Headache, Migraine
Basics
Description
Description
- Chronic episodic headache disorder
- Neurovascular pathophysiology:
- Aberrant trigeminal nerve activation
- Activation of nociceptive pathways within brainstem
- Vascular dilation is reactive rather than causative
- No longer considered primarily a vascular headache
- Disordered sensory processing and autonomic dysfunction
- Cortical spreading depression underlies aura
- 1.2 million ED visits per year
- Causes majority of ED headache visits
- 3× as common in women
- Prevalence peaks in fourth decade of life
- Established criteria for migraine without aura:
- A. 5 attacks fulfilling criteria B, C, D, E
- B. Attack lasts 4–72 hr
- C. Headache has 2 of the following:
- 1. Unilateral location
- 2. Pulsating
- 3. Moderate to severe pain (impairs activities)
- 4. Aggravation by or avoidance of physical activity
- D. During headache, nausea, or vomiting and/or photophobia + phonophobia
- E. Not attributable to other cause
- Migraine with aura:
- Less common
- Classically, reversible neurologic symptoms that precede headache
- Some patients report aura at the same time or after the headache
- Rarer subtypes of migraine include:
- Basilar type migraine:
- Dysarthria, vertigo, ataxia, diplopia, or decreased level of consciousness
- Hemiplegic migraine:
- Full reversible motor weakness
- Retinal migraine:
- Repeated attacks of monocular visual disturbance
- Basilar type migraine:
Pediatric Considerations
- More commonly bilateral pain and shorter duration of headache
- Associated symptoms may be difficult to elicit and can be inferred from behavior
- Cyclical vomiting syndrome associated with migraine
- High placebo response
Etiology
Etiology
Genetic disorder with variable penetrance, influenced by the environmental factors
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Citation
Schaider, Jeffrey J., et al., editors. "Headache, Migraine." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307036/all/Headache__Migraine.
Headache, Migraine. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307036/all/Headache__Migraine. Accessed November 3, 2024.
Headache, Migraine. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307036/all/Headache__Migraine
Headache, Migraine [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 November 03]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307036/all/Headache__Migraine.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Headache, Migraine
ID - 307036
ED - Barkin,Adam Z,
ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307036/all/Headache__Migraine
PB - Lippincott Williams & Wilkins
ET - 6
DB - Emergency Central
DP - Unbound Medicine
ER -