Primary Headache Disorders: Focus on Migraine

Abstract

k e y w o r d s migraine, aura, headache, primary headache disorders, disabling tension-type headache, medication overuse headache s u m m a r y p o i n t s• Migraine is the most common disabling headache disorder.• Most patients with disabling tension-type headache are likely to have migraine and accordingly respond to treatments efficacious in migraine.• Individuals are genetically predisposed to experiencing recurrent migraine.• Evidence supports migraine to be a primarily neural and not vascular mediated disorder.• 1-2% of the population have chronic daily headache associated with acute-relief medication overuse; the majority are migraineurs.• The presence of acute-relief medication overuse renders preventative medication less adequately efficacious.unipolar depression. The only painful disorder with greater disability than migraine is osteoarthritis, which is the 4 th most disabling in women and 6 th in men. The one year prevalence rate of migraine with or without aura in the UK is 7.6% in men and 18.3% in women (3). The prevalence varies by age and gender. Before puberty it is higher in boys than girls. The prevalence increases more rapidly in girls than boys into adolescence. Thereafter the prevalence increases in both sexes to peak at 40, and then declines (4). About one third of individuals will experience migraine with aura. Four to five percent of the population suffer from daily headache (5-7), and between 30 and 50% of these have a clinical syndrome which is consistent with migraine. One to two percent of the population have daily headache associated with medication overuse (6,8). Clinical characteristicsThere are a number of aspects to the migraine attack: the premonitory phase, headache, aura and recovery (9) (Table 1).

Change in intraindividual ICHD-II headache diagnosis over time: A follow-up of the DMKG headache study

“…As in our study, the most irreproducible criterion was 'duration of headaches lasting 4-72 hours' (5), supporting the suggestion by Rasmussen et al to reduce the lower limit to 2 hours to improve specificity and sensitivity of this feature (5,15). Coexisting TTH in migraine has been reported to increase response variability, because patients cannot clearly tell symptoms apart (4,5,16,17). Features of the most recent headache are also more likely to be remembered, which has been described as 'recency effect' by Lipton et al (4).…”

“…Coexisting TTH in migraine has been reported to increase response variability, because patients cannot clearly tell symptoms apart (4,5,16,17). Features of the most recent headache are also more likely to be remembered, which has been described as ‘recency effect’ by Lipton et al (4).…”

Phenome-wide analysis highlights putative causal relationships between self-reported migraine and other complex traits

“…A migraine episode is commonly composed of three stages [1,3,6,7]. First, during the prodromal phase, which can last from a couple of hours to several days, individuals may experience fatigue, lack of concentration, excessive yawning, irritability, neck stiffness, light sensitivity, and nausea [1,3,6,7].…”

Migraine, attention deficit hyperactivity disorder and screen time in children attending a Sri Lankan tertiary care facility: are they associated?

“…Headache is a common problem among children and adolescents, with 82% reporting at least one severe episode by 15 years of age [1]. Migraine meanwhile is described as the commonest disabling condition among headache disorders [2]. In the Global Burden of Disease Survey 2010, it was ranked as the third most prevalent disorder, and the seventh-highest cause of disability worldwide [3].…”