Phases of Migraine. Migraine is divided into four phases, all of which may be present during the attack:
Premonitory symptoms occur up to 24 hours prior to developing a migraine. These include food cravings, unexplained mood changes (depression or euphoria), uncontrollable yawning, fluid retention, or increased urination.
Aura. Some people will see flashing or bright lights or what looks like heat waves immediately prior to or during the migraine, while others may experience muscle weakness or the sensation of being touched or grabbed.
Headache. A migraine usually starts gradually and builds in intensity. It is possible to have migraine without a headache.
Postdrome (following the headache). Individuals are often exhausted or confused following a migraine. The postdrome period may last up to a day before people feel healthy.
Migraine Headaches Are Classified?
Classification Of Migraine Headache According to The International Headache Society (IHS).
International Headache Society
International Classification Headache Disorders –II
It is based on the headache’s characteristics and associated symptoms. The International Headache Society (IHS) diagnostic criteria for headache disorders provide definitions for six subtypes of migraine
Table 1.1. Diagnostic Criteria For Migraine Without Aura (Common Migraine)
A. At least 5 attacks fulfilling criteria B-D
B. Headache attack last 4 to 72 hours (untreated or unsuccessfully treated)
C. Headache has at least two of the following Characteristics:
Vomiting and intense Nausea. Attacks associated w/ Pallor & lethargy. There is
Complete resolution of symptoms between attacks.
B. At least 5 attacks fulfilling criteria C and D
C. Episodic attacks, stereotypical in the individual patient, of intense Nausea and
Vomiting last from 1 hours to 5 days
D. Vomiting during attacks occurs at least 4 times/ hr for at least 1 hr.
E. Symptoms-free between attacks
F. Not attributes to another disorder.
NOTE: In particular, H/P examination do not show signs of Gastrointestinal Disease
Table 1.3.2. Diagnostic Criteria for Abdominal Migraine
A. An Idiopathic Recurrent disorder seen mainly in children and characterized by
Episodic midline abd pain manifesting in attacks lasting 1-72 hours with
Normality between episodes. The pain is of moderate to severe intensity and
asso. w/ Vasomotor symptoms, N & V.
B. At least 5 attacks fulfilling criteria C-E
C. Attacks of Abd pain lasting 1-72 hrs (untreated or unsuccessfully treated)
D. Abd Pain has all of the following characteristic:
Midline location, periumbilical or poorly localized
Dull or “just sore” quality
Moderate or severe intensity
E. During Abd pain at least 2 of the following:
F. Not attributed to another disorder
NOTE: In H&P, do not show any signs of GI or renal disease. Pain is severe enough to interfere with daily activities. The pallor is often accompanied by dark shadow under eyes. In few patients flushing is predominant vasomotor phenomenon. MOST children with Abd migraine will develop migraine headache later in life.
Table 1.3.3. Diagnostic Criteria for Benign Positional Vertigo of Childhood
A. Heterogeneous Disorder is characterized by recurrent brief episodic attack of vertigo