Migraine and Cluster Headache

Abstract

Migraine is a common primary episodic headache disorder. The most common migraine form is migraine without aura, with an estimated prevalence of 10–12 % in most Western societies. It is more frequent in women and usually starts before the age of 20, peaking between 35 and 45. In women, migraine often develops post menarche, worsens during menses, and may vanish during the last two trimesters of pregnancy or after menopause, suggesting an endocrine component to be involved. Two forms of migraine without aura are recognized: episodic (0–14 days per month with headache) and chronic (15 or more days per month with headache; Table 1). Usually, headache is unilateral, in the frontotemporal region, reaches its peak intensity gradually, is moderate to severe, is usually throbbing, and is aggravated by movements. It lasts 4–72 h (untreated or unsuccessfully treated) and can be associated with other symptoms, such as phonophobia, photophobia, nausea, and vomiting. Premonitory symptoms occur in 20–60 % of patients with migraines, hours to days before headache onset. They can include depression, fatigue, irritability, sensory sensitivity, anorexia/hunger, diarrhea/constipation, sensations of heat or cold, and sweating. In migraine with aura, focal neurological symptoms, mainly in the visual field, precede the headache and last about 15–30 min.