Migraine in adults – clinic, diagnosis, stages

Migraine in adults – clinic, diagnosis, stages

As a rule, a migraine is felt in the form of a periodic headache, which drastically reduces work capacity, lasting about 8-12 hours. A migraine attack can be divided into four stages: prodrome, aura, headache and postdromus. The appearance of signs of prodroma suggests more development of migraine pain. Today, most headache experts consider prodrome as the initial stage of a migraine attack. The prodromal period occurs in every third patient suffering from migraine. Symptoms of prodrome appear on average 9 hours before the onset of a headache. Patients whose headaches are preceded by a prodromal period are more likely to indicate provoking factors and report longer episodes of headaches. Neurochemical changes in migraine begin already in the prodromal period, so taking medicines for headaches in the prodroma stage can contribute to the effective relief of an attack even before the onset of pain symptoms that disrupt working ability.

About 15-20% of patients suffering from migraine, 30-60 minutes before the onset of pain attack feel the aura. It is characterized by impaired visual function, manifested by scotoma (usually described as a “spot before eyes”) and teihopsy (described as the appearance of zigzags before eyes). The aura can also manifest itself by other neurological phenomena, such as sensory impairments.

The frequency of symptoms of prodrome in migraine:

1. Increased fatigue 26%
2. Mood changes 23%
3. Violations of the gastrointestinal tract 22%
4. Headache 6%

In the headache phase, patients experience a characteristic one-sided pain, although in rare cases it can affect both sides or the entire head. Characteristic signs of migraine attacks in 1283 patients were investigated. During attacks, patients usually seek to reduce the intensity of pain, reducing activity levels and avoiding irritants (such as lighting, sounds, smells, and food). Migraine can be accompanied by nausea and vomiting, but most attacks are accompanied by only mild nausea or aversion to food. In severe attacks, the patient tends to stay in a dark, quiet room, closes his eyes and forehead with a towel.

Characteristic features of a typical acute migraine attack:

1. The usual time of day when an attack begins: 53% at any time, 19% in the morning, 14% at lunchtime, 4% in the evening, 9% at night
2. Time to reach maximum intensity of headache: up to 3 h
3. Duration of headache: 29 hours
4. The degree of intensity of a headache (0 – no pain, 10 – the most intense): 7
5. Exhausting pain: 90%
6. Recurrence rate of headaches after treatment: 44%
7. The time after which the headache recurs: 10 hours

local_offerevent_note December 27, 2018

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