech symptoms, lasting no more than 60 minutes. The aura is characterized by complete reversibility of the symptoms and is associated with headache fulfilling the criteria for migraine without aura. It begins during the aura or follow the aura within 60 minutes and is not attributed to another disorder.
Typical aura with non-migraine headache Is a typical aura involving visual and/or sensory and/or speech symptoms, lasting no more than 60 minutes. The aura is characterized by complete reversibility of the symptoms, which is associated with headache that does not fulfil the criteria for migraine without aura.
Typical aura without headache Is a typical aura involving visual and/or sensory and/or speech symptoms, lasting no more than 60 minutes. The aura is characterized by complete reversibility of the symptoms, which is not associated with headache.
Familial hemiplegic migraine (FHM) Familial hemiplegic migraine (FHM) is a type of migraine with a possible polygenetic component. These migraine attacks may last 4-72 hours[6] and are apparently caused by ion channel mutations, three types of which have been identified to date. Patients who experience this syndrome have relatively typical migraine headaches preceded and/or accompanied by reversible limb weakness on one side as well as visual, sensory or speech difficulties.
Sporadic hemiplegic migraine Sporadic hemiplegic migraine (SHM) have migraine attacks that may last 4-72 hours[6]. Patients who experience this syndrome have relatively typical migraine headaches preceded and/or accompanied by reversible limb weakness on one side as well as visual, sensory or speech difficulties without a first or second relative with hemiplegic migraine.
Basilar-type migraine Basilar type migraine (BTM), formerly known as basilar artery migraine (BAM) or basilar migraine (BM), is an uncommon type of complicated migraine with aura. In the majority of migraineurs the aura progress gradually for 5 minutes or more, lasting 5 - 120 minutes and the headache starts after the onset of the aura.[7] The symptoms are originated from the brain stem and/or from both hemispheres simultaniously attacked, without weakness.[8] It always present 2 or more brain stem related aura symptoms (eg. Dysarthria, vertigo, hypoacusis, diplopia, ataxia, decreased level of consciousness) .[9] Serious episodes of BTM can lead to stroke, coma, or even death. The use of triptans and other vasoconstrictors as abortive treatments in BTM is contraindicated. Abortive treatments for BTM often focus on vasodilation and restoration of normal blood flow to the vertebrobasilar territory and subsequent return of normal brain stem function.

Childhood Periodic Syndromes That Are Commonly Precursors Of Migraine

Cyclical Vomiting

Are recurrent episodic attacks that last from 1 hour to 5 days of nausea and vomiting at least 4 times per hour, free of symptoms between attacks and it is not attributed to another disorder.

Abdominal migraine

Is a recurrent disorder of unknown origin which occurs mainly in children. It is characterised by episodes of moderate to severe central abdominal pain lasting 1-72 hours. There is usually associated nausea and vomiting but the child is entirely well between attacks. In order to diagnose abdominal migraine, there must be at least five attacks, not attributable to another cause, fulfilling the following criteria

1. Attacks lasting 1-72 hours when untreated

2. Pain must have ALL of the following characteristics

  • Location in the midline, around the umbilicus or poorly localised
  • Dull or 'just sore' quality
  • Moderate or severe intensity

3. During an attack there must be at least two of the following

Most children with abdominal migraine will develop migraine headache later in life and the two may co-exist during adolescence.

Bening paroxysmal Vertigo Of Childhood

Are recurrent brief episodic attacks of vertigo. In order to diagnose benign paroxysmal vertigo of childhood there must have been at least 5 attacks of multiple episodes with severe vertigo, starting without warning and resolving spontaneously. The patient must have a normal neurological, audiometric and vestibular functions between attacks and a normal electroencephalogram.

Retinal Migraine

Also called ocular migraine is a rare condition described as multiples attacks of monocular scotoma or blindness. In order to diagnose retinal migraine there must have been at least 2 attacks with reversible monocular (positive and/or negative) visual phenomena (eg, scotoma or blindness) and a headache fulfilling criteria for Migraine without aura begins during the visual symptoms or follows them within 60 minutes. The patient should have normal ophthalmological examination between attacks and is not attributed to another disorder.

References

  1. ↑ Lipton RB, Stewart WF, Celentano DD, Reed ML (1992). "Undiagnosed migraine headaches. A comparison of symptom-based and reported physician diagnosis". Arch. Intern. Med. 152 (6): 1273–8. PMID 1599358.
  2. ↑ Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C (2004). "Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache". Arch. Intern. Med. 164 (16): 1769–72. doi:10.1001/archinte.164.16.1769. PMID 15364670.
  3. ↑ 3.0 3.1 Headache Classification Committee of the International Headache Society (IHS) (2013). "The International Classification of Headache Disorders, 3rd edition (beta version)". Cephalalgia. 33 (9): 629–808. doi:10.1177/0333102413485658. PMID 23771276.
  4. ↑ Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM (2006). "Does this patient with headache have a migraine or need neuroimaging?". JAMA. 296 (10): 1274–83. doi:10.1001/jama.296.10.1274. PMID 16968852.
  5. ↑ Lipton RB, Dodick D, Sadovsky R; et al. (2003). "A self-administered screener for migraine in primary care: The ID Migraine validation study". Neurology. 61 (3): 375–82. PMID 12913201.
  6. ↑ 6.0 6.1 "The International Classification of Headache Disorders: 2nd edition". Cephalalgia : an International Journal of Headache. 24 Suppl 1: 9–160. 2004. PMID 14979299. Retrieved 2012-08-30.
  7. ↑ name="pmid23771276">Headache Classification Committee of the International Headache Society (IHS) (2013). "The International Classification of Headache Disorders, 3rd edition (beta version)". Cephalalgia. 33 (9): 629–808. doi:10.1177/0333102413485658. PMID 23771276.
  8. ↑ name="pmid3537212">Pearce JM (1986). "Historical aspects of migraine". J Neurol Neurosurg Psychiatry. 49 (10): 1097–103. PMC 1029040. PMID 3537212.
  9. ↑ name="pmid23771276">Headache Classification Committee of the International Headache Society (IHS) (2013). "The International Classification of Headache Disorders, 3rd edition (beta version)". Cephalalgia. 33 (9): 629–808. doi:10.1177/0333102413485658. PMID 23771276.

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