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| ===Migraine Without Aura=== | | ===Migraine Without Aura=== |
| This is the most commonly seen form of migraine; patients who primarily suffer from migraine without aura may also have attacks of migraine with aura. According to the International Classification of Headache Disorders,<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> it is a recurrent headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia. 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
| | 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 |
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| 1. Headache attacks lasting 4-72 hours when untreated | | 1. Headache attacks lasting 4-72 hours |
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| 2. At least two of the following characteristics | | 2. At least two of the following characteristics |
| | * Unilateral location |
| | * Pulsating quality |
| | * Moderate or severe pain intensity |
| | * Aggravation by or causing avoidance of routine physical activity |
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| * Unilateral location
| | 3. During the [[headache]] there must be at least one of the following associated symptom clusters |
| * Pulsating quality
| | * [[Nausea and Vomiting|Nausea]] and/or [[Nausea and Vomiting|vomiting]] |
| * Moderate or severe pain intensity | | * Photophobia and phonophobia |
| * Aggravation by or causing avoidance of routine physical activity | |
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| 3. During the headache there must be at least one of the following associated symptom clusters
| | 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. |
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| * Nausea and/or vomiting
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| * Photophobia and phonophobia
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| Where these criteria are not fully met, the problem may be classified as "probable migraine without aura" but other diagnoses such as "episodic tension type headache" must also be excluded.
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| ===Migraine With Aura=== | | ===Migraine With Aura=== |
| | ====Typical Aura With Migraine Headache==== |
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| This 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. According to the International Classification of Headache Disorders,<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> it 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. Headache with the features of "migraine without aura" usually follows the aura symptoms. 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
| | ====Typical Aura with non-Migraine headache==== |
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| 1. Aura consisting of at least one of the following, but no muscle weakness or paralysis
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| *Fully reversible visual symptoms (e.g. flickering lights, spots, lines, loss of vision)
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| *Fully reversible sensory symptoms (e.g. pins and needles, numbness)
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| *Fully reversible dysphasia (speech disturbance)
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| 2. Aura has at least two of the following characteristics
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| *Visual symptoms affecting just one side of the field of vision and/or sensory symptoms affecting just one side of the body
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| *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
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| *Each symptom lasts from 5-60 minutes
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| 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.
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| 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.
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| ===Migraine Variants===
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| ====Basilar Type Migraine====
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| 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.
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| ====Familial Hemiplegic Migraine====
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| ''See also the main article on [[Familial hemiplegic migraine]]
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| Familial hemiplegic migraine 'FHM' is a type of migraine with a possible 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. A non-familial form exists as well, "sporadic hemiplegic migraine" (SHM). It is often difficult to make the diagnosis between basilar-type migraine and hemiplegic migraine. When making the [[differential diagnosis]] is difficult, the deciding symptom is often the motor weakness or unilateral paralysis which can occur in FHM or SHM. While basilar-type migraine can present with tingling or numbness, true motor weakness and/or paralysis occur only in hemiplegic migraine.
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| ====Retinal Migraine====
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| Retinal migraine or ocular migraine is a rare condition described as multiples attacks of monocular [[scotoma]] or [[blindness]]. In order to diagnose retinal migraine the following criteria must be fulfilled. <br>
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| 1. At least 2 attacks fulfilling criteria 2 and 3<br>
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| 2. Fully reversible monocular positive and/or negative visual phenomena (eg, scintillations, scotomata or blindness) confirmed by examination during an attack or by the patient's drawing of a monocular field defect during an attack<br>
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| 3. Headache fulfilling criteria B-D for Migraine without aura begins during the visual symptoms or follows them within 60 minutes<br>
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| 4. Normal ophthalmological examination between attacks<br>
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| 5. Not attributed to another disorder
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| ====Migraine Aura Without Headache==== | | ====Typical Aura without headache==== |
| Acephalgic migraine is a neurological syndrome. It is a variant of migraine in which the patient may experience [[aura (symptom)|aura symptoms]] such as [[scintillating scotoma]], [[nausea]], [[photophobia]], [[hemiparesis]] and other migraine [[symptoms]] but does not experience [[headache]]. Acephalgic migraine is also referred to as '''amigrainous migraine''', '''ocular migraine''', or '''optical migraine'''. Sufferers of acephalgic migraine are more likely than the general population to develop classical migraine with headache. The prevention and treatment of acephalgic migraine is broadly the same as for classical migraine. However, because of the absence of "headache", diagnosis of acephalgic migraine is apt to be significantly delayed and the risk of misdiagnosis significantly increased.[[Visual snow]] might be a form of acephalgic migraine.If symptoms are primarily visual, it may be necessary to consult an [[ophthalmologist]] to rule out potential eye disease before considering this diagnosis.
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| ====Migraine With Acute Onset Aura==== | | ====Familial Hemiplejic Migraine (FHM)==== |
| ====Ophthalmoplegic Migraine====
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| ===Childhood Migraines=== | | ====Sporadic Hemiplejic Migraine==== |
| ====Cyclical vomiting====
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| ====Abdominal Migraine====
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| According to the International Classification of Headache Disorders<ref name="pmid14979299"></ref> 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
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| 1. Attacks lasting 1-72 hours when untreated
| | ====Basilar-Type Migraine==== |
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| 2. Pain must have ALL of the following characteristics
| | ===Childhood Periodic Syndromes That Are Commonly Precursors Of Migraine=== |
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| *Location in the midline, around the umbilicus or poorly localised
| | ====Cyclical Vomiting==== |
| *Dull or 'just sore' quality
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| *Moderate or severe intensity
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| 3. During an attack there must be at least two of the following
| | ====Abdominal migraine==== |
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| *Loss of appetite
| | ====Bening paroxysmal Vertigo Of Childhood==== |
| *Nausea
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| *Vomiting
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| *Pallor - Most children with abdominal migraine will develop migraine headache later in life and the two may co-exist during adolescence.
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| ====Benign paroxysmal vertigo of childhood==== | | ===Retinal Migraine=== |
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| ==References== | | ==References== |