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Migraine is one of the causes of recurrent, episodic headache. About 1 in 4 women, and 1 in 12 men, develop migraine at some point in their life. It usually starts in childhood or adolescence, and peaks in adolescence. Generally migraine becomes less common after 45-50 years old, though some may persist throughout life. The actual cause of migraine is still unknown. However, one is more likely to develop migraine if his/her immediate family members also have migraine.
Migraine can be generally classified into 2 main types :
Migraine without aura: patient has headache without aura. This is 5 times more common than migraine with aura.
Migraine with aura: headache is preceded by aura.
Migraine Symptoms
Headache
Migraine headache is usually one-sided and often described as throbbing' or pulsating'. The headache may spread to involve both sides.Typically, it slowly gets worse, then gradually eases off, lasting 4 to 72 hours. Migraine headache can be moderate to severe. Patients may complain that they could not resume their activity or work when the attack comes. The attack may come infrequently, eg once in few months, or sometimes more frequently, eg few times a week.
Other than that, patient may feel nauseous, with or without vomiting. During the attack, most patients could not tolerate bright lights or loud noises, and prefer to lie in a dark room until the headache subsides. Head movement may worsen headache.
Aura
Aura refers to warning signs before the headache. Usually it lasts 1- 15 minutes. Examples of aura:
*Visual aura: eg temporary loss of part of vision, flashes of lights eg zig-zag lines that slowly spread before disappearing
*Numbness and pins and needles' sensation in the lips, face and hands
*Speech problem.
*Others: odd smell/sensation, slight confusion in thinking
Before each attack, patient may have vague changes in mood and appetite. This feeling may begin hours or even days before the actual headache. This is then followed by the aura( absent in migraine without aura), then the headache. Finally the headache gradually fades. During this time patient may feel tired, irritable, depressed, and may have difficulty concentrating.
Triggering factors :
Migraine may occur more frequently in the presence of triggering factors :
*Diet: cheese, chocolate, red wines, citrus fruits, caffeine, and foods containing tyramine.
*Environmental: Smoking and smoky rooms, glaring light like bright screens or flickering TV sets, loud noises, strong smells eg perfume.
*Psychological: Depression, anxiety, anger, tiredness, stress, etc. Some attacks occur not during stress but when patient relaxes, leading to so-called weekend migraine'.
*Medicines: Hormone replacement therapy (HRT), some sleeping tablets, and oral contraceptive pill.
However these triggering factors may not apply to all patients, eg some may be able to take cheese or chocolate without increase in the frequency of attack