Chapter 015. Headache (Part 4)

Migraine HeadacheMigraine, the second most common cause of headache, afflicts approximately 15% of women and 6% of men. It is usually an episodic headache that is associated with certain features such as sensitivity to light, sound, or movement; nausea and vomiting often accompany the headache.A useful description of migraine is a benign and recurring syndrome of headache associated with other symptoms of neurologic dysfunction in varying admixtures (Table 15-3). Migraine can often be recognized by its activators, referred to as triggers.Table 15-3 Symptoms Accompanying Severe Migraine Attacks in 500 PatientsSymptomPatients Affected, %Nausea87Photophobia82Lightheadedness72Scalp tenderness65Vomiting56Visual disturbances36Photopsia26Fortification spectra10Paresthesias33Vertigo33Alteration of consciousness18Syncope10Seizure4Confusional state4Diarrhea ...
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Chapter 015. Headache (Part 4) Chapter 015. Headache (Part 4) Migraine Headache Migraine, the second most common cause of headache, afflictsapproximately 15% of women and 6% of men. It is usually an episodic headachethat is associated with certain features such as sensitivity to light, sound, ormovement; nausea and vomiting often accompany the headache. A useful description of migraine is a benign and recurring syndrome ofheadache associated with other symptoms of neurologic dysfunction in varyingadmixtures (Table 15-3). Migraine can often be recognized by its activators,referred to as triggers. Table 15-3 Symptoms Accompanying Severe Migraine Attacks in 500Patients Symptom Patients Affected, % Nausea 87 Photophobia 82 Lightheadedness 72 Scalp tenderness 65 Vomiting 56 Visual disturbances 36 Photopsia 26 Fortification spectra 10 Paresthesias 33 Vertigo 33 Alteration of consciousness 18 Syncope 10 Seizure 4 Confusional state 4 Diarrhea 16 Source: From NH Raskin, Headache, 2d ed. New York, ChurchillLivingston, 1988; with permission. The brain of the migraineur is particularly sensitive to environmental andsensory stimuli; migraine-prone patients do not habituate easily to sensory stimuli.This sensitivity is amplified in females during the menstrual cycle. Headache canbe initiated or amplified by various triggers, including glare, bright lights, sounds,or other afferent stimulation; hunger; excess stress; physical exertion; stormyweather or barometric pressure changes; hormonal fluctuations during menses;lack of or excess sleep; and alcohol or other chemical stimulation. Knowledge of apatients susceptibility to specific triggers can be useful in management strategiesinvolving lifestyle adjustments. Pathogenesis The sensory sensitivity that is characteristic of migraine is probably due todysfunction of monoaminergic sensory control systems located in the brainstemand thalamus (Fig. 15-1). Figure 15-1