b) Migraine

Type

Frequency Based +

Migraine is classified as either episodic or chronic:-
Episodic migraine
Chronic migraine- over 15 days of headache per month, over a period of 3 months


There are three phenotypes:-
Migraine without aura
Migraine with aura
Migraine aura without headache


These account for the vast majority of migrainous headaches encountered in clinical practice.


Unusual forms of migraine include Hemiplegic migraine (IHS definition). Research is gradually uncovering some genetic variations that account for a small proportion of migraine (couple of sentences here)

  
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Symptoms Based +

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Unusual Forms +

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Clinical Features

Headache Symptoms


Typically:-
Unilateral, or bilateral
Throbbing. Pulsating
Moderate to severe
May wake at night
Duration hours (4-72)
Worse with physical activity


Associated symptoms
Nausea
Vomiting
Diarrhoea
Poor concentration
Photophobia, phonophobia, osmophobia
A prodrome and a postdrome can often occur from a few hours to a few days before and/ or after the headache


Aura symptoms
The hallmark of aura is of an evolving and reversible focal deficit, and usually lasts less than an hour.
One third of patients with have aura.
Visual aura seems the most common
Sensory symptoms also are a relatively common feature of aura
Speech disturbance can also occur as an aura but is more uncommon
Weakness as an aura is rare

  
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Management

Acute +

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Preventive +

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