Headache, Migraine

  • It begins mostly at puberty and climaxed at the age between 35 and 45 years.
  • It is twice as common with women as with men
  • The risk of migraine tends to be reduced in pregnancy
  • A migraine lasting longer than 72 hours is termed status migrainosus
  • Migraine with an aura doubles the risk of ischemic stroke
  • Statistics: the global prevalence is 14.7%; it is the 3rd most common disease globally; the prevalence of chronic migraine globally is 2%; it is 3 times more common in women than men; it is responsible for 2.9% of all years of life lost to disability; it is the 7th most disabling disease among all diseases.

##Causes of migraine

  • Genetic factors (about 2/3 of cases)
  • Unknown causes

There are 4 possible phases to a migraine (but not all them are experienced by all patients)

## Prodrome (that occurs hours or days before the headache)

  • Also known as premonitory symptoms
  • It occurs in about 60% of those with migraines
  • The onset of prodrome is normally 2 - 48hrs before the start of pain or the aura
  • It can lead to aura or jump the aura stage directly to pain stage
  • It features include:

_Altered mood

_Constipation or diarrhea

_Craving for certain food(s)

_Depression or euphoria



_Sensitivity to smells or noise

_Stiff muscles (especially in the neck)

##The aura (immediately precedes the headache and lasts for < 1 hour)

(In only 33% of the people with migraine)

  • Flashes of light
  • Blind spots
  • Tingling on one side of the face or arm or leg.
  • (Sometimes, an aura may not be followed by migraine)

##The pain phase (or the headache phase)

  • Headache which is moderate or severe in intensity
  • One-sided and pulsating headache
  • Headache that is aggravated by routine physical activity
  • Headache that lasts for of hours to 2-3 days
  • Nausea (which the most characteristic feature of migraine headache)
  • Vomiting
  • Extreme sensitivity to light and sound.

## The postdrome (the effects experienced after migraine attack)

  • A sore feeling in the area where a migraine was
  • Cognitive challenges
  • Fatigue
  • Impaired thinking for a few days after the headache
  • Mood changes
  • Refreshed
  • Weakness
  • Clinical review
  • Acute glaucoma
  • Cluster headaches
  • Meningitis
  • Subarachnoid hemorrhage
  • Temporal arteritis


  • ACE inhibitors
  • Amitriptyline
  • ARB
  • Gabapentin
  • Metoprolol
  • Pregabalin
  • Propranolol
  • Sodium valproate
  • Timolol
  • Topiramate
  • Venlafaxine
  • Botulinum toxin

##Nutritional supplements

##Lifestyle alterations


  • Decompression of some nerves around the head and neck


  • Use of a Transcutaneous Electrical Nerve Stimulation (TENS) device and other biofeedback and neurostimulator devices
  • NSAIDs such as diclofenac and ibuprofen.
  • Fixed-dose Combination of paracetamol, aspirin, and caffeine
  • Ketorolac IV
  • Paracetamol either alone or in combination with metoclopramide
  • Metoclopramide alone
  • Sumatriptan
  • Sumatriptan PLUS Naproxen
  • Ergotamine and dihydroergotamine Fixed-Dose Combination
  • Haloperidol
  • A single dose of IV dexamethasone PLUS standard treatment
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