What is Migraine?

Migraine is under-recognised, under-diagnosed and under-treated in clinical practice

Migraine is a severe, episodic disorder with freedom from symptoms between attacks. Attacks are characterised by transient focal neurological symptoms, headache, or both.

• Symptoms have a duration of 4-72 hours and can occur at any time.^[1]
• Symptoms may include a headache that is throbbing in nature and exacerbated by movement or physical activity. Headache pain is often on one side of the head (unilateral) and regularly accompanied by nausea, vomiting and sensitivity to light (photophobia) and/or sound (phonophobia). Symptoms generally increase in intensity as the headache progresses.^[1]
• In young children, migraine may be shorter in duration (e.g. 1–72 hours) and headache pain is commonly bilateral in nature.^[1]
• Transient neurological symptoms often precede the onset of headache and these symptoms are almost always sensory in nature.
• Headache symptoms can be so intense as to interfere with a sufferer’s ability to undertake normal daily activities, and can be incapacitating to the extent that sufferers require bed rest.

Despite the seriousness of migraine and the impact that this condition has on the sufferer in terms of pain and impaired quality of life, population-based studies consistently show that migraine is under-recognised, under-diagnosed and under-treated in clinical practice.^[2-4]

 
The vast majority of migraine disorders can be classified according to two different subtypes:

Migraine without aura 

• 'Common migraine'
• Accounts for around 85% of all attacks
• Characterised by episodes of severe headache pain, often accompanied by symptoms of nausea and vomiting, photophobia, phonophobia and osmophobia (sensitivity to smell).

Migraine with aura

• 'Classic migraine'
• Accounts for around 15% of all attacks
• In addition to the symptoms of common migraine, attacks are preceded by ‘aura’ – a disturbance of the nervous system that typically manifests itself as bright flashing lights, black spots or partial loss of vision, or involves the body, with pins and needles moving over one limb or one side. These disturbances are temporary and last for less than one hour for most sufferers.

Migraine sufferers may experience a mixture of attacks with and without aura.

The International Headache Society migraine classification criteria can be used in daily clinical practice to help diagnose migraine without aura and migraine with aura.^[1]

References:
1.International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004;24 Suppl 1: 9-160.507.
2. Lipton RB, Stewart WF, Simon D. Medical consultation for migraine: results from the American Migraine Study. Headache 1998;38: 87-96.
3. Dowson AJ, Lipscombe S, Sender J, Rees T, Watson D. New guidelines for the management of migraine in primary care. Curr Med Res Opin 2002;18: 414-39.
4. MacGregor EA, Brandes J, Eikermann A. Migraine prevalence and treatment patterns: the global Migraine and Zolmitriptan Evaluation survey. Headache 2003;43: 19-26.