27 May 2014

Diagnosis of migraine

Migraine is a common familial disorder which is characterized by periodic,commonly unilateral and often throbbing headaches, it begin in childhood, adolescence, or early adult life and the frequency decreases during advancing years. The most characteristic features are throbbing nature and its occurrence in one side of head (Hemicranial ). In more than 80 percent of patients, the onset is before 30 years of age. 

There are two types migraine, classic Migraine( with aura ) and common migraine (without aura). Aura is commonly visual. Sensitivity to light and noise occur which is called as photophobia and phonophobia respectively. In women, the headaches tend to occur during the premenstrual period

Diagnostic criteria
Migraine without aura - Migraine without aura is a recurrent headache disorder that fulfills the following IHS criteria : 
  • Headache attacks last 4 to 72 hours.
  • Headache has at least two of the following characteristics.
    (a) Unilateral location.
     (b) Pulsating quality.
    (c) Moderate or severe intensity.
     (d) Aggravation by routine physical activity. 
  • During headache at least one of the following occurs.
      (a) Nausea and /or vomiting.
      (b) Photophobia and phonophobia.
  • At least five attacks occur fulfilling the above criteria. 
  • History, physical examination, and neurological examination do not suggest any underlying organic disease.
Migraine with aura
  • At least two attacks of aura with migraine headache.
  • The migraine aura fulfills criteria for one of the sub forms of aura with migraine headache. 
  • The symptoms are not attributed to another disorder.
  • First, the aura has at least one of the following characteristics without motor weakness:
    (a) Fully reversible visual symptoms including positive features (example : flickering lights, spots, or lines) and/or negative features (ie, loss of vision)
    (b) Fully reversible sensory symptoms including positive features (ie, pins and needles) and/or negative features (ie, numbness)
    (c) Fully reversible dysphasic speech disturbance.
  • Second, the aura has at least two of the following characteristics.
    (a) Homonymous visual symptoms or unilateral sensory symptoms.
    (b) At least one aura symptom develops gradually over greater than or equal to 5 minutes or different aura symptoms occur in succession over greater than or equal to 5 minutes. 
  • Each symptom lasts greater than or equal to 5 minutes and less than or equal to 60 minutes.

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