Migraine is a recurrent throbbing headache on one or both sides of the temporal region, with visual and somatosensory aura before the attack, and often accompanied by vomiting. It is more frequent in women, about 3 to 4 times more often than in men, and most often starts in adolescence, with an age of onset of 25 to 34 years, with a few occurring in childhood or after middle age.
Causes
1.Heredity
About 60% of migraine patients have a family history, and the risk of migraine in parents, children and siblings (same parents) is 3 to 6 times higher than that of the general population.
2.Endocrine and metabolic factors
It is more common in females, starts in adolescence, often attacks during menstruation, and decreases or stops after pregnancy or menopause, suggesting the influence of endocrine and metabolism.
3.Diet and drugs
Certain foods can trigger migraine, such as cheese containing tyramine, meat containing nitrite antiseptic such as hot dogs or bacon, chocolate containing phenethylamine, food additives such as monosodium glutamate (MSG), red wine, etc.
4, mental factors
Fasting, emotional stress, bright light can be induced.
Clinical manifestations
Migraine mainly consists of two categories: migraine with aura and migraine without aura. In addition, there are 7 special types of migraine.
1. Migraine with aura
It is also called typical migraine, which accounts for 15% to 18% of migraine and mostly has family history. The onset process of typical cases is divided into three phases.
(1) Brief aura appears before the onset of aura, such as visual aura: flashing light, flickering jagged lines, dark spots, black blindness and hemianopia, etc.; there may also be visual distortion and object color change, etc. Next are somatosensory aura, such as numbness and abnormal sensation in one limb or face, and motor aura, such as mild hemiparesis and aphasia, but they are relatively rare. The aura may last for several minutes to one hour.
(2) The headache period is accompanied or followed by temporal or retro-orbital throbbing headache on one side. It is unilateral in about 2/3 of patients and bilateral or alternating on both sides in 1/3. It may also present as a full headache, unilateral or bilateral frontal headache and uncommon occipital headache. The headache often starts in the frontal, temporal and retro-orbital regions and spreads to the hemilateral or whole head. The headache is typically associated with marked pulsation of the superficial temporal artery, often accompanied by nausea, vomiting, photophobia or phonophobia, irritability, odor terror and fatigue. The patient prefers to lie still in a dark room and is relieved after sleep. The headache lasts from 2 to 10 hours, a few can last from 1 to 2 days, and in children it lasts from 2 to 8 hours. The frequency of attacks can be weekly, monthly or several months, and the number of attacks varies. The intervals between attacks are mostly asymptomatic.
(3) Patients often show fatigue, tiredness, weakness and poor appetite after the headache subsides in the late stage of the headache, which improves in 1 to 2 days.
2.Migraine without aura
Also called common migraine, it is the most common type of migraine, accounting for about 80% of migraine. Compared with migraine with aura, it lacks typical aura and is often bilateral temporal and periorbital pain, which may be pulsating, with recurrent headache and vomiting. The headache lasts for a long time, up to several days, and the symptoms can be complicated by cervical muscle contractions when the pain persists. There is often scalp tenderness during the attack, and vomiting may occasionally end the headache. This type of migraine is often significantly associated with menstruation. Compared with migraine with aura, migraine without aura has a higher frequency of attacks, which can seriously affect the work and life of patients and often requires frequent application of painkillers.
3.Special type of migraine
(1) Migraine of hemiplegic type is rare. The hemiplegia can be the aura symptom of migraine, occurring alone or with hemianesthesia and aphasia, and the hemiplegia can last from 10 minutes to several weeks after the migraine subsides.
(2) Basilar migraine or basilar artery migraine. It is more common in children and adolescent females, and attacks can be associated with menstruation. There is often a family history of this or other types of migraine. It is common to have visual aura such as flashes of light, dark spots, blurred vision, blackness, and visual field loss, followed by an occipital throbbing headache lasting 20 to 30 minutes, often accompanied by nausea and vomiting, and a headache lasting several hours to a day that resolves after sleep. The headache lasts for several hours to a day and is relieved after sleep. It may also cause brainstem and temporo-occipital symptoms due to basilar artery ischemia, such as vertigo, double vision, nystagmus, tinnitus, slurred speech, bilateral limb numbness and weakness, ataxia (loss of body coordination, inability to maintain balance), altered consciousness (drowsiness), fall attacks and black clouding.
(3) Complex migraine migraine with prolonged aura. The symptoms are the same as those of migraine with aura. The aura persists during the headache attack and lasts for 1 hour or even 1 week. This type requires MRI to rule out intracerebral lesions.
(4) The oculomotor paralysis type of migraine is less common, and patients tend to have a history of migraine without aura. Paralysis of the eye muscles on the side of the headache occurs at the beginning of the migraine attack or when the attack tends to subside, with the oculomotor nerve being most often involved, and the talipes and adductor nerve may also be involved, lasting from a few hours to several weeks. Recurrence is usually ipsilateral, and the paralysis may persist after multiple attacks. This type should be excluded from intracranial aneurysm and diabetic ophthalmic muscle paralysis.
(5) Retinal artery migraine is usually seen in young people with a history of migraine with aura and may be caused by retinal artery spasm. It is often associated with aura of darkness in one eye with flashing dark spots, and there may be a decrease in the range of visual acuity. Retinal edema may be seen on funduscopic examination.
(6) Late onset migraine after 45 years of age, with episodic headache with recurrent episodes of hemiparesis, numbness, aphasia or slurred speech, each episode with the same symptoms of neurological deficits lasting from 1 minute to 72 hours. This should be noted to exclude transient ischemic attack.
(7) Migraine equilibrium manifests episodes of vascular dysfunction caused by abnormal autonomic function. In rare cases, the elderly and children may present with recurrent autonomic symptoms such as vertigo, vomiting, abdominal pain, diarrhea, limb and joint pain without or alternating with headache attacks.