Classic migraine headache is preceded by an aura that occurs 2 to 60 mins before the onset of pain and may be visual, motor or psychic disturbance. Common migraine no distinct aura precedes the headache. Atypical migraine neurological symptoms other than headache predominate. Women more often affected than men.
Pregnancy has a variable effect on migraine headaches.
Pathophysiology Used to be thought that the severe throbbing head pain associated with migrain was a consequence of dilatation of cerebral blood vessels while the aura of migraine resulted from vasoconstriction. Newer theories suggest that 5HT plays an important role in the pathogenesis of migraine. Once the full blown headache develops these agents are less effective. Dihydroergotamine administered parenterally with a phenothiazine antiemetic is effective in aborting an acute attack. Narcotic analgesics should be used only if the above is inneffective.