Migraine headache: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
Migraines are underdiagnosed<ref name="pmid1599358">{{cite journal |author=Lipton RB, Stewart WF, Celentano DD, Reed ML |title=Undiagnosed migraine headaches. A comparison of symptom-based and reported physician diagnosis |journal=Arch. Intern. Med. |volume=152 |issue=6 |pages=1273–8 |year=1992 |pmid=1599358 |doi=}}</ref> and misdiagnosed.<ref name="pmid15364670">{{cite journal |author=Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C |title=Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache |journal=Arch. Intern. Med. |volume=164 |issue=16 |pages=1769–72 |year=2004 |pmid=15364670 |doi=10.1001/archinte.164.16.1769}}</ref> The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria": | Migraines are underdiagnosed<ref name="pmid1599358">{{cite journal |author=Lipton RB, Stewart WF, Celentano DD, Reed ML |title=Undiagnosed migraine headaches. A comparison of symptom-based and reported physician diagnosis |journal=Arch. Intern. Med. |volume=152 |issue=6 |pages=1273–8 |year=1992 |pmid=1599358 |doi=}}</ref> and misdiagnosed.<ref name="pmid15364670">{{cite journal |author=Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C |title=Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache |journal=Arch. Intern. Med. |volume=164 |issue=16 |pages=1769–72 |year=2004 |pmid=15364670 |doi=10.1001/archinte.164.16.1769}}</ref> About a third of headaches that patients report as being migraines are truly migraines<ref name="pmid12011270">{{cite journal |author=Lipton RB, Stewart WF, Liberman JN |title=Self-awareness of migraine: interpreting the labels that headache sufferers apply to their headaches |journal=Neurology |volume=58 |issue=9 Suppl 6 |pages=S21–6 |year=2002 |pmid=12011270 |doi=}}</ref>; while about 90% of headaches that are self-reported not to be migraines are truly not migraines.<ref name="pmid12011270"/> The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria": | ||
*5 or more attacks | *5 or more attacks | ||
*4 hours to 3 days in duration | *4 hours to 3 days in duration | ||
Revision as of 16:49, 9 December 2007
Migraine headaches are "a class of disabling primary headache disorders, characterized by recurrent unilateral pulsatile headaches. The two major subtypes are common migraine (without aura) and classic migraine (with aura or neurological symptoms)."[1]
Classification
- Common migraine (without aura)
- Classic migraine (with aura or neurological symptoms)
Diagnosis
Migraines are underdiagnosed[2] and misdiagnosed.[3] About a third of headaches that patients report as being migraines are truly migraines[4]; while about 90% of headaches that are self-reported not to be migraines are truly not migraines.[4] The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria":
- 5 or more attacks
- 4 hours to 3 days in duration
- 2 or more of - unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity
- 1 or more accompanying symptoms - nausea and/or vomiting, photophobia, phonophobia
For migraine with aura, only two attacks are required to justify the diagnosis.
The mnemonic POUNDing (Pulsating, duration of 4-72 hOurs, Unilateral, Nausea, Disabling) can help diagnose migraine. If 4 of the 5 criteria are met, then the positive likelihood ratio for diagnosing migraine is 24.[5]
The presence of either disability, nausea or sensitivity, can diagnose migraine with[6]:
- sensitivity of 81%
- specificity of 75%
Treatment
Abortive treatment
Comparative studies
A randomized controlled trial found that high dose acetylsalicylic acid (1000 mg), sumatriptan 50 mg and low dose ibuprofen 400 mg are equally effective at reducing pain to mild or none at two hours; however, sumatriptan was led to more patients being pain free at two hours (37% versus less than 33% for other groups).[7]
Another randomized controlled trial, funded by the manufacturer of the study drug, found that a combination of sumatriptan 85 mg and naproxen sodium 200 mg was better than either drug alone.[8]
Preventive treatment
The antiepileptic drug topiramate can reduce the frequency of migraine attacks.[9]
References
- ↑ National Library of Medicine. Migraine Disorders. Retrieved on 2007-11-02.
- ↑ Lipton RB, Stewart WF, Celentano DD, Reed ML (1992). "Undiagnosed migraine headaches. A comparison of symptom-based and reported physician diagnosis". Arch. Intern. Med. 152 (6): 1273–8. PMID 1599358. [e]
- ↑ Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C (2004). "Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache". Arch. Intern. Med. 164 (16): 1769–72. DOI:10.1001/archinte.164.16.1769. PMID 15364670. Research Blogging.
- ↑ 4.0 4.1 Lipton RB, Stewart WF, Liberman JN (2002). "Self-awareness of migraine: interpreting the labels that headache sufferers apply to their headaches". Neurology 58 (9 Suppl 6): S21–6. PMID 12011270. [e]
- ↑ Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM (2006). "Does this patient with headache have a migraine or need neuroimaging?". JAMA 296 (10): 1274–83. DOI:10.1001/jama.296.10.1274. PMID 16968852. Research Blogging.
- ↑ Lipton RB, Dodick D, Sadovsky R, et al (2003). "A self-administered screener for migraine in primary care: The ID Migraine validation study". Neurology 61 (3): 375-82. PMID 12913201. [e]
- ↑ Diener HC, Bussone G, de Liano H, et al (2004). "Placebo-controlled comparison of effervescent acetylsalicylic acid, sumatriptan and ibuprofen in the treatment of migraine attacks". Cephalalgia : an international journal of headache 24 (11): 947–54. DOI:10.1111/j.1468-2982.2004.00783.x. PMID 15482357. Research Blogging.
- ↑ Brandes JL, Kudrow D, Stark SR, et al (2007). "Sumatriptan-naproxen for acute treatment of migraine: a randomized trial". JAMA 297 (13): 1443-54. DOI:10.1001/jama.297.13.1443. PMID 17405970. Research Blogging.
- ↑ Brandes JL, Saper JR, Diamond M, et al (2004). "Topiramate for migraine prevention: a randomized controlled trial". JAMA 291 (8): 965–73. DOI:10.1001/jama.291.8.965. PMID 14982912. Research Blogging.