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Migraine

K Poply FRCA, FCA RCSI, FFPM RCA, A Bahra FRCP MD, V Mehta FRCA MD FFPMRCA
DOI: http://dx.doi.org/10.1093/bjaed/mkw004 357-361 First published online: 20 May 2016
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Key points

  • Migraine is a neurological disorder with genetic predisposition.

  • Diagnosis is essentially clinical, which is based upon compatible history and normal neurological examination.

  • Current literature supports that primary headache disorders are principally neurally mediated.

  • If treated early in the course of attacks, abortive strategies may be more effective if given as a large single dose.

  • Prophylaxis should be considered in patients who have ≥4–5 headache days per month to avoid medication overuse headache, which is reported for ≥8 treated days per month.

Migraine is considered to be a common disabling primary headache disorder. It has a high prevalence with epidemiological studies documenting high socio-economic and personal impact. It is one of the most common clinical presentations to neurologists in routine practice. In a systematic analysis of Global Burden of Disease Study 2010,1 it was found that migraine is the seventh most common cause globally of years lived with disability with a global prevalence of 14.7% and nearly 3% worldwide disability attributable to any specific disease. Migraine is about twice as common in women (12–14%) than men (6–8%). If untreated, the median duration of a migraine attack is 18 h with the median attack frequency 1 per month. In Europe, 12–28% of people get affected by migraine at some stage in their lives, which includes about 6–15% of adult men and 14–35% of adult women.2

Clinical features and diagnosis

A typical migraine attack is a spectrum that may consist of: premonitory symptoms, headache, and the postdrome. Nearly 20–30% of people experience one or more focal reversible neurological symptoms, called the migraine aura. Although the majority of individuals have episodic migraine, about 2–3% of the population has chronic migraine currently defined as migraine headache on at least 15 days per month for at least 3 months.

Premonitory symptoms

Prevalence varies from 7% to 88% and symptoms may …

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