Migraine is a common type of headache disorder characterized by recurrent headaches that can cause severe throbbing pain, nausea, vomiting, and sensitivity to light and sound. It is believed to involve changes in brain activity and inflammation of the blood vessels around the brain. Migraines can be further classified based on whether an "aura" occurs before the headache, as well as other associated neurological symptoms. Common triggers include hormonal changes, stress, foods, and environmental factors. Treatment involves managing acute attacks with over-the-counter or prescription medications as well as lifestyle changes and preventive medications to reduce frequency and severity of migraines.

1. MIGRAINE HEADACHE
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2. Definition of headache:
• Headache is pain in any region of the head.
Headaches may occur on one or both sides of
the head, be isolated to a certain location,
radiate across the head from one point, or
have a viselike quality.
• A headache may appear as a sharp pain, a
throbbing sensation or a dull ache. Headaches
can develop gradually or suddenly, and may
last from less than an hour to several days

3. Symptom Migraine headache Tension headache Cluster headache
Location
Unilateral (one sided) in 60 to 70
percent; occurs on both sides of the
forehead or all over the head in 30
percent of cases
Bilateral (involves both sides of the
head)
Always unilateral, usually begins
around the eye or temple
Characteristics
Gradual in onset, builds up over time;
pulsating; moderate or severe
intensity; aggravated by routine
physical activity
Pressure or tightness which waxes
and wanes
Pain begins quickly, reaches a
crescendo within minutes; pain is
deep, continuous, excruciating, and
explosive in quality
Activity Prefers to rest in a dark, quiet room
May remain active or may need to
rest
Remains active
Duration 4 to 72 hours Variable 30 minutes to 3 hours
Associated
symptoms
Nausea, vomiting, photophobia
(bothered by light), phonophobia
(bothered by sound); may have aura
(usually visual, but can involve other
senses or cause speech or motor
problems)
None
Tearing and redness of the eye on the
same side as the headache; stuffy,
runny nose; pallor; sweating; eye
drooping; rarely neurologic deficits;
sensitivity to alcohol
Characteristics of common headache syndromes

5. Migraine
• Migraine is a common episodic neurologic
disorder characterized by disabling headache
preceded in one third of patients by
various combinations of neurologic,
gastrointestinal, and autonomic phenomena
(termed the “aura”)
• The prevalence of migraine is up to 18% in
women and 6% in men

6. Migraine: Men vs Women
Around the time of a girl’s first menstruation, there is a rapid rise in the incidence
of migraine for this gender. The ratio of 3:1 (female migraineurs to male) reflects
this trend. In women, the incidence of migraine with aura peaks between ages 12
and 13 and migraine without aura between ages 14 and 17.
Oestrogen levels are a key factor in the increased prevalence of migraine in
women. Evidence for this includes the following:
Migraine prevalence increases at the time of first menstruation
Oestrogen withdrawal during menstruation is a common migraine trigger factor
Oestrogen in oral contraceptives and HRT can trigger migraines
Migraine typically decreases during the second and third trimesters of pregnancy
when oestrogen levels are high
Migraine is common immediately after the birth as oestrogen levels fall
Migraine generally improves with the onset of menopause

7. Pathophysiology of Migraine
• factors include a genetic predisposition, a
susceptibility of the
central nervous system to certain stimuli,
hormonal factors, and
a sequence of neurovascular events.
• A positive family history
• the etiology of migraine in the majority of
patients remains unknown.

8. • One of the
key structures in the mechanism of pain in
migraine is the trigeminal vascular system.
Stimulation of the trigeminal nucleus
caudalis can activate serotonin receptors and
nerve endings on small dural arteries and
result in a state of neurogenic inflammation.

9. Biologic Basis Of Migraine Headaches:
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• Aura is a spreading depression of neuronal activity
accompanied by REDUCED BLOOD flow of the cerebral
hemisphere HYPOPERFUSION.
• Patients who have migraine without aura DO NOT show
HYPOPERFUSION.
• However, the pain of both types of migraine ??due to
extracranial and intracranial arterial VASODILATION,
release of neuroactive molecules, such as substance P,
neurokinin A, and calcitonin gene–related peptide.

10. Alarm Symptoms:
• Comes on suddenly, becomes severe within a few
seconds or minutes, or that could be described as "the
worst headache of your life"
• Is severe and occurs with a fever or stiff neck
• Occurs with a seizure, personality changes, confusion,
or passing out
• Begins quickly after strenuous exercise or minor injury
• Is new and occurs with weakness, numbness, or
difficulty seeing. While migraine headaches can
sometimes cause these symptoms, you should be
evaluated urgently the first time these symptoms
appear.

11. Migraine Triggers
Migraine triggers or trigger factors do not cause
migraine but they can help to bring about an attack.
• Travel (motion sickness)
• Sleep related triggers – sleep deprivation or
disturbance, irregular sleeping patterns, too much
sleep
• Changes in routine e.g changing to shiftwork
• Increases in stress or anxiety levels
• Excitement or other positive stressors
• Foods and Beverages – Cheese, chocolate,
products containing MSG (e.g. hot dogs, Chinese
food), citrus fruits, dairy products, nuts, wheat,
fatty foods, nitrates and marinated or pickled foods

12. Trigger Factors Continued:
• Lack of food, delayed meals, irregular eating patterns, fasting and dieting (all
lead to lowered blood sugar levels)
• Alcohol, especially red wine
• Caffeine products or withdrawal from caffeine,
• Hormonal changes in women. Puberty, menstruation, pregnancy, HRT and
menopause are all potential triggers.
• Meteorological Triggers – change of seasons, high atmospheric pressure, heat or
cold
• Environmental Triggers – smoke, strong smells, high altitude, loud noise, bright,
irregular or flickering lights, glare (e.g. from sunlight, from wet surface while
driving)
• Exercise – too much exercise may act as a trigger, although lack of exercise can
also be a trigger
• Long periods in front of a computer screen
• Head, neck or back injury, High Blood Pressure and other physiological
irregularities.

13. Types of migraine
1-Migraine Without Aura: 70% of patients
The most common symptoms of Migraine without Aura
are:
• Intense throbbing headache, usually on one side of the
head, worsened by movement and lasting from 4-72
hours.
• Nausea, sometimes vomiting
• Sensitivity to light
• Sensitivity to noise
• Sensitivity to smells
• Stiffness of the neck and shoulders.
• Blurred vision

14. 2-Migraine With Aura:15% of patients
Migraine with Aura refers to a range of neurological
disturbances that occur before the headache begins, usually
lasting about 20-60 minutes.
The disturbances are usually visual e.g.
• Blind spots
• Flashing lights
• Zig-zag patterns
• Aura can also present in other ways:
• Pins and needles on one side usually starting in the fingers/
arm, sometimes spreading up into the face
• Slurring of speech
• Muscular weakness
• Loss of co-ordination
• Confusion

15. 3-Vestibular Migraine
including, but not limited to;
• Severe dizziness
• Vertigo
• Other motion problems in the head, eyes or body,
• Diminished eye focus
• Photo-sensitivity (light)
• Phono-sensitivity (sound)
• Tinnitus
• Nausea and vomiting
• Ataxia (loss of control over bodily movement)
• Neck pain
• Muscle spasms in the upper spine area
• Confusion
• Disorientation
• Anxiety/panic

16. 4-Basilar Migraine
• Basilar migraine is a rare form of migraine that
includes symptoms such as loss of balance, double
vision, blurred vision, difficulty in speaking and
fainting. During the headache, some people lose
consciousness.
• These are very frightening sensations for the
migraine sufferer, and often people describe the
feeling of terror and fear that they are about to
suffer a stroke.
• Basilar migraine occurs when the circulation in the
back of the brain or neck is affected. It usually affects
young women but is sometimes seen in children too.

17. 5-Hemiplegic Migraine
• Hemiplegic migraine is another rare but severe
form of migraine where reversible paralysis
occurs, usually on one side. In some people,
aura symptoms can last for days or weeks.
• Hemiplegic migraine often begins in childhood
and there is frequently a strong family history.
Diagnosing this condition usually requires a full
neurological examination to rule out other
causes, as the symptoms can be indicative of
other diseases.

18. 6-Ophthalmoplegic Migraine
• Ophthalmoplegic migraine is a very rare type of
migraine that occurs mainly in young people in
which there is weakness of one or more of the
muscles that move the eye.
• In addition to headache, symptoms of
ophthalmoplegic migraine include dilation of
the pupils, inability to move the eye upward,
downward or across, as well as a drooping of
the upper eyelid.

19. Chronic (Transformed) Migraine
• Chronic migraine is diagnosed if you have migraine
on 15 or more days a month over a period of at least
six months.
• As time passes, some people with migraine may
begin to experience additional or almost daily
headache. As the frequency increases, the headache
pain and other symptoms associated with migraine
become milder, but may also become less responsive
to treatment.
• People will usually experience more typical
‘breakthrough’ migraine attacks on top of the new
milder ‘background’ headache. Depression and
irregular sleeping are other effects of chronic
migraine.

20. Treatment of Migraine
• relieving acute attacks; and preventing pain and
associated symptoms of recurrent headaches
•
It is important that the patient keep a headache diary
:covert headache triggers, assists in monitoring
headache frequency and response to treatment, and
actively involves the patient in the management of the
condition.

22. • Many attacks of migraine respond to simple analgesics, such as
acetaminophen, aspirin, or nonsteroidal anti-inflammatory
agents (NSAIDs) with monitor (overuse)
• anti-emetic agent early in an attack (Phenothiazine)
• serotonin agonist drugs (sumatriptan ) triptans,
:largely circumvented the problem of emesis and gastroparesis
in migrainepatients resulting in greater effacacy
• Preventive treatment:
β-adrenoceptor blockers (Propranolol, Metoprolol
,Timolol )
Antiepileptic drugs (Divalproex sodium ,Topiramate
,Gabapentin)
Antidepressants (Amitriptyline ,Nortriptyline )
Calcium channel blockers (Verapamil )
others: Flunarizine*

24. Future of Migraine Treatment
• Te most signifcant recent advance in acute migraine treatment
relates to calcitonin gene-related peptide (CGRP) receptor
antagonists. Stimulation of trigeminal ganglia neurons results
in release of CGRP; telcagepant, a CGRP receptor antagonist
has
been found to have similar efficacy to oral triptan therapy.
Greater
insights into the genetic basis for migraine has enhanced our
understanding of ion channel dysfunction in this disorder, and
are likely to lead to new therapeutic targets.