Migraine is a paroxysmal headache disorder characterized by varying degrees of recurrent vascular-quality headache, photophobia, sleep disruption and depression.

Pathophysiology 

Although the mechanism of migraine remains not completely understood, various theories have been put forward: vascular theory, depolarization theory, serotonin theory and neural theory.

Variants of Migraine 

According to the ICHD(International classification of headache disorders), second edition(ICHD-2), there are the following subclasses of migraine(some of which include further subdivisions):

• Migraine without aura or common migraine.
• Migraine with aura.
• Childhood periodic syndromes.
• Retinal migraine.
• Complications of migraine.
• Probable migraine.

Clinical Features

There are 4 phases of migraine attack:

• The Prodrome phase is the one that occurs hours or days before the headache.
• Aura phase, which immediately precedes the headache.
• Pain phase, also known as the headache phase.
• Postdrome phase.

Diagnosis

To diagnose migraine without aura, according to the IHS, can be made according to the following criteria: five or more attacks,4-72 hours with nausea/vomiting, photophobia/phonophobia; and two or more of these symptoms: unilateral, moderate/severe pain intensity, pulsating, worsened by physical activity.

Management 

Conventional treatment mainly focuses on three areas: Trigger avoidance, abortive therapy and prophylactic pharmacological drugs.

1. Trigger avoidance: Avoid alcohol, birth control pills, caffeine, anxiety, smoking or exposure to smoke, hunger and loud noises.
2. Abortive therapy: Analgesics/nonsteroidal anti-inflammatory drugs(NSAIDs): High dose aspirin 900 mg/6h or paracetamol 1g/6h p.o. with metoclopramide. Serotonin agonists: Sumatriptan
3. Prophylactic therapy: propranolol, atenolol, metoprolol, flunarizine, sodium valproate, topiramate, and tricyclics are commonly used drugs.