TOC | Neurology
MIGRAINE RX | Prophylactic Rx
See Med Letter 2004 Migraine
See Prevention of Migraine in Women throughout the life span (Mayo Clinic 2006)
is a benign recurring headache and/or neurologic dysfunction usually attended by pain-free interludes and almost always provoked by stereotyped stimuli. It is more common in women, and has a hereditary predisposition toward attacks.
A Brief 3-item screening questions for migraine headache: Any associated
If 2 of 3 positive answers, the positive predictive value for having
migraine is 93%,
if all 3 positive answers, the positive predictive value for having migraine is 98%.
CLASSIC MIGRAINE with aura
denotes the syndrome of headache associated with characteristic premonitory visual, sensory, or motor symptoms.
International Headache Society Criteria for Migraine Without
(Ref: Cephalagia 1988;8 Suppl 7;1-96)
A. At least 5 attacks fulfilling criteria listed in B, C, D and E below.
B. Headache lasts 4-72 h if untreated or unsucessfully treated.
C. Headache has at least 2 of the following characteristics:
- Unilateral location
- Pulsating quality
- Moderate to severe intensity
- Aggravation by walking stairs or similar physical activity
D. During headache, at least 1 of the following:
E. History, physical, & neurologic examinations, & if appropriate, diagnostic tests exclude related organic disease.
The visual Sx of scotomas and/or hallucinations may last 20-25 minutes, always occur before the headache. It is from dysfunction of occipital lobe neurons.
COMMON MIGRAINE without aura
denotes one in which there is no focal neurologic disturbance preceding the occurrence of headache.
It is commonly described as benign periodic headache of several hours, with pain unilaterality, attendant N&V, positive family history, responsiveness to ergotamine, and scalp tenderness in varying combinations.
International Headache Society Criteria for Migraine With
(Ref: Cephalagia 1988;8 Suppl 7;1-96)
A. At least 2 attacks that fulfill criteria in B and C
B. At least 3 of the 4 following characteristics:
C. History, physical & neurologic exam, and if appropriate, diagnostic tests exclude related organic disease.
The Sx of a disturbance in brainstem function such as vertigo, dysarthria, and diplopia.
Bickerstaff called attention to a stereotyped sequence of dramatic neurologic events often comprising total blindness and sensorial clouding, accompanied or followed by admixtures of vertigo, ataxia, dysarthria, tinnitus, and distal and perioral paresthesia. In about 1/4 of pts, a confusional state supervenes. It usually persit for 20-30 min and are generally followed by a throbbing occipital headache. The sensorial alterations may last for as long as 5 days and may take the form of confusional states that may be mistaken for psychotic reactions.
CAROTIDYNIASYNDROME (Lower half headache or facial
The pain is usually at the jaw or neck, sometimes periorbital or maxillary pain. It may be continuous, deep, dull, and aching, & becomes pounding or throbbing episodically. , often superimposed by sharp, ice-picklike jabs. Attacks occur one to several times per week, lasting several minutes to hours. Tenderness and prominent pulsations of the cervical carotid artery, and soft tissue swelling overlying the carotid, are usually present homolateral to the pain. Dental trauma is a common precipitant of this syndrome.
MIGRAINE EQUIVALENTS or ACCOMPANIMENTS
denotes focal neurologic disturbances without headache or vomiting.
denotes migraine with dramatic focal neurologic features that may persist as a residuum of a migraine attack.
ACUTE TREATMENT OF COMMON or CLASSIC
Early Rx is critical to obtaining benefit
Rest in the dark & quiet enivronment
May need to try different medications to find 1 or more that are helpful.
PROPHYLAXIS RX of COMMON or CLASSIC MIGRAINE Top | HomePage
CLUSTER MIGRAINE HEADACHE Top | HomePage
The episodic type is characterized by 1-3 short-lived attacks of periorbital or less commonly temporal pain per day over a 4-8 week period, followed by a pain-free interval. The pain begins without warning and reaches a crescendo within 5 min. It is often excruciating in intensity and is deep, nonfluctuating, and explosive in quality; only rarely is it pulsatile. Pain is strictly unilateral & usually affects the same side in subsequent months. Attacks last from 30 min to 2 h; there are often the associated Sx of homolateral lacrimation, reddening of the eye, nasal stuffiness, lid ptosis, and nausea. Alcohol provocation of attacks occurs in about 70% of pts & ceases when the bout remits. This on-off vulnerability to alcohol is pathognomonic of the cluster headache syndrome.
The chronic form of cluster headache may begin de novo or several years after an episodic pattern has become established. Men are affected more commonly than women in a proportion of 7-8:1.
Hypothalamus may be the site of activation.
TREATMENT of CLUSTER HEADACHE: