Migraine Headache

Presentation

Migraine headache is one of the most disabling neurologic disorders, with a lifetime prevalence of 33% in women and 13% in men worldwide. In a third of cases, patients will have an aura, which can manifest with visual phenomena or paresthesias, typically in the hand or oral area. The headache is typically moderate to severe and can be associated with other symptoms such as photophobia, phonophobia, neck pain, nausea, emesis, and cutaneous allodynia. The headache is typically unilateral, throbbing, and worsened by movement, and it commonly lasts 1 to 24 hours or more.

Basilar-type migraine may be associated with fully reversible dysarthria, vertigo, tinnitus, decreased hearing, double vision, or ataxia. Unlike other headaches, migraines are especially likely to wake the patient in the morning. There may be a family or personal history of similar headaches, and onset during the patient’s teens or 20s is common. Primary headaches, which include migraine, tension-type headache, and cluster headache, are benign; these headaches are usually recurrent and not caused by organic disease. Secondary headaches are caused by underlying organic diseases, ranging from sinusitis to subarachnoid hemorrhage.