Classical Migraine: Clinical Course

 

Patients may experience one or more type of positive sensory experience with each attack with visual auras, specifically scintillating scotomata being the most common. Negative auras or auras lasting more than an hour should prompt a search for another diagnosis such as tumor or stroke. It is important to remember that even in classical migraines auras are not always present.

Classic migraine or migraine with aura is a form of chronic headache which is often, but not always preceded by a premonitory visual, auditory or other sensory disturbance. The headaches are usually one sided but the involved side often switches from attack to attack. Attacks are most often preceded by a prodromal period lasting from hours to days, wherein the patient feels distinctly abnormal, often experiencing symptoms of depression, hyperactivity, yawning, food cravings or thirst.

 

In classic migraines this prodromal period is often followed by an aura, a period of altered perception or sensation. Patients may experience more than one type of positive sensory experience, aura with each attack with visual auras, specifically scintillating scotomata being the most common. The aura will usually develop over a period of 5-20 minutes and should not last for more than an hour. Negative auras or auras lasting longer than an hour should prompt a search for another diagnosis (most commonly tumor, infection or stroke). It is important to remember that even in classical migraines auras are not always present.

 

The aura if it occurs is usually followed rapidly by the pain of the headache which commonly unilateral, severe and pulsating in nature. The headache is often accompanied by nausea and is made worse by light (photophobia) and noise (phonophobia). The headaches can last from 1 to 72 hours and are often improved by rest and sleep. Migraine patients characteristically look for a dark quiet place and prefer to be left alone. Following the headache the patients usually enter a postdromal phase lasting from several hours to several days. Most patients report fatigue malaise and depression during this period, however, some patients feel energized and report a sense of euphoria. During the postdromal phase patients often feel tired and hung-over. They often complain of residual pain and soreness in the area of their headache as well as complaining of impaired thinking, mood changes, gastrointestinal symptoms and malaise. Some patients with relatively short and mild headaches actually find chronic pain of the postdromal phase the most disturbing.

 

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