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CLINICAL FEATURES OF MIGRAINE
New words
Migraine Migraine 偏头痛偏头痛 Aura Aura 先兆先兆 Teichopsia Teichopsia 闪光暗点闪光暗点 Hemianopic field defects Hemianopic field defects 视野缺损视野缺损
OUTLINE
1 1 Definition of MigraineDefinition of Migraine 2 Facts of Migraine2 Facts of Migraine 3 Triggers of Migraine3 Triggers of Migraine 4 Stages of Migraine4 Stages of Migraine
Migraine - Definition
““Migraine is a familial disorder characterized Migraine is a familial disorder characterized
by by recurrent attacks of headacherecurrent attacks of headache widely widely
variable in intensity, frequency and duration. variable in intensity, frequency and duration.
Attacks are commonlyAttacks are commonly unilateral unilateral and and
throbbingthrobbing and are usually associated with and are usually associated with
anorexia, nausea and vomiting”anorexia, nausea and vomiting”
-World Federation of Neurology-World Federation of Neurology
OUTLINE
1 Definition of Migraine1 Definition of Migraine 2 2 Facts of MigraineFacts of Migraine 3 Triggers of Migraine3 Triggers of Migraine 4 Stages of Migraine4 Stages of Migraine
Migraine Facts
Migraine is one of the common Migraine is one of the common causes of recurrent headachescauses of recurrent headaches
According to IHS, migraine According to IHS, migraine constitutes 16% of primary constitutes 16% of primary headachesheadaches
Migraine afflicts 10-20% of the Migraine afflicts 10-20% of the general populationgeneral population
Migraine Facts
Two-thirds to three-fourths of cases occur Two-thirds to three-fourths of cases occur in womenin women
The onset is early in life—90% before age The onset is early in life—90% before age 4040
A family history is present in most casesA family history is present in most cases
NEJM 2002; 346(4): 257-269; XI Congress of the IHS, 2004
OUTLINE
1 Definition of Migraine1 Definition of Migraine 2 Facts of Migraine2 Facts of Migraine 3 3 Triggers of MigraineTriggers of Migraine 4 Stages of Migraine4 Stages of Migraine
Causes of Migraine Increased excitability of CNSIncreased excitability of CNS Meningeal blood vessel dilationMeningeal blood vessel dilation Activation of perivascular sensory trigeminal Activation of perivascular sensory trigeminal
nerves nerves Pain impulses Pain impulses Vasoactive neuropeptides contain:Vasoactive neuropeptides contain:
substance Psubstance P calcitonin gene-related peptide (CGRP)calcitonin gene-related peptide (CGRP) neurokinin A neurokinin A
combination of increased pain sensitivity, tissue combination of increased pain sensitivity, tissue and vessel swelling, and inflammation and vessel swelling, and inflammation
Triggers and Risk Factors
Migraine headaches are often Migraine headaches are often triggered by specific thingstriggered by specific things
Triggers: Changes in Daily Cycles
Triggers: Environment or Diet
Triggers: Mental Disorders
OUTLINE
1 Definition of Migraine1 Definition of Migraine 2 Facts of Migraine2 Facts of Migraine 3 Triggers of Migraine3 Triggers of Migraine 4 4 Stages of MigraineStages of Migraine
4 Stages of Migraine
1. Prodrome1. Prodrome
2. Aura2. Aura
3. Headache3. Headache
4. Postdrome4. Postdrome
The Stages of a Migraine Attack
PRODROME
Premonitory symptoms that begin from 12 to 36 Premonitory symptoms that begin from 12 to 36 hours before the aura and headachehours before the aura and headache
Symptoms includeSymptoms include Yawning Yawning 哈欠哈欠 Excitation Excitation 兴奋兴奋 Depression Depression 情绪低落情绪低落 Lethargy Lethargy 疲倦疲倦 Craving or distaste for various foods Craving or distaste for various foods
Duration – 15 to 20 minDuration – 15 to 20 min
AURAAura is a warning or signal beforeAura is a warning or signal before
onset of headacheonset of headache
Visual aura includesVisual aura includes
Hemianopic field defects Hemianopic field defects 视野缺损视野缺损 Flashing of lights—TeichopsiaFlashing of lights—Teichopsia 闪光暗点闪光暗点 Zig-zag lines Zig-zag lines 视物变型视物变型Duration : 15-30 minDuration : 15-30 min
TeichopsiaTeichopsia
Zig-zag lines
HEADACHE
Headache is generally unilateral and Headache is generally unilateral and throbbingthrobbing
Repeated attacks of headache Repeated attacks of headache Moderately or severely painfulModerately or severely painful Frequent or infrequentFrequent or infrequent Last a few hours to a couple of daysLast 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 Nausea 恶心恶心 Vomiting Vomiting 呕吐呕吐 Diarrhea Diarrhea 腹泻腹泻 Sweating Sweating 出汗出汗 Cold handsCold hands
Pale colorPale color Pulsing templePulsing temple 太阳穴太阳穴 Pressure painPressure pain Photophobia Photophobia 恐光恐光 Phonophobia Phonophobia 恐声恐声
POSTDROME
Following headache, patient complains ofFollowing headache, patient complains of
Fatigue Fatigue 疲乏疲乏 DepressionDepression
Severe exhaustion Severe exhaustion 极度疲惫极度疲惫 Loss of appetite Loss of appetite 食欲缺乏食欲缺乏Duration: Few hours or up to 2 daysDuration: Few hours or up to 2 days
MIGRAINE – CLASSIFICATION
According to Headache Classification Committee of the According to Headache Classification Committee of the
International Headache Society, Migraine has been classified as:International Headache Society, Migraine has been classified as:
Migraine without aura Migraine without aura (common migraine) (common migraine)
70%70%
Migraine with auraMigraine with aura (classic migraine)25% (classic migraine)25%
Specific migraine 5%%
hemiplegic migrainehemiplegic migraine 、 、 basilar migrainebasilar migraine
complicated migrainecomplicated migraine 、、 migraine equivalentsmigraine equivalents
Status migrainosusStatus migrainosus
Migraine Without AuraMigraine Without Aura Migraine With AuraMigraine With Aura
No aura or ProdromeNo aura or Prodrome Aura or prodrome is presentAura or prodrome is present
Unilateral throbbing headache Unilateral throbbing headache may be accompanied by nausea may be accompanied by nausea and vomitingand vomiting
Unilateral throbbing headache Unilateral throbbing headache and later becomes generalizedand later becomes generalized
During headache, patient During headache, patient complains of phonophobiacomplains of phonophobia 恐声 恐声 and photophobiaand photophobia 恐光恐光
Patient complains of visual Patient complains of visual disturbances and may have mood disturbances and may have mood variationsvariations
MIGRAINE: CLINICAL FEATURES
What is Migraine?
World Federation of Neurology
What is Migraine?
Repeated attacks of headacheRepeated attacks of headache Moderate or severe painModerate or severe pain
World Federation of Neurology
What is Migraine?
Repeated attacks of headacheRepeated attacks of headache Moderate or severe painModerate or severe pain
UUnilateralnilateral and throbbing and throbbing painpain
World Federation of Neurology
What is Migraine?
Repeated attacks of headacheRepeated attacks of headache Moderate or severe painModerate or severe pain
UUnilateralnilateral and throbbing and throbbing painpain Often experience loss of appetite, nausea, Often experience loss of appetite, nausea,
and vomitingand vomiting
World Federation of Neurology