Expertise Details




• Migraine is characterised by periodic headaches, typically unilateral, often associated with visual disturbance and vomiting.

Precipitating Factors

• "Anything under the sun including sun" can precipitate an attack, but each person has his own triggering factors.

• Commonly, these are stress, exposure to bright light, loud noises, smoke or strong scents, menstruation, lack or excess of sleep, cheese, caffeine, alcohol, chocolate, citrus fruit and food additives such as monosodium glutamate, vasodilators, exercise and contraceptive pills.

• Familial tendency is usual.

Clinical Features

• Attacks are episodic and start at puberty and continue till late middle life with variable degree of spontaneous remissions. Frequency, duration and severity of attacks vary in the same individual.

• Headache is typically hernicranial, throbbing in character, and associated with nausea and vomiting.

• In classical migraine, headache is preceded by an aura that is a focal neurologic disturbance manifestating as visual aura (flashing lights or scintillating spots that may cross visual field over minutes, scotoma), sensory aura or language aura.

• Allodynia (production of pain from normally nonpainful stimuli) is an extremely common phenomenon in migraine, occurring in about two-thirds of patients.

• Severe attacks are associated with photophobia and prostration. The attack spontaneously terminates after a few hours or sleep.

Diagnostic Criteria

Common Migraine

• Repeated attacks (at least five attacks) of headache lasting 4-72 hours that have the following features:

• Normal physical examination

• No other reasonable cause for the headache

• Headache has at least two of the following:

  • Unilateral pain • Throbbing or pulsatile pain • Aggravation of pain by movement

  • Moderate or severe intensity of pain

• At least one of the following during headache:

  • Nausea or vomiting • Photophobia and phonophobia

Classical Migraine

• Repeated attacks (at least two attacks) of headache lasting 4-72 hours that have the following features:

  • Normal physical examination • No other reasonable cause for the headache

  • Aura but no motor weakness

• Headache begins during aura or follows aura within 60 minutes


• Explain that headache has no sinister prognosis (significance).

• Trigger factors like bright light and dietary precipitants are avoided. Keeping a headache diary can help in this regard. It may take up to 24 hours for a trigger to provoke a migraine attack.

Drug Prophylaxis-Indications

• Recurring migraine that significantly interferes with a patient's quality of life and daily routine despite acute treatment

• Four or more attacks per month

• Frequent, extremely long or uncomfortable auras



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