migraine

• headache disorders  are classified by the ICHD-III as (1)
  • primary headache disorders:
    • migraine
    • tension type headache
    • cluster headache and other trigeminal autonomic cephalagias
    • other primary headache disorders
  • secondary headache disorders
    • these include a new headache occurring with another lesion capable of causing it.( e.g., headache attributed to intracranial tumour)

• migraine is a common disabling primary headache disorder
  • migraine is the second most prevalent neurologic disorder (after tension-type headache), with a female-to-male ratio of 3:1 and an estimated 1-year prevalence
    of approximately 15% in the general population (4)
  • prevalence peaks between the ages of 35 and 39 years, and about 75% of affected persons report the onset of migraine before the age of 35 years (4)
  • since the disorder tends to remit with older age, an onset of migraine after the age of 50 years should arouse suspicion of a secondary headache disorder (4)

• migraine is a syndrome characterised by:
  • periodic headaches with complete resolution between attacks
  • an attack may be composed of the following stages:
    • prodrome
    • aura
    • headache
    • resolution
  • the frequency of attacks is variable:
    • as high as several per week
    • as low as several per lifetime
  • a prodrome is a vague change in mood or appetite
  • an aura is a clear neurological symptom:
    • visual disturbance
    • motor or sensory disturbance
• in children, migraine is a diagnosis of exclusion (3).

Reference:

• (1)Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia 2018; 38: 1-211
• (2) Drug and Therapeutics Bulletin (1998); 36(6):41-4.
• (3) Drug and Therapeutics Bulletin (2004); 42 (4): 25-8.
• (4) Ashina M. Migraine. N Engl J Med 2020;383:1866-76. DOI: 10.1056/NEJMra1915327

Last edited 11/2020 and last reviewed 07/2021