What is a migraine?

There are important distinctions between headache and migraine.

Headache disorders are amongst the top ten causes of disability in Europe.

Three of these (migraine, tension-type headache and medication-overuse headache) are important in primary care because they are common and responsible for almost all headache related burden.

A fourth headache disorder (cluster headache) is also important because it is severely painful, treatable but often misdiagnosed. (extract from WHO publication)

Migraine is a common disabling primary headache disorder. According to the World Health Organisation (WHO) in the Global Burden of Disease Survey 2010, migraine was ranked as the third most prevalent disorder and seventh-highest specific cause of disability worldwide. It’s high prevalence impacts significantly on the personal and socio-economic.

Migraine sub-types

Migraine with aura – Classical Migraine

In 50-75% of patients suffering from frequent migraine with aura a patent foramen ovale (PFO) is present.

Migraine with aura, often referred to as ‘classical migraineaffects one third of people with migraine and accounts for 10% of migraine attacks overall. It is characterised by aura preceding headache, consisting of one or more neurological symptoms that develop gradually over >5 minutes and resolve within 60 minutes. A combination of any of the symptoms below characterise migraine with aura.

Visual – visual disturbances in one or both eyes causing loss of vision, tunnel vision, loss of field of view, jagged lines, ‘kaleidoscope’, coloured or pixelated appearance.

Speech – inability to say words or talk coherently (aphasia/ dysphasia)

Body - numbness, drooping, pins and needles, tingling (paraesthesia) to one side of the face, arm, hands or legs.Some of the subtypes of migraine with aura

Migraine with aura sub-types

Basilar migraine

-often with typical aura and double vision, vertigo, ringing ears or altered gait/ balance.

Hemiplegic migraine

- aura symptoms with weakness or loss of function in arms or legs which can last up to 72 hours.

Retinal migraine 

- visual symptoms + headache.

Familial hemiplegic migraine 

-genetic trait

Aura without headache

- is also referred to as acephalic migraine. Any or all of the above ‘aura’ symptoms can be experienced with out the headache. Patients can often be diagnosed as having a TIA or mini-stroke or may even be referred to an Optometrist/ Opthalmologist due to the visual changes and not ever be recognised as a ‘acephalic migraine’.

Migraine without aura

In ~50% of patients suffering from frequent migraine without aura a patent foramen ovale (PFO) is present.

Adults with this disorder typically describe:

• recurrent episodic moderate or severe headaches which:- are often unilateral and/or pulsating

- last 4 hours to 3 days- are often associated with nausea and/or vomiting

- are aggravated by routine physical activity

• during which they limit activity and prefer dark and quiet

• with freedom from symptoms between attacks.

In children:

• attacks may be shorter-lasting

• headache is more commonly bilateral and less usually pulsating

• gastrointestinal disturbance is more prominent.

Other headache disorders

Tension-type headache

- occurs in attack like episodes- unilateral but often generalised- typically described as pressure or tightness like a vice or tight band around the head, or is felt in the neck- lacks the associated symptom complex of migraine

Cluster headache

- mostly affects men

- strictly one sided with excruciating pain around the eye

- recurs frequently, typically once or more daily, commonly at night

- is short-lasting, for 15-180 minutes (~30-60 minutes)

- other features can include: red and watering eye, running or blocked nostril, drooping eyelid

- can cause marked agitation (the patient, unable to stay in bed,paces the room, even going outdoors).


Information collated and summarised from the World Health Organization and European Headache Foundation Publication Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide 

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