MIGRAINE HEADCHE

Symptoms

·         Throbbing or pulsatile headache, with moderate to severe pain that intensifies with movement or physical activity

·         Unilateral and localized pain in the frontotemporal and ocular area, but the pain may be felt anywhere around the head or neck

·         Headache lasts 4-72 hours

·         Pain builds up over a period of 1-2 hours, progressing posteriorly and becoming diffuse

·         Nausea (80%) and vomiting (50%), including anorexia and food intolerance, and light-headedness

·         Sensitivity to light and sound

Diagnosis

·         Unilateral location

·         Pulsating quality

·         Moderate or severe pain intensity

·         Aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)

In addition, during the headache the patient must have had at least 1 of the following:

·         Nausea and/or vomiting

·         Photophobia(difficulty to see in light) and phonophobia(difficulty to hear sound)

Treatment

• Identification and avoidance of precipitants or exacerbating factors (such as the contraceptive pill) may prevent attacks.
• Treatment of an acute attack consists of simple analgesia with aspirin or paracetamol, often combined with an antiemetic such as metoclopramide or domperidone.
• Severe attacks can be treated with one of the ‘triptans’ (e.g. sumatriptan), 5-HT agonists that are potent vasoconstrictors of the extracranial arteries. These can be administered orally, sublingually, by subcutaneous injection or by nasal spray.