Migrainewithoutaura-formerlytermedcommon migraineis characterized by a unilateral throbbing headache, nausea and vomiting, or photophobia.
2.
Migraine with aura-formerly termed classic migraine-has similar symptoms preceded by premonitory neurological phenomena such as visual scotoma or hallucinations. A third of patients have this type of migraine, which sometimes can be averted ifmedication is taken at the first premonitory sign.
3.
Chronic migraine is defined by a migraine headache occurring at least 15 days each month for more than 3 months.
These are the most common reason for admission for headache evaluation and management. Migraines may begin in childhood, peak in adolescence, and tend to diminish in both frequency and severity with advancing years. According to Lipton and associates (2007), their annual prevalence is 17 percent in women and 6 percent in men. Another 5 percent ofwomen have probable migraine, that is, they have all criteria but one (Silberstein, 2007). Speciic polymorphisms have been identified that modulate the risk of migraines (Chen, 2015; Schiirks, 2010). hese headaches are especially common in young women and have been linked to hormone levels (Charles, 2017; Pavlovic, 2017). They are frequently encountered during pregnancy.
Sensory sensitivity with migraines is likely caused by monoaminergic sensory control systems in the brainstem and hypothalamus (Goadsby, 2015). his exact pathophysiology is uncertain, but they occur when neuronal dysfunction leads to decreased cortical blood How, activation ofvascular and meningeal nociceptors, and stimulation oftrigeminal sensory neurons (Brandes, 2007; D'Andrea, 2010). A predilection for the posterior circulation has been described (Kruit, 2004). Migrainesespecially those with aura in young women-are associated with increased risk for ischemic strokes. The risk is greater in those who smoke or use combination oral contraceptives.
The prevalence of migraine headaches in the first trimester is 2 percent (Chen, 1994). Most migraineurs have improvement during pregnancy (Kvisvik, 2011). Still, migraines-usually those with an aura-occasionally appear for the first time during pregnancy. Pregnant women with preexisting migraine symptoms may have other symptoms suggestive of a more serious disorder, and new neurological symptoms should prompt a complete evaluation (Detsky, 2006; Heaney, 2010).
Although conventional thinking has been that migraine headaches do not pose increased maternal or fetal risks, several recent studies have refuted this (Allais, 2010). In these, rates of preeclampsia, gestational hypertension, preterm birth, and other cardiovascular morbidities, including ischemic stroke, were increased (Grossman, 2017; Wabnitz, 2015). Bushnell and coworkers (2009) identiied an incidence of migraines during pregnancy of 185 per 100,000 deliveries. Of diagnoses associated in these gravid migraineurs, risks were signiicantly higher for stroke, 16-fold; myocardial infarction, ivefold; heart disease, twofold; venous thromboembolism, twofold; and preeclampsia/gestational hypertension, twofold.
Data are limited regarding non pharmacological management in pregnancy such as biofeedback techniques, acupuncture, and transcranial magnetic stimulation (Airola, 2010; Dodick, 2010). Efective medications include nonsteroidal antiinlammatory drugs (NSAIDs), and most migraine headaches respond to simple analgesics such as ibuprofen, acetaminophen, or Midrin, especially if given early.