CLINICAL FEATURES OF MIGRAINE

New words Migraine 偏头痛 Migraine 偏头痛 Aura 先兆 Aura 先兆 Teichopsia 闪光暗点 Teichopsia 闪光暗点 Hemianopic field defects 视野缺损 Hemianopic field defects 视野缺损

OUTLINE 1 Definition of Migraine 1 Definition of Migraine 2 Facts of Migraine 2 Facts of Migraine 3 Triggers of Migraine 3 Triggers of Migraine 4 Stages of Migraine 4 Stages of Migraine

Migraine - Definition “Migraine is a familial disorder characterized by recurrent attacks of headache widely variable in intensity, frequency and duration. Attacks are commonly unilateral and throbbing and are usually associated with anorexia, nausea and vomiting” -World Federation of Neurology -World Federation of Neurology

OUTLINE 1 Definition of Migraine 1 Definition of Migraine 2 Facts of Migraine 2 Facts of Migraine 3 Triggers of Migraine 3 Triggers of Migraine 4 Stages of Migraine 4 Stages of Migraine

Migraine Facts Migraine is one of the common causes of recurrent headaches Migraine is one of the common causes of recurrent headaches According to IHS, migraine constitutes 16% of primary headaches According to IHS, migraine constitutes 16% of primary headaches Migraine afflicts 10-20% of the general population Migraine afflicts 10-20% of the general population

Migraine Facts Two-thirds to three-fourths of cases occur in women Two-thirds to three-fourths of cases occur in women The onset is early in life—90% before age 40 The onset is early in life—90% before age 40 A family history is present in most cases A family history is present in most cases NEJM 2002; 346(4): ; XI Congress of the IHS, 2004

OUTLINE 1 Definition of Migraine 1 Definition of Migraine 2 Facts of Migraine 2 Facts of Migraine 3 Triggers of Migraine 3 Triggers of Migraine 4 Stages of Migraine 4 Stages of Migraine

Causes of Migraine Increased excitability of CNS Increased excitability of CNS Meningeal blood vessel dilation Meningeal blood vessel dilation Activation of perivascular sensory trigeminal nerves Activation of perivascular sensory trigeminal nerves Pain impulses Pain impulses Vasoactive neuropeptides contain: Vasoactive neuropeptides contain:  substance P  calcitonin gene-related peptide (CGRP)  neurokinin A combination of increased pain sensitivity, tissue and vessel swelling, and inflammation combination of increased pain sensitivity, tissue and vessel swelling, and inflammation

Triggers and Risk Factors Migraine headaches are often triggered by specific things

Triggers: Changes in Daily Cycles

Triggers: Environment or Diet

Triggers: Mental Disorders

OUTLINE 1 Definition of Migraine 1 Definition of Migraine 2 Facts of Migraine 2 Facts of Migraine 3 Triggers of Migraine 3 Triggers of Migraine 4 Stages of Migraine 4 Stages of Migraine

4 Stages of Migraine 1. Prodrome 2. Aura 3. Headache 4. Postdrome

The Stages of a Migraine Attack

PRODROME Premonitory symptoms that begin from 12 to 36 hours before the aura and headache Premonitory symptoms that begin from 12 to 36 hours before the aura and headache Symptoms include Symptoms include  Yawning 哈欠  Excitation 兴奋  Depression 情绪低落  Lethargy 疲倦  Craving or distaste for various foods Duration – 15 to 20 min

AURA Aura is a warning or signal before onset of headache Visual aura includes Hemianopic field defects 视野缺损 Hemianopic field defects 视野缺损 Flashing of lights—Teichopsia 闪光暗点 Flashing of lights—Teichopsia 闪光暗点 Zig-zag lines 视物变型 Zig-zag lines 视物变型 Duration : min

Teichopsia

Zig-zag lines

HEADACHE Headache is generally unilateral and throbbing Headache is generally unilateral and throbbing Repeated attacks of headache Repeated attacks of headache  Moderately or severely painful  Frequent or infrequent  Last a few hours to a couple of days Duration is 4-72 hrs Duration is 4-72 hrs

1.2% 18.4% 47.2% 33.2% Mild Moderately severe Severe Extremely severe Most Patients ’ Headaches Are Severe or Extremely Severe National Headache Foundation. American Migraine Study II: Migraine in the United States: Burden of Illness and Patterns of Treatment

What Else You Might Experience During an Attack Nausea 恶心 Nausea 恶心 Vomiting 呕吐 Vomiting 呕吐 Diarrhea 腹泻 Diarrhea 腹泻 Sweating 出汗 Sweating 出汗 Cold hands Cold hands Pale color Pulsing temple 太阳穴 Pressure pain Photophobia 恐光 Phonophobia 恐声

POSTDROME Following headache, patient complains of Fatigue 疲乏 Fatigue 疲乏 Depression Depression Severe exhaustion 极度疲惫 Severe exhaustion 极度疲惫 Loss of appetite 食欲缺乏 Loss of appetite 食欲缺乏 Duration: Few hours or up to 2 days

MIGRAINE – CLASSIFICATION According to Headache Classification Committee of the International Headache Society, Migraine has been classified as: According to Headache Classification Committee of the International Headache Society, Migraine has been classified as: Migraine without aura (common migraine) 70% Migraine without aura (common migraine) 70% Migraine with aura (classic migraine)25% Migraine with aura (classic migraine)25% % Specific migraine 5% hemiplegic migraine 、 basilar migraine hemiplegic migraine 、 basilar migraine complicated migraine 、 migraine equivalents complicated migraine 、 migraine equivalents Status migrainosus Status migrainosus

Migraine Without Aura Migraine Without Aura Migraine With Aura No aura or Prodrome Aura or prodrome is present Unilateral throbbing headache may be accompanied by nausea and vomiting Unilateral throbbing headache and later becomes generalized During headache, patient complains of phonophobia 恐声 and photophobia 恐光 Patient complains of visual disturbances and may have mood variations MIGRAINE: CLINICAL FEATURES

What is Migraine? World Federation of Neurology

What is Migraine? Repeated attacks of headache Repeated attacks of headache  Moderate or severe pain World Federation of Neurology

What is Migraine? Repeated attacks of headache Repeated attacks of headache  Moderate or severe pain Unilateral and throbbing pain Unilateral and throbbing pain World Federation of Neurology

What is Migraine? Repeated attacks of headache Repeated attacks of headache  Moderate or severe pain Unilateral and throbbing pain Unilateral and throbbing pain Often experience loss of appetite, nausea, and vomiting Often experience loss of appetite, nausea, and vomiting World Federation of Neurology