Migraine headache in adults

Migraine is a chronic, genetically determined, episodic, neurological disorder that usually presents in early-to-mid life.

Patients complain of intermittent headache and associated symptoms, such as visual disturbance, nausea, vomiting, and sensitivity to light or noise (photophobia and phonophobia).

The diagnosis is based on history and physical examination. No laboratory or imaging tests are essential for diagnosis.

Treatment approaches involve identification and avoidance of trigger factors, and the use of medication to treat the acute attack or prevent future attacks.

There are no clinical trials that identify one migraine therapy (acute therapy or prophylaxis therapy) as superior over others. Triptans in general are preferred over non-specific treatments. However, there are no trials directly comparing triptans.

Complications include status migrainosus, migrainous infarction, chronic migraine, persistent aura without infarction and seizures, analgesic gastropathy, transformation of episodic to chronic migraine, and medication-overuse headache.

Migraine is a chronic, genetically determined, episodic neurological disorder that usually presents in early-to-mid life. Key features in the history that support a diagnosis of migraine are nausea, photophobia, and disability, along with headache. Typical migraine aura (a complex of reversible visual, sensory, or speech symptoms), which occurs during or precedes headache, is pathognomonic of migraine but only occurs in 15% to 30% of patients. [1] Hadjikhani N, Sanchez Del Rio M, Wu O, et al. Mechanisms of migraine aura revealed by functional MRI in human visual cortex. Proc Natl Acad Sci USA. 2001 Apr 10;98(8):4687-92. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC31895/ http://www.ncbi.nlm.nih.gov/pubmed/11287655?tool=bestpractice.com [2] Bashir A, Lipton RB, Ashina S, et al. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology. 2013 Oct 1;81(14):1260-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795609/ http://www.ncbi.nlm.nih.gov/pubmed/23986301?tool=bestpractice.com