Migraine: Spectrum of Symptoms and Diagnosis
KEY POINT: MIGRAINE: SPECTRUM A Most patients develop migraine in the first 3 OF SYMPTOMS decades of life, some in the AND DIAGNOSIS fourth and even the fifth decade. William B. Young, Stephen D. Silberstein ABSTRACT The migraine attack can be divided into four phases. Premonitory phenomena occur hours to days before headache onset and consist of psychological, neuro- logical, or general symptoms. The migraine aura is comprised of focal neurological phenomena that precede or accompany an attack. Visual and sensory auras are the most common. The migraine headache is typically unilateral, throbbing, and aggravated by routine physical activity. Cutaneous allodynia develops during un- treated migraine in 60% to 75% of cases. Migraine attacks can be accompanied by other associated symptoms, including nausea and vomiting, gastroparesis, di- arrhea, photophobia, phonophobia, osmophobia, lightheadedness and vertigo, and constitutional, mood, and mental changes. Differential diagnoses include cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoenphalopathy (CADASIL), pseudomigraine with lymphocytic pleocytosis, ophthalmoplegic mi- graine, Tolosa-Hunt syndrome, mitochondrial disorders, encephalitis, ornithine transcarbamylase deficiency, and benign idiopathic thunderclap headache. Migraine is a common episodic head- (Headache Classification Subcommittee, ache disorder with a 1-year prevalence 2004): of approximately 18% in women, 6% inmen,and4%inchildren.Attacks Recurrent attacks of headache, consist of various combinations of widely varied in intensity, fre- headache and neurological, gastrointes- quency, and duration. The attacks tinal, and autonomic symptoms. Most are commonly unilateral in onset; patients develop migraine in the first are usually associated with an- 67 3 decades of life, some in the fourth orexia and sometimes with nausea and even the fifth decade.
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