Definition and clinical manifestations of Migraine
(Lancet 2018;391:1315 & Continuum 2021;27:586) POUNDing Mnemonic
Epidemiology:
affects 15% of women and 6% of men; onset usually by 30 y
Migraine without aura (most common):
≥5 attacks lasting 4–72 h with both
- (a) N/V or photophobia & phonophobia,
- (b) ≥2 of following:
- unilateral
- pulsating,
- mod–severe intensity, or aggravated by routine activity
Migraine w/ aura: Migraine with aura
≥2 attacks w/:
- (a) aura defined as ≥1 fully reversible sx: visual Δs (flickering spots, visual loss), sensory sx (paresthesias, numbness), speech disturbance
- (b) unilateral progression of sx over ≥5 but ≤60 min
- (c) HA w/in 60 min of aura
Aura may occur w/o HA (“acephalgic migraine”),
must r/o TIA/stroke (typically rapid onset)
If motor weakness, consider
sporadic or familial hemiplegic migraine: aura of reversible motor weakness (up to 24 h), a/w CACNA1A, ATP1A2, or SCN1A mutations