Migraine

Alternative Names

Headache - migraine

Symptoms

Migraine headaches, which can be dull or severe, usually:

• Feel throbbing, pounding, or pulsating
• Are worse on one side of the head
• Last 6 to 48 hours

Symptoms accompanying migraines include:

• Nausea and vomiting
• Sensitivity to light or sound
• Loss of appetite
• Fatigue
• Numbness, tingling, or weakness

Warning signs (auras) that can precede a migraine include seeing stars or zigzag lines, tunnel vision, or a temporary blind spot.

Symptoms that may linger even after the migraine has gone away include:

• Feeling mentally dull, like your thinking is not clear or sharp
• Increased need for sleep
• Neck pain

Exams and Tests

Migraine headache may be diagnosed by your doctor based on your symptoms, history of migraines in the family, and your response to treatment. Your doctor will take a detailed history to make sure that your headaches are not due to tension, sinus inflammation, or a more serious underlying brain disorder. During the physical exam, your doctor will probably not find anything wrong with you.

Sometimes an MRI or CT scan is obtained to rule out other causes of headache like sinus inflammation or a brain mass. In the case of a complicated migraine, an EEG may be needed to exclude seizures. Rarely, a lumbar puncture (spinal tap) might be performed.

References

Morantz C. Practice Guideline Briefs. Am Fam Physician. Mar 2005; 71(5); 1019-899.

Schroeder BM . AAFP/ACP-ASIM release guidelines on the management and prevention of migraines.  Am Fam Physician. Mar 2003; 67(6): 1392, 1395-7.

Noble J, ed. Textbook of Primary Care Medicine. 3rd ed. St. Louis, MO: Mosby; 2001.

Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, MO: Mosby; 2002.

Goetz CG, Pappert EJ. Textbook of Clinical Neurology. 2nd ed. Philadelphia, PA: Saunders; 2003.