Types of Migraine
MO is a recurrent headache with several attacks occurring between 4 and 72 hours that is worsened by and/or causing avoidance of everyday physical activity (“The International Classification of Headache Disorders, 3rd edition (beta version),” 2013). Usually the headache is located frontal-temporally with unilateral placement in adults and late adolescents, but bilateral placement in children and adolescents. The headache is of moderate to severe intensity with at least one of the following occurring: (a) nausea and/or vomiting, (b) photophobia and phonophobia. Also, MO is correlated with cranial autonomic symptoms (e.g. nasal congestion) and cutaneous allodynia (pain triggered by a harmless stimulus to normal skin (Landy et al., 2004). Furthermore, it is often associated with menstruation (“The International Classification of Headache Disorders, 3rd edition (beta version),” 2013). Patients diagnosed with MA experience temporary focal neurological symptoms before or during a headache, along with similar symptoms of MO (“The International Classification of Headache Disorders, 3rd edition (beta version),” 2013). These fully reversible central nervous system symptoms occur unilaterally and carry on for minutes to an hour. Also, aura symptoms are visual, sensory, motor, speech, language, brainstem, and/or retinal with visual symptoms being the most prevalent, followed by sensory disruptions such as paresthesia (tingling, pricking, tickling, or burning sensation of the
skin). A premonitory phase and a headache resolution phase accompany MA with symptoms of depression, hyperactivity, hypoactivity, yawning, fatigue, food cravings, and neck stiffness and/or pain. Further, the premonitory phase includes light and/or sound sensitivity, trouble concentrating, blurry vision, pallor, and nausea. MA patients can have MO as well.
In chronic migraine, headache occurs on 15 or more days per month for greater than 3 months with attacks characteristic of migraine on 8 or more days per month (“The International Classification of Headache Disorders, 3rd edition (beta version),” 2013). These migraine headaches can be with or without aura. If the patient is taking medication, s/he should describe the headache as a migraine at onset but was then relieved by ergot or triptan medication. The headache severity and duration may fluctuate from day to day or within the same day and it may be difficult to keep the patient drug-free. In order to distinguish between chronic migraine and medication-overuse headache, if the patient undergoes medication withdrawal and still has chronic migraine then the patient can be diagnosed with chronic migraine.