Basics
- A term normally used to describe a certain type of headache with a suspected vascular cause
Symptoms and Signs
- Initially one sided (unilateral) and throbbing headache that builds up over the course of several hours
- Patients prefer dark, quiet rooms
- Nausea and vomiting
- Normally subsides within 24hours
- Auras- can be visual (shimmering lights), sensory (paresthesias), or motor (heaviness of hte limbs)
- May see neurological deficit
Demographics
- 18% of females and 6% of males are affected
- 75% of individuals with migraines are adult women
- In children: Boys and girls are equally affected
- More common in whites than African/Asian Americans
Diagnosis
- Based on clinical history and exam: Additional studies to rule out other causes-
- CT / MRI
- Lumbar puncture
- EEG
Treatment
- Medication options have two main goals: Abortive therapy (for an ongoing migraine) and Preventive therapy (to prevent the future occurence of migraines)
- Abortive: Ibuprofen, Triptans (Imitrex, Maxalt, Axert), Opioids, DHE IV medication
- Abortive medication overuse (>2 days per week) can lead to analgesic rebound headaches
- Preventive: Methysergide, Calcium channel blockers, Beta blockers, antidepressants, anticonvulsants
Prognosis
- Not all severe headaches are due to a migraine and often they are a warning sign to a more severe condition (such as a ruptured aneurysm)
- In terms of migraines:
Differential Diagnosis
- Arteriovenous malformation
- aneurysm
- Cluster headache
- Tumor
- Infection
- Lupus
- Temporal arteritis
- Tolosa-Hunt syndrome