This document discusses clinical manifestations and neurological symptoms of migraine headaches. It describes the signs and symptoms of migraines including throbbing headaches, nausea, photophobia, and possible neurological symptoms like hemiparesis. It outlines the characteristics of migraine without aura versus migraine with aura and lists some migraine variants. The goals of migraine treatment are outlined as reducing attack frequency, severity and disability as well as improving quality of life.

1. Learning Outcomes # 2.
Clinical manifestations and neurological symptoms.
Ange M. Pompee-Synsmir, MSN ARNP FNP-BC

2. Learning Objectives
By the end of the session, participants will:
1. Describe clinical manifestations, signs and symptoms of
migraine headaches.
2. Develop proficiency and demonstrate a systematic approach in
the evaluation of patients who present with acute migrainous
headache.
Participants will receive a self assessment quiz and an evaluation at
the end of the lecture; and will receive immediate feedback to
clarify any misunderstandings.

3. Migraine Headaches

4. Signs and Symptoms of Migraine
• Throbbing, pulsating headache
• Unilateral and localized pain in the frontotemporal and ocular area.
• Nausea and vomiting
• Photophobia and Phonophobia
Neurologic symptoms may include:
Hemiparesis (this symptom defines hemiplegic migraine)
Aphasia
Visual Field defects (scotoma, light flashes, visual hallucinations)
Confusion
Paresthesias or numbness
(http://emedicine.medscape.com/article/1142556-clinical)

5. Migraine Symptoms and Stages

6. Migraine Without Aura
Attacks lasting 4-72 hours
At least two of following characteristics: unilateral,
pulsating, moderate to severe, aggravated by movement
At least one associated symptom: nausea or vomiting,
photophobia and phonophobia.
http://www.achenet.org/resources/types_of_headaches/

7. Migraine with Aura
One or more transient focal aura symptoms
Gradual development of aura symptom over >4 minutes
Aura symptoms last 4 to 60 minutes
Headache follows or accompanies the aura within 60
minutes

8. Migraine Variants
Hemiplegic (familial)
Basilar
Ophthalmologic
Transient migrainous accompaniments
http://www.achenet.org/resources/types_of_headaches/

9. Migraine Variants
Hemiplegic (familial)
Basilar
Ophthalmologic
Transient migrainous accompaniments
http://www.achenet.org/resources/types_of_headaches/

10. Migraine headaches cont’d.

11. Migraines

12. Migraine Assessment

13. Goal of Therapy in Treatment of Migraine
The goals of both pharmacologic and nonpharmacological treatment
of migraine are:
Reduce attack frequency, severity, and disability
Reduce reliance on poorly tolerated, ineffective, or unwanted acute
pharmacotherapies
Improve quality of life
Avoid acute headache medication escalation
Educate and enable patients to manage their disease to enhance
personal control of their migraine
Reduce headache-related distress and psychological symptoms

14. The End