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Seminars in Ophthalmology Dec 2003Transient visual and neurological episodes are relatively common and can occur for the first time in middle and old age. In many cases these transient events are... (Review)
Review
Transient visual and neurological episodes are relatively common and can occur for the first time in middle and old age. In many cases these transient events are migraine auras. An aura is a transient, stereotypical, visual or neurological episode usually lasting 4 to 60 minutes in duration. Migraine is usually, but not always, associated with headache and can be accompanied by systemic and autonomic symptoms. Diagnosis is dependent on International Headache Society criteria. The pathophysiology is believed to involve neurovascular mechanisms. There is a hereditary component to migraine. When migraine auras occur in the absence of headache they are termed acephalgic migraines. Late onset migraine accompaniment is an acephalgic migraine that presents in middle-aged and older adults. It is usually benign. Migraines can be mimicked by other more serious conditions. Most patients with a stable migraine pattern and normal neurological evaluation do not require further testing. Some patients with atypical presentation, older age, or suspected secondary causes need further investigation.
Topics: Aged; Female; Humans; Migraine Disorders; Pain
PubMed: 15513008
DOI: 10.1080/08820530390895226 -
Acta Anaesthesiologica Taiwanica :... Jun 2012Migraine is a common and disabling disorder with a 1-year prevalence of 4.5-6% in men and 14.5-18% in women. The diagnosis of migraine is usually made according to the... (Review)
Review
Migraine is a common and disabling disorder with a 1-year prevalence of 4.5-6% in men and 14.5-18% in women. The diagnosis of migraine is usually made according to the second edition of the International Classification of Headache Disorders (ICHD-2) criteria; however, not all physicians are familiar with the diagnostic criteria. Underdiagnosis remains a major issue in general practice, resulting in inadequate treatment. Several instruments are designed to improve the diagnosis of migraine, to identify the comorbid psychological disturbances, to measure the burden and disability, and to access any reduction in quality of life (QoL) that occurs due to migraine attacks with good reliability and validity. Furthermore, the disability and QoL measured by certain instruments serve as surrogate targets when treating migraines. In this review, we examine the instruments that are in common use in daily practice and current research on migraines, focusing on the purpose of each instrument, clinical applications, pitfalls in interpretation, and, if any, minimally clinically important difference(s) (MCID). In general, a structured intake form and a headache diary are recommended in approaching patients with headache. In addition, ID-Migraine, a three-item screening test, has been validated in primary care settings as a way to improve the rapid diagnosis of migraine. The Visual Aura Rating Scale (VARS) is helpful for the diagnosis of migraine with aura. In addition, migraine is commonly associated with psychiatric comorbidities, which can be assessed by the Beck Depression Inventory (BDI), 9-item Patient Health Questionnaire (PHQ-9), and Hospital Anxiety and Depression Scale (HADS). To evaluate the impact of migraines, disability can be assessed using the Migraine Disability Assessment Questionnaire (MIDAS). Reduction in QoL can be evaluated using the Migraine-Specific Quality of Life Survey (MSQ 2.1), European Quality of Life-Five Dimensions (EQ-5D), or Short-Form 36 (SF-36). Despite all these instruments, proper selection and interpretation of each instrument remain crucial.
Topics: Comorbidity; Disability Evaluation; General Practitioners; Humans; Mental Disorders; Migraine Disorders; Quality of Life
PubMed: 22769861
DOI: 10.1016/j.aat.2012.05.002 -
The Journal of Headache and Pain Apr 2011Migraine is an extremely common disorder. The underlying mechanisms of this chronic illness interspersed with acute symptoms appear to be increasingly complex. An... (Review)
Review
Migraine is an extremely common disorder. The underlying mechanisms of this chronic illness interspersed with acute symptoms appear to be increasingly complex. An important aspect of migraine heterogeneity is comorbidity with other neurological diseases, cardiovascular disorders, and psychiatric illnesses. Depressive disorders are among the leading causes of disability worldwide according to WHO estimation. In this review, we have mainly considered the findings from general population studies and studies on clinical samples, in adults and children, focusing on the association between migraine and psychiatric disorders (axis I of the DSM), carried over after the first classification of IHS (1988). Though not easily comparable due to differences in methodology to reach diagnosis, general population studies generally indicate an increased risk of affective and anxiety disorders in patients with migraine, compared to non-migrainous subjects. There would also be a trend towards an association of migraine with bipolar disorder, but not with substance abuse/dependence. With respect to migraine subtypes, comorbidity mainly involves migraine with aura. Patients suffering from migraine, however, show a decreased risk of developing affective and anxiety disorders compared to patients with daily chronic headache. It would also appear that psychiatric disorders prevail in patients with chronic headache and substance use than in patients with simple migraine. The mechanisms underlying migraine psychiatric comorbidity are presently poorly understood, but this topic remains a priority for future research. Psychiatric comorbidity indeed affects migraine evolution, may lead to chronic substance use, and may change treatment strategies, eventually modifying the outcome of this important disorder.
Topics: Adult; Child; Comorbidity; Depressive Disorder; Humans; Migraine Disorders
PubMed: 21210177
DOI: 10.1007/s10194-010-0282-4 -
Advances in Pediatrics 2000Migraines are a common and often undiagnosed and undertreated problem in children of all ages. Migraine symptoms can vary dramatically in terms of character and... (Review)
Review
Migraines are a common and often undiagnosed and undertreated problem in children of all ages. Migraine symptoms can vary dramatically in terms of character and severity, from brief self-limited headaches to prolonged events with complex neurologic and systemic symptoms. Identification of migraines requires an index of suspicion in any child with acute recurrent headaches or neurologic symptoms. Diagnosis remains predominately based on the patient's history of symptoms and supported by a positive family history. Neurodiagnostic tests are often unnecessary and of value predominately to exclude nonmigraine disorders that may present with similar symptoms. A number of recent advances in our understanding of the pathophysiology and genetics of migraines have occurred, and continued progress in these exciting areas of investigation is anticipated. Identification of genetic markers in individuals with FHM is potentially the first step in discovery of genetic markers that may be useful in other migraine syndromes and may lead to the development of new therapeutic interventions. The movement from a vascular to integrated neurovascular pathogenesis for migraine headaches is already being translated into the study of new pharmacologic treatments, such as nitric oxide inhibitors and continued development of 5-HT1 agonist (triptans) medications. Although not currently approved for use in children, triptans are being widely evaluated in clinical trials. As additional triptans and new dosage formulations are developed and approved, it is anticipated that the treatment of migraine headaches in children may change significantly in the next several years.
Topics: Analgesics; Antiemetics; Behavior Therapy; Child; Ergotamines; Female; Humans; Life Style; Male; Migraine Disorders; Ophthalmoplegia; Serotonin Receptor Agonists; Sumatriptan
PubMed: 10959443
DOI: No ID Found -
JNMA; Journal of the Nepal Medical... Jul 2021Menstrual migraine is a condition in females, where headaches are linked with menstruation and may be debilitating. Hormonal fluctuations could have a key role in...
Menstrual migraine is a condition in females, where headaches are linked with menstruation and may be debilitating. Hormonal fluctuations could have a key role in migraine etiopathogenesis, as several women experience that their migraine attacks correlate with their menstrual cycle. Estrogen withdrawal appears to have a significant role in migraine associated with menstrual cycles, despite the fact that its pathophysiology is not well known. The treatment method can also vary from that used to treat nonmenstrual migraines. However, with proper identification and management of the condition, it can be bearable. This article highlights some portions of what is known about migraine, its triggers including the experience of a sufferer and aims to provide readers with a better understanding of migraine in women by understanding these aspects of the condition.
Topics: Female; Headache; Humans; Menstrual Cycle; Menstruation; Migraine Disorders
PubMed: 34508410
DOI: 10.31729/jnma.6332 -
Pediatric Emergency Care Oct 2015Migraines are common, incapacitating, and often stress inducing for pediatric patients and parents alike. According to the Agency for Healthcare Research and Quality,... (Review)
Review
Migraines are common, incapacitating, and often stress inducing for pediatric patients and parents alike. According to the Agency for Healthcare Research and Quality, more than 1 million Americans seek emergency care every year due to migraines, with increasing frequency among adolescents. The disease can vary in severity and character, often mimicking life-threatening conditions, requiring prompt nuanced recognition by emergency personnel and implementation of an effective treatment strategy. Development of emergency department guidelines for the management of pediatric migraines should be based on up-to-date evidence supporting safe, appropriate therapies for children.
Topics: Adolescent; Analgesics; Child; Emergency Medical Services; Humans; Migraine Disorders; Randomized Controlled Trials as Topic; Treatment Outcome; United States
PubMed: 26427947
DOI: 10.1097/PEC.0000000000000590 -
Revista de NeurologiaThere is a close relation between female sex hormones and migraine. Before puberty the incidence of migraine is the same in both sexes, but it becomes three times more... (Review)
Review
INTRODUCTION AND DEVELOPMENT
There is a close relation between female sex hormones and migraine. Before puberty the incidence of migraine is the same in both sexes, but it becomes three times more frequent in females following menarche. Thus, approximately 25% of females of reproductive age suffer migraine versus 8% of males; above the age of fifty, however, the prevalence is again similar in the two sexes. Other evidence backing this theory include the existence of menstrual migraines, improvements in migraines between the fourth and ninth month of pregnancy and the fact that both contraceptives and hormone replacement therapy can modify the frequency and intensity of migraines. The changes in the characteristics of the migraines of females in different phases of their lives, such as puberty, pregnancy, lactation, menopause, and while they are using contraceptives or hormone replacement therapy, are closely related to the concentrations of estrogens in the blood. This relation is even closer in the case of migraine without aura.
AIMS
The aim of this study was to review the changes that take place in the characteristics of the migraines suffered by women in the different stages of their lives (menstruation, pregnancy, lactation and menopause), as well as when using contraceptives and hormone replacement therapy. We also sought to examine the therapeutic options that are indicated in each situation.
Topics: Contraceptives, Oral; Female; Humans; Menopause; Menstruation; Migraine Disorders; Sex Factors
PubMed: 18368683
DOI: No ID Found -
Clinical Neurology and Neurosurgery Feb 2005Both migraine and vertigo are common complaints. Although they may coincide by chance, there is growing evidence for a clinical entity of recurrent vestibular symptoms... (Review)
Review
Both migraine and vertigo are common complaints. Although they may coincide by chance, there is growing evidence for a clinical entity of recurrent vestibular symptoms related to migraine. This syndrome implies a possible causal relationship although the pathophysiology of migraine-related vertigo has not been fully elucidated. A migrainous aseptic inflammation is thought to create a central sensitivity that spreads from the trigeminal to the vestibular system. Diagnostic criteria for migraine-related vertigo are proposed. Treatment is based on anti-vertiginous drugs for acute interventions and prophylactic measures as are taken for migraine headaches. Multicenter, prospective controlled studies are highly warranted.
Topics: Humans; Meniere Disease; Migraine Disorders; Motion Sickness; Vertigo
PubMed: 15708220
DOI: 10.1016/j.clineuro.2004.07.003 -
Optometry (St. Louis, Mo.) Mar 2009Patients often complain to their optometrist about their headaches, of which migraines are a common type. They may ask if their pain is from visual causes or whether the... (Review)
Review
BACKGROUND
Patients often complain to their optometrist about their headaches, of which migraines are a common type. They may ask if their pain is from visual causes or whether the visual auras they experience are normal.
METHODS
The literature on migraine is reviewed to provide the optometrist with current information to manage these patients.
RESULTS
Included in the review are migraine epidemiology, pathophysiology, categorization, clinical presentation, diagnosis, and treatment.
CONCLUSION
Optometrists can help their migraine patients with a thorough examination, advice, proper referrals, and optical management when appropriate.
Topics: Humans; Migraine Disorders; Optometry; Prevalence; Vision Tests
PubMed: 19264290
DOI: 10.1016/j.optm.2008.06.008 -
Medicinski Pregled 2007The prevalence of migraine in childhood and adolescence has not changed to a great extent, but it increases in adolescence, especially in female adolescents. MENSTRUAL... (Review)
Review
INTRODUCTION
The prevalence of migraine in childhood and adolescence has not changed to a great extent, but it increases in adolescence, especially in female adolescents. MENSTRUAL MIGRAINE--DEFINITION: There are two types of menstrual migraine: true menstrual migraine and menstrually related migraine. True menstrual migraine occurs predominantly around menstruation, whereas menstrually related migraine occurs during menstruation, but also at other times during the month.
CAUSES
Exaggerated or abnormal neurotransmitter responses to normal cyclic changes in the ovarian hormones are probably the basic cause of menstrual migraines. The fall in estrogen levels during menstrual cycle is trigger for the menstrual migraine.
SYMPTOMS
Menstrual migraine has the same symptoms as other types of migraine, but the pain is stronger, it lasts longer, and it is more frequent than other types of migraines.
DIAGNOSIS
In order to make a diagnosis, women are asked to keep a headache diary for three months. If the migraine headache is severe and occurs regularly between two days before and three days after the start of menstrual bleeding, it is true menstrual migraine.
THERAPY
Menstrual migraines are more difficult to treat than other types of migraines. Treatment principles for menstrual migraine are the same as for migraines in general, with certain particularities.
CONCLUSION
Hormonally associated migraine is a specific clinical entity. It is important to diagnose the type of migraine, considering the fact that a decline in estrogen level at the end of menstrual cycle triggers migraine, so it can be treated by low levels of estrogen.
Topics: Adolescent; Adult; Diagnosis, Differential; Female; Humans; Menstruation; Migraine Disorders; Premenstrual Syndrome
PubMed: 18265590
DOI: 10.2298/mpns0710449s