Migraine (synonyms: hemicrania; hemicrania; ICD-10-GM G43.-: migraine) is characterized by seizure-like, pulsating headache. The International Headache Society classifies migraine as follows:
- Migraine without aura
- Migraine with aura
- Ophtalmoplegic migraine – unilateral migraine with reversible (regressing) paralysis of one or more cranial nerves supplying the eye muscles
- Retinal migraine – visual disturbances up to temporary blindness in one eye.
- Periodic symptoms in childhood as possible precursors or concomitants of migraine
- Migraine complications – status migraenosus, i.e., attack lasting longer than 72 hours; migrainous infarction, i.e., aura symptoms lasting more than 7 days, which may be accompanied by stroke (apoplexy)
- Migraine-like disorders that do not meet the above criteria.
Aura is the medical term for phenomena that precede migraine. These include visual disturbances (glaring light; central flickering scotoma), sensory disturbances, paresis (incomplete paralysis) or aphasia (speech disorders). Symptoms usually develop within a few minutes and change in the following 10-60 minutes (see also under “Classification”). A migraine is called episodic if it occurs 15 days in a month. A migraine is said to be chronic if it persists for at least 3 months with at least 15 headache days per month and more than 8 of these meet the diagnostic criteria for migraine. Sex ratio: males to females is 1: 3 (in the age group 35-45 years); before puberty, boys and girls are equally affected. Frequency peak: the disease occurs predominantly between the ages of 35 and 45 years (in women). Onset of the disease between the ages of 10-20 years. 4-5% of boys and girls are affected before puberty. In a pediatric practice, recurrent tension headache and migraine and their subtypes account for over 90% of headache complaints presented. Note: Beyond the age of 60, the initial manifestation of migraine is a rarity. Prevalence (disease incidence) is 12-14% for women and 6-8% for men. Lifetime prevalence (disease incidence over a lifetime) is 25% for women and 8% for men (in Germany). About 3.7 million women and 2 million men suffer from migraine in Germany. Children can also be affected. Approximately 4-5% of children before puberty suffer from this type of headache.The prevalence of chronic migraine is 1.0-1.5%, with about half of those affected also having Medication Overuse Headache (MOH). Course and prognosis: In many patients, a migraine attack is announced in advance by harbingers or typical symptoms. Initial cues may occur up to two days before an attack, while others occur as little as one to two hours before. Migraine occurs unilaterally (hemicrania) in about 60% of cases and generalized in about 40% of cases. Unilateral headaches may change sides within an attack or from attack to attack. Attacks last 4-72 hours. If a migraine attack lasts longer than 72 hours, it is called status migraenosus. In children, the attacks are shorter. There are two forms of migraine: migraine with and without aura. Migraine with aura (synonyms: classic migraine, ophthalmic migraine, migraine accompagné) occurs in about 10-15% of cases. It usually occurs hemifacially and is usually accompanied by photophobia and phonophobia (aversion to light and noise). Visual disturbances (flashes of light, zigzag vision, scotomas (loss/attenuation of part of the visual field) and/or sensory disturbances and/or speech disturbances precede the headache. These symptoms are completely reversible (regress). In rare cases, the auras occur without a subsequent pain phase. Physical activity exacerbates the headache and the accompanying occurrence of nausea (sickness) and vomiting (vomiting). Comorbidities: Migraine is associated with an increased risk of urinary stones, depression (especially in migraine with aura and in women), generalized anxiety disorder and bipolar disorder. Furthermore, migraine is associated with celiac disease (hypersensitivity to the grain protein gluten): Celiac disease sufferers have a 3.8-fold increased risk of developing migraine.
