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| This news site is not sanctioned by, nor part of, the Diamond Headache Foundation, The American Academy of Neurology OR The American Headache Society. |
| News covering selected sessions related to migraine from 2008 medical conferences. |
| Annual Meeting of the American Academy of Neurology |
Chicago, IL April 15-18, 2008 |
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Migraine Onset and Progression Have
Multiple Variations |
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BY DON SCHRADER
Contributing Writer |
CHICAGO
(ECCC)— Migraine spans a wide range of
characteristics and symptoms that often overlap with other
headache syndromes, said Philadelphia headache specialist Dr.
William Young on April 18 during the annual meeting of the
American Academy of Neurology.
This overlap can lead to complication in diagnosis of migraine
and other headache disorders. Patients with cluster or
tension-type headache, for example, might have nausea,
photophobia, phonophobia, and even aura. Similarly, nonmigraine
headache syndromes can result in pain characteristics similar to
those of migraine.
“Essentially all of the pain syndromes of other primary headache
disorders are also seen with migraine,” said Dr. Young of the
Jefferson Headache Center.
Almost 90% of patients who have migraine have symptoms, pain, or
characteristics that are also found in tension-type headache,
including stiffness or tightness in the shoulders or neck, and
occipital or cervical pain. Three fourths of patients with
migraine describe neck pain.
The stereotypical timeline of migraine begins with prodromal
symptoms, followed by aura, headache and associated features,
and concluding with postdromal features. However, that
traditionalistic perspective does not have universal
applicability, said Dr. Young. The phases of migraine evolution
may often in a different order. Some patients may have aura with
no headache.
“The headache might try to begin, and some symptoms develop,”
said Dr. Young. “That is followed either by the whole cascade—or
stampeding herd—of migraine or by resolution of the episode
without a headache.”
About 60% of migraine patients have premonitory symptoms, and
studies have shown that many patients can predict the occurrence
of migraine with a reasonable degree of accuracy. The
premonitory symptoms are usually excitatory or inhibitory in
nature.
Characteristics of aura tend to fall into three broad
categories: visual, sensory, and other (such as weakness and
aphasia). Symptoms usually evolve slowly, persist for as long as
60 minutes, and usually precede the headache. Occasionally, the
aura persists into the headache or has an onset that coincides
with that of the headache, said Dr. Young.
Migraine patients have reported many variations on aura,
including olfactory and gustatory phenomena, delirium, and
room-tilt illusion. Some patients have auditory components to
aura, and others have “Alice in Wonderland” syndrome that
requires reassurance about disturbing phenomena, such as
disordered body image or visual perception.
Aura without headache tends to have a later onset in life as
compared with migraine’s frequent onset in the teenage years. In
patients with a history of migraine, the headache might
disappear but the aura persists. Other patients may develop new
auras.
“If you carefully question young patients who have migraine with
aura, some of them occasionally describe an aura that is not
followed by a migrainous or any other type of headache,” said
Dr. Young.
Dr. Young added that migraine with vertigo is “a real disaster
to try to understand and to sort through the literature.” The
condition goes by multiple names (basilar migraine, migrainous
vertigo, vertiginous migraine, vestibular migraine, and
Bickerstaff’s syndrome, to name a few). It ranks second only to
benign positional vertigo in prevalence among recurrent forms of
vertigo. Migraine with vertigo requires a careful evaluation to
rule out coronary artery disease, with which the condition also
is associated. |
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