Migraine is a severe headache type and can have a considerable impact on the daily life of sufferers and affects between 17 per cent of women and 6 per cent of men, although estimates vary. Accurate diagnosis of the different presentations of migraine is the foundation of effective prescribing, management and treatment. Diagnostic pointers for migraine

  1. Attacks last from 4 to 72 hours
  2. Patients are usually symptom-free between attacks
  3. Headache is at least two of the following
    1. Unilateral (on one side)
    2. Pulsating
    3. Moderate to severe
    4. Aggravated by routine activities
  4. Accompanying symptoms may include
    1. Photophobia (more sensitive to light)
    2. Phonophobia (more sensitive to noise)
    3. Nausea and Vomiting

In any medical condition it is of paramount importance for the diagnosis to be accurate and this can only be made by your health professional or neurologist who knows your private medical history in detail. Only after this has been achieved can an appropriate management plan be established. In the late 1980s, the International Headache Society (IHS) formulated a classification for migraine, which has helped us to determine the correct patient groupings for migraine clinical trials. If five headache attacks meet the criteria, the patient is given the diagnostic label of “migraineur”. It is important to realise that not all four main symptoms have to be present. It is quite possible for the patient to have a mild headache which is bilateral, but still have migraine.

Recently clinicians have realised that it is helpful to ask questions of patients with acute or intermittent headaches. Information about their quality of life and ability, or otherwise, to perform normal activities is very important. High impact, acute headache would, therefore, tend to have a default diagnosis of migraine and the IHS classification is used to confirm this.

The main part of the classification is concerned with the headache phase of the attack. However, approximately 10 per cent of patients will have reversible sensory symptoms in the hour preceding the headache. These symptoms are known as aura and will often include visual changes, such as zigzag lines or scotoma (holes in the vision), but a variety of other symptoms may also occur.

Other symptoms include, dizziness, numbness and “word salading” (words being mixed up). About 40 per cent of patients describe more vague symptoms of aura that can last substantially longer. In the day or two before an attack, prodromal symptoms, such as cravings and lethargy, can be observed. From within these two groups of symptoms, useful warnings can be identified and patients taking simple treatments during such a warning may have success in heading off a migraine before it has started.

Often ignored is the postdrome phase of migraine. Once the headache has subsided the postdrome usually involves the patient feeling quite washed out or hung-over. A few patients may feel entirely the opposite, almost as if they are super-human. Relatively little can be done to alleviate these prodromal symptoms, the cost in terms of disruption to work, relationships, and social activities, which can result from this phase of the attack can be considerable.

Trigger Factors For Migraine

Environmental factors: Build up of tiredness over the working week, emotion and stress (eg, anger), missed meals (hypoglycaemia), smoke, strong odours (eg, perfume, paint), too much/little sleep, weather changes, bright/flashing lights.

Hormonal changes: Hormone replacement therapy (HRT), menstruation, oral contraceptives, pregnancy.

Exercise or exertion: Eye strain, head injury, irregular/no exercise.

Food/ingredients: Alcohol, artificial sweeteners, caffeine, chocolate, cultured dairy products fermented/pickled foods, fruits, mature cheese, monosodium glutamate, nitrates (eg, in cured meats), sugar, sulphites, vegetables, yeast.