Migraine podcourse with Dr Deborah Kerr, part 1: diagnosis and management

Well, the International Classification of Headache Disorders classifies migraine as a headache lasting between 4 and 72 hours.

There should be 2 out of 4 of either unilateral location, a pulsating quality, moderate to severe intensity, or aggravating routine activity.

So during the attack, there should be either nausea or photophobia or phonophobia, so sensitivity to light or to sound.

Simone has told us that her symptoms last up to two days, that it's unilateral.

that it's affecting her ability to work and that she has photophobia.

So we can be reassured by the clear days in between attacks.

It's reassuring also that the frequency has increased, but the pattern of the attack remains the same.

And there does appear to be a recognised trigger for the change in frequency in the form of stress.

So what are the different forms of migraine and how can you distinguish them? So migraine is differentiated into being with or without aura.

Simone has described migraine without aura.

Aura is fully reversible neurological disturbance lasting between 5 and 60 minutes that usually happens at the beginning of a migraine, perhaps after the predrome or symptoms.

The most common aura are visual, then sensory aura and speech disturbance.

So visual aura, there's about 25 different types of visual aura that have been described.

A lot of people would describe a kaleidoscope pattern, zigzags, spots, or an enlarging blank spot that then moves across the vision to the side.

But there's all sorts of odd patterns.

visual aura that have been described.

Sensory aura is usually tingling, sometimes numbness, which migrates up the arm or into the face, sometimes up a leg.

And speech disturbance is common too.

Less commonly is

aura

causing motor weakness.

This is hemiplegic migraine and true hemiplegic migraine is actually quite rare.

Most often it's going to be inherited so they will know they've got it because their parent had it.

A lot of patients confuse true motor weakness with sensory symptoms.

So they think they're weak but actually they're just not feeling properly in that limb.