Caffeine in combination with other analgesics is safe and effective in treatment of acute migraine. A number of medications are useful to prevent attacks including metoprolol, valproate, and topiramate.Globally, approximately 15% of people are affected by migraine. In the Global Burden of Disease Study of 2010, it was ranked as the third most prevalent disorder in the world. It most often starts at puberty and is worst during middle age. As of 2016, it is one of the most common causes of disability. An early description consistent with migraines is contained in the Ebers papyrus, written around 1500 BC in ancient Egypt. The word migraine is from the Greek ἡμικρᾱνίᾱ (hēmikrāníā), pain in half of the head, from ἡμι- (hēmi-), half and κρᾱνίον (krāníon), skull. Signs and symptoms
Migraine typically presents with self-limited, recurrent severe headache associated with autonomic symptoms. About 15–30% of people living with migraine experience episodes with aura, and they also frequently experience episodes without aura. The severity of the pain, duration of the headache, and frequency of attacks are variable. A migraine attack lasting longer than 72 hours is termed status migrainosus. There are four possible phases to a migraine attack, although not all the phases are necessarily experienced:
The prodrome, which occurs hours or days before the headache
The aura, which immediately precedes the headache
The pain phase, also known as headache phase
The postdrome, the effects experienced following the end of a migraine attackMigraine is associated with major depression, bipolar disorder, anxiety disorders, and obsessive–compulsive disorder.
Christianson syndrome is an X linked syndrome associated with intellectual disability, microcephaly, seizures, ataxia and absent speech. Presentation
Onset of symptoms is normally within the first year of life with truncal ataxia and seizures. The head is small (microcephaly). Common facial abnormalities include:
Long narrow face
Prominent nose
Prominent jaw
Large ears
Open mouth
Thick eyebrowsOther common features include:
Uncontrolled drooling
Abnormal eye movementsThe associated intellectual disability is usually in the profound range. Those affected often have a happy demeanor with frequent smiling and spontaneous laughter. Genetics
This condition is caused by mutations in the SLC9A6 gene. This gene is located on the long arm of the X chromosome (Xq26.3). The gene encodes a sodium/hydrogen exchanger located in the endosomes. Mutations in this gene cause a rise in the pH of the endosomes.How this causes the clinical features is not known presently. The inheritance of this condition is X-linked dominant. Diagnosis
The diagnosis may be suspected on clinical grounds.It is made by sequencing the SLC9A6 gene. Differential diagnosis
Angelman syndrome
Spinocerebellar ataxia type 29

Management
There is presently no curative treatment. Management is supportive. Epidemiology
The prevalence is not known but this is considered to be a rare disease. History
This condition was first described in 1999. The causative mutation was discovered in 2008. == References ==