Diagnosing migraine

Abstract

Migraine is a common headache disorder, particularly in women. It usually starts during the teens and twenties, a time when many women are seeking contraception advice. Migraine without aura is the most prevalent type of migraine, affecting up to 70% of people with migraine, while the remainder experience attacks with and/or without aura. Aura is a phase of focal neurological symptoms, typically visual. An increasing body of evidence identifies aura as a marker of increased risk of ischaemic stroke and its presence is a contraindication to the use of combined hormonal contraception (CHC). However, aura is often confused with more generalised premonitory visual symptoms of migraine that may precede attacks of migraine with and without aura, which are not associated with stroke risk. Diagnostic confidence is needed so that CHC is not withheld unnecessarily.

Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC)

“…Ideally, a screening should initially assess whether women seeking HC suffer from recurrent headaches, then whether recurrent headaches are migraine and, finally, whether migraine is with or without aura. Types of migraine are not mutually exclusive and around 30% of people with migraine with aura also have attacks without aura [ 22 , 46 – 48 ], with the pattern changing over time.…”

“…Comment: The risk of ischemic stroke associated with HC use mostly depends on the estrogen compound and is dose dependent [ 22 , 63 ]. Initially, combined oral HCs contained estrogen in doses up to 150 μg of mestranol, a prodrug of ethinylestradiol.…”

“…Whether the risk of ischemic stroke in women with migraine is magnified by use of combined hormonal contraceptives (HCs) is unclear. As migraine prevalence is high in women of reproductive age it is common to face the issue of migraine and HC use in clinical practice [ 22 ]. Hence, the aim of the present paper is to systematically review the association between migraine, ischemic stroke and HC use and to develop a consensus among international experts to support clinical decision-making in terms of cardiovascular safety for prescription by healthcare professionals of HCs to women with migraine.…”

Migraine Burden of Disease: From the Patient's Experience to a Socio‐Economic View

“…Migraine is the second of the primary headache disorders after tension‐type headache in terms of prevalence, but ranks first in terms of disability . Two main subtypes have been characterized, migraine without aura (approximately 70% of attacks) and migraine with aura (approximately 30% of attacks) (Table ]) . Migraines with and without aura are believed to have different, though somewhat overlapping, etiologies Studies with twins indicate that genetics plays a greater role in migraine with aura than without .…”

A very specific absence of focus? A patient's response to ‘Diagnosing migraine’

“…As a sufferer from ‘classic’ migraine with aura from the age of 15 years, who has in the past used a combined oral contraceptive pill during my 30s, I read Anne MacGregor's review article1 with great interest. Safe prescription of contraception for those of us who suffer from migraine has to be important, and this article promised clarification and assistance.…”