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