Migraine Headache Overview

Migraine Headache

• Migraines are characterized by recurrent, pulsating headaches, often on one side of the head.

• Symptoms frequently include:

  • Moderate to severe pain intensity
  • Duration of 1-2 days
  • Nausea, vomiting, sensitivity to noise and light
  • Often severe manifestations

• Migraine cause is not well understood but is potentially linked to alterations in the brain's nerve cells, triggered by inherited genetic abnormalities.

Migraine Headache Pathophysiology

• Neurologic and biochemical events likely initiate migraine.
• Trigeminal nerve activation releases neuropeptides, causing inflammation.
• Decreased serotonin levels may trigger the release of chemical mediators.
• This process leads to altered blood vessel function,
• Low magnesium levels and resulting communication problems.
• Cortical spreading depression is implicated.

Migraine Headache Clinical Manifestations

• Migraines typically progress through four phases.

  • Prodrome- includes mood changes, food cravings, constipation, neck stiffness, yawning, fatigue, and irritability.
    • Occur 24 to 48 hours before the headache.
  • Aura- some individuals experience visual, auditory, somatosensory, or motor symptoms.
    • Occur 15-30 minutes before the headache begins
    • Classic aura type affects roughly 15% of migraine sufferers
  • Headache phase – intense, unilateral pulsing, throbbing pain
  • Postdrome – head movement can trigger or exacerbate pain, fatigue, and emotional changes

• Two classifications of migraine are recognized.

  • Common migraines without aura (most prevalent)
  • Classic or uncommon migraines with aura.

Migraine Headache Diagnostic Criteria

• Diagnostic processes typically include:

  • Patient history review
  • Physical exam
  • Neurologic examination
  • Imaging tests, like MRI or CT (if acute, sudden onset) to rule out other conditions.

• Presence of aura increases risk of ischemic cardiovascular events.

Migraine Headache Treatment

• Prevention strategies are often indicated when 2 or more migraines occur/month, and/or pain relief medications are used more than twice a week.

• Inadequate relief from analgesic treatment.

• Prevention for uncommon migraines

• Prevention measures include:

  • Avoidance of known triggers
  • Regular sleep
  • Regular eating habits
  • Smoking cessation

• Pharmacologic treatments include:

  • Analgesics (e.g., acetaminophen, NSAIDs, aspirin)
  • Triptans
  • Ergots
  • Anti-convulsants such as Botox and other preventative medications

• Non-pharmacological options include surgical deactivation of trigger sites.

This quiz explores the characteristics, pathophysiology, and clinical manifestations of migraine headaches. It covers symptoms such as pain intensity, duration, and the neurological mechanisms involved. Gain a better understanding of this complex condition and its triggers.