a band around the largest part of the head. These headaches usually
occur around a time of stress and may persist for months. These
types of headaches differ from migraines in that they lack aura;
they are also more prominent in men, whereas migraines are more
common in women.
A migraine attack can be divided into several phases that include
the premonitory phase, migraine aura (if present), the migraine
phase, and the resolution phase.2
The premonitory phase is experienced by 20% to 60% of
migraineurs and is characterized by a wide variety of symptoms.2
Neurologic symptoms (e.g., sensitivity to light, sound, or smells and
difficulty concentrating) are most common, but some people may
also experience psychological symptoms (e.g., anxiety, depression,
euphoria, irritability, drowsiness, or excitability), autonomic
symptoms (e.g., frequent urination, diarrhea, or constipation), or
constitutional symptoms (e.g., stiff neck, yawning, thirst, food
cravings, or anorexia).
In people who experience aura, it may occur before or during
a migraine attack.2 It usually evolves over 5 to 20 minutes and lasts
less than 60 minutes; pain from the migraine usually occurs within
60 minutes of the end of the aura. The most common sensory
abnormality with aura is visual, often characterized by flickering
lights or loss of vision, but the symptoms could be motor related as
well, such as numbness and tingling.
The migraine headache itself may occur at any time of day
but most patients seem to experience migraine upon wakening
in the early morning.2 There is a gradual onset that may peak in
minutes and last anywhere from 4 to 72 hours. The pain is usually
accompanied by fatigue, irritability and nausea. Some less common
symptoms include anorexia, certain cravings, gastrointestinal
discomfort as well as sensitivity to light and sound.
The resolution phase is the final phase of a migraine attack and
is characterized by feeling tired and exhausted.2 Some of the sensory
sensitivities as well as impaired concentration and scalp tenderness
may persist; however, the length of this phase is highly variable
among patients.
Diagnosis
The IHS provides guidelines to follow when diagnosing
migraine headaches.2 It is important to note that there are different
criteria depending on the presence or absence of aura. The
International Headache Society Diagnostic Criteria for Migraine are
provided in Table 1.
Triggers
Several triggers have been identified that increase one’s risk
of experiencing a migraine attack. These may include different kinds
of foods, environmental factors, and behavioral-physiologic factors.2
It is important for migraineurs to identify and avoid the triggers
that cause their migraines in order to decrease the likelihood of
experiencing an attack. Common triggers are described in Table 2.