At least one symptom is present in 56 percent of migraineurs, usually bilateral and not present with each attack, most commonly forehead/facial sweating, conjunctival injection and/ or lacrimation, and nasal congestion and/or rhinorrhea. 10Ĭranial autonomic symptoms are caused by parasympathetic activation of the sphenopalatine ganglion during an attack which innervates the tear ducts and sinuses. Migraine triggers are present in 76 percent of migraineurs with the following endorsed by migraineurs with triggers in one study: stress, 89 percent female hormones, 65 percent not eating, 57 percent weather, 53 percent physical exhaustion or traveling, 53 percent sleep disturbance, 50 percent perfume or odor, 44 percent bright lights, 38 percent neck pain 38 percent alcohol, 38 percent smoke, 36 percent sleeping late, 32 percent heat, 30 percent, food, 27 percent and exercise, 22 percent. Over a three-month period, 35.1 percent of the migraineurs had at least one day of activity restriction related to headache. 1 During migraine attacks in one study, most migraineurs reported severe impairment or the need for bed rest (53.7 percent) with only 7.2 percent who reported no attack-related impairment. The number of attacks per month for migraineurs is about as follows: 25 percent, four or more severe attacks a month 35 percent, one to four severe attacks per month 38 percent, one or less severe attacks per month and 37 percent, five or more headache days per month. When patients deny a history of light and noise sensitivity, the questions should be asked, ‘‘During a headache, would you prefer to be in bright sunlight or in a dark room?’’ and ‘‘During a headache, would you prefer to be in a room with loud music or in a quiet room?’’ About 20 percent additional patients become aware of associated light and noise sensitivity by use of the follow-up questions. The pain, which is usually increased by physical activity or movement, is associated with nausea in about 80 percent of episodes, vomiting in about 30 percent, photophobia in about 90 percent, and phonophobia in about 80 percent. Without treatment, 80 percent of patients have moderate to severe pain and 20 percent have mild pain. Migraine which persists for more than 72 hours, termed status migrainosus by Taverner in 1978, 7 has an unknown prevalence. Migraines last four to 72 hours if left untreated or if unsuccessfully treated although pediatric migraine may have a duration of two to 72 hours and is more often bilateral and frontotemporal. The neck pain can occur during the migraine prodrome, the attack itself, or the postdrome. Up to 75 percent of migraineurs report, along with the head pain, unilateral or bilateral tightness, stiffness, or throbbing pain in the posterior neck. Throbbing pain is present in 85 percent of episodes of migraine, although up to 50 percent of patients describe non-throbbing pain during some attacks. Any region of the head or face may be affected, including the parietal region, the upper or lower jaw or teeth, the malar eminence, and the upper anterior neck. The pain is often more intense in the frontotemporal and ocular regions before spreading to the parietal and occipital areas. About 15 percent of migraineurs report so-called ‘‘side-locked’’ headaches, with migraine always occurring on the same side. Migraine pain is unilateral in 60 percent of cases and bilateral in 40 percent. 4 Chronic migraine, with attacks occurring on 15 or more days per month for at least three months, occurs in about 3.2 million people per year in the United States, 80 percent women. About 8 percent of boys and 11 percent of girls have migraine. 3 percent in females with onset before the age of 25 in 50 percent of cases, in 75 percent before the age of 35 years, and only two percent over the age of 50. The cumulative incidence of migraine by age 85 is 18.5 percent in males and 44. Migraine has a one-year period prevalence of 12 percent (17.1 percent in women and 5.6 percent in men) and 2 some 35 million people annually have migraine in the United States. Although we see migraineurs almost daily and over 50 percent of us are migraineurs, 1 a review of the clinical features may be of interest.
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