Author: Robert P. Friedlaender, M.D., See Clearly Vision
Migraine is a neurologic syndrome (a group of symptoms that characteristically occur together) usually associated with moderate to severe headache, and recurrent episodes that last 4-72 hours. There is usually a throbbing headache on one side of the head (unilateral) that can be accompanied by sensory changes, gastrointestinal symptoms, or mood disturbances. The symptoms are frequently the same for repeat attacks, or stereotyped.
Five stages of migraine are generally identified:
- Prodrome-premonitory symptoms present 24 to 72 hours before other symptoms
- Aura-transient neurologic symptoms that are usually visual in nature
The headache is typically one sided and is described as a throbbing or boring head pain. It typically occurs behind one eye, both eyes, or across the entire front of head. It will less commonly occur on the side of the head in the temporal region. Most unilateral migraine headaches change from one side to the other side at some point. Recurrent headaches always on the same side or at the same place often have another cause and less likely to be caused by a migraine; these should be thoroughly investigated to determine their cause.
An aura is a visual disturbance that is often described by patients to appear as flashing lights, zigzag lights, blurred vision, or a visual field defect in which areas of vision are missing. Areas of missing vision are known as scotomas. The aura may last from 15 to 50 minutes, and is usually the preceding event to the migraine headache. It should be noted that a headache does not have to occur for the condition to qualify as migraine.
The area of visual loss typically marches or gradually spreads across the visual field, and has what’s known as a build-up or increase over 15 to 20 minutes. Scotomas are frequently, but not always, surrounded by sparkles or flickering lights called scintallations. Other visual disturbances have been reported that resemble heat waves or water running down glass.
Migraine accompaniments can include nausea, vomiting, mood changes, fatigue, sensitivity to light, or sensitivity to noise. There can also be temporary neurologic deficits such as local paralysis, numbness, or a tingling sensation, just to name a few.