Migraine

Diagnosis

There are two major forms of migraine attacks, migraine with aura and migraine without aura.

In migraine without aura the attacks usually begin as a dull ache and gradually develop into an intense, throbbing pain which can either be restricted to one side of the head or spread all over.

The common headache characteristics and associated symptoms are:

• a moderate-to-severe headache that usually lasts from 4 to 72 hours
• throbbing pain on one or both sides of the head
• pain that is:
  • aggravated by physical activity
  • often associated with nausea and/or vomiting
  • often associated with a hypersensitivity to light and sound (photo- and phonophobia).

In migraine with aura so-called aura symptoms occur before the onset of headache. Visual disturbances such as zig-zag lines and impaired vision that gradually spreads in front of the eyes are most common. Slightly less common are gradually spreading sensory disturbances and speech disturbances. These symptoms normally develop over more than 4 minutes, last less than 1 hour and often disappear before the migraine headache begins. A special form of migraine with aura is the rarer but severe familial hemiplegic migraine which has strong familial association and a known mode of inheritance (autosomal dominant). In this form the aura symptoms include hemiparesis.