No abstract

Summary and conclusions Detailed questioning of 50 patients with uncomplicated migraine has shown that 17 had symptoms that preceded the headache phase by several hours. These prodromes consisted of changes in mood, behaviour, wakefulness, appetite, bowel activity, or fluid balance. The term "complete migraine" is proposed for attacks that include prodromal symptoms, whose occurrence implies an initial diffuse cerebral or hypothalamic disturbance.

SUMMARY A study of 50 migraineurs has confirmed previous observations that sleep is a common way of ending the headache phase. 14 subjects could shorten attacks by going to sleep during the day for an average of 2-hours. Different methods used by patients to aid falling asleep are described. 47 of the 50 subjects had symptoms after the headache had gone-here called the recovery phase which can double the length of individual attacks. It is suggested that prodromata, some symptoms of the headache and recovery phases, as well as the therapeutic effect of sleep, indicate that migraine is primarily a neurological rather than a vascular disorder.This inquiry was stimtulated by a patient saying that she could shorten and end her migraine attacks by making herself sleep for two hours. Perhaps other patients had found similar or alternative methods to abbreviate attacks that could be more widely used in treatment. Furthermore, techniques which resolve migraine episodes could illuminate the underlying, still unknown "migraine process" that initiates and maintains individual attacks.When asking patients how their attacks ended, a range of symptoms that persisted after the headache had resolved became apparent. Although patients often state that after an attack they feel "washed out", these symptoms have gained scant attention, even by Liveing,1 one of the few who annotated how attacks terminated in individual patients.Patients and methods 50 subjects with uncomplicated migraine were questioned: 29 were patients referred by their personal physician to a neurological or migraine clinic; 21 were colleagues and friends, 11 being medically qualified. Having ascertained that they had migraine as previously defined,2 each was asked how their migraine ended and if they had tried or found ways of shortening attacks, then how they felt after the headache had gone, followed by specific questions about feeling tired, yawning, mental, physical, alimentary and urinary symptoms, and their duration.

Fifty patients with migraine were asked about the occurrence of neck symptoms during different phases of their attacks, and if they felt the neck could act as a precipitant. Of the 32 reporting neck pain or stiffness, 10 noted symptoms during the premonitory phase, 30 during the headache phase, and 10 postdromally. In 7 cases the pain radiated into the shoulder and in 1 case into the lumbar region. These findings indicate extracerebral involvement of the migraine process and an overlap between the trigeminal and cervical distribution.

SUMMARY One hundred epileptic patients were questioned about their headaches. Post-ictal headaches occurred in 51 of these patients and most commonly lasted 6-72 hours. Major seizures were more often associated with post-epileptic headaches than minor attacks. Nine patients in this series of 100 also had migraine: in eight of these nine a typical, albeit a mild, migraine attack was provoked by fits. including nausea and vomiting, photophobia, phonophobia, and visual disturbances were also noted. Patients were specifically asked whether they suffered local head trauma during their fits, and only patients who rarely experienced any head injury and clearly developed headaches without trauma were included in this study. Details of other headaches, associated neurological conditions, electroencephalographic and neuroradiological findings were recorded. The results of computed tomographic scans were present in the notes of 32 patients, of which five revealed abnormalities (two presumed gliomas, neither of which had been operated upon, one infarct, one arteriovenous malformation and one arachnoid cyst). All patients had experienced more than 10 fits and only patients who had post-ictal headaches after more than a quarter of their attacks were included in the detailed analysis of post-epileptic headaches.