Migraine without aura
About 85% of patients with migraine suffer from this form of the disease.The following symptoms or complaints occur:
- Unilateral pain in 60% of patients
- Pain may change sides during an attack or from one attack to the next
- Pain character: pulsating, throbbing, probing pain.
- Attack duration: headache attacks, lasting four to 72 hours.
- Pain becomes more intense with physical activity!
- Neck pain
- Nausea / vomiting
- Vomiting
- Photophobia (photophobia)
- Noise aversion / noise sensitivity (phonophobia).
- Visual symptoms
- Neurological deficits
- General feeling of illness
Migraine with aura (migraine aura)
About 10-15% of patients with migraine suffer from this form of the disease. It usually, but not always, occurs hemifacially.Notice! In basilar migraine (see below), aura always occurs bilaterally.In migraine with aura, the following symptoms or discomfort (up to 30 minutes) occur:
- Visual disturbances such as scotoma/flicker scotoma, fortification, loss of spatial vision and blurring; diplopia (double vision, double images).
- Balance disorders
- Speech disorders
- Sensory disturbances (such as loss of touch or sensations of tingling in the arms, legs, and face)
- Paralysis symptoms
- Vertigo (spinning dizziness)
Basilar migraine
Basilar migraine is also known as migraine with brainstem auroasymptoms. In this case, the following symptoms or complaints occur:
- Ataxia (disturbance of movement coordination and postural innervation).
- Bilateral paresis (paralysis)
- Severe dizziness
- Paresthesias (sensory disturbances)
- Speech, hearing and visual disturbances
- Disturbances of consciousness
Migraine in early childhood
- Headache attacks in migraine are often shorter and less typical than after puberty and in adulthood. Migraine equivalents are prominent. These include:
- Abdominal migraine – episodic midline abdominal pain.
- Episodic syndromes such as vomiting (> 4 times/h, > 1 h-10 d).
- Benign (benign) paroxysmal vertigo.
- Benign paroxysmal torticollis (tilting of the head).
- Colic in infancy
- Presence of special aura forms in infancy:
- Alice in Wonderland syndrome, in which the environment is perceived larger (macropsia), but own body parts appear smaller (microsomatognopsia).
- Confusional migraine (synonym: “footballer’s migraine”), this is based on small craniocerebral trauma (TBI), as can occur in soccer; symptoms: disoriented behavior
Migraine in old age
Beyond the age of 60, the initial manifestation of migraine is a rarity. The relative number of patients reporting aura increases with age. Differentiating migraine from tension headache or symptomatic headache can be difficult.
Warning signs (red flags)
- Refer to cephalgia (headache).
Further notes
- Characteristic of migraine auras is the dynamic nature of the process (onset of symptoms within a few minutes; changes in the following 10-60 minutes) – e.g., the “wandering” of the flickering scotoma in the visual field or wandering of the tingling sensation in the arm – as well as the dynamic nature of the symptoms – from visual disturbances to sensory disturbances to speech disturbances and paralysis. The dynamics of the symptoms, as well as their slow onset and resolution, is an important distinguishing feature from other neurological diseases (here, in particular, from apoplexy).
- Flicker scotoma is the term used to describe a scotoma (visual field loss), usually of peripheral onset, with visual sensations such as flickering (scintillations) or flashes of light (photopsia). The visual field loss usually occurs with zigzag-shaped borders (like fortifications or pondopsia: star-shaped or fortress-wall-like appearances/shapes) and can spread rapidly. Flickering scotoma occurs in the context of migraine with aura and appears in both eyes on the same side (homonymous).The duration of the scotoma is often between 20 and 30 minutes.Differential diagnosis (diseases with similar or almost identical symptoms): In ophthalmic migraine (synonyms: ophthalmic migraine, migraine ophtalmique, retinal migraine) similar visual sensations may occur, but usually unilateral and of shorter duration (often 5-20 min, rarely longer).
