Migraine headache: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
Migraines are underdiagnosed<ref name="pmid1599358">{{cite journal |author=Lipton RB, Stewart WF, Celentano DD, Reed ML |title=Undiagnosed migraine headaches. A comparison of symptom-based and reported physician diagnosis |journal=Arch. Intern. Med. |volume=152 |issue=6 |pages=1273–8 |year=1992 |pmid=1599358 |doi=}}</ref> and misdiagnosed.<ref name="pmid15364670">{{cite journal |author=Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C |title=Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache |journal=Arch. Intern. Med. |volume=164 |issue=16 |pages=1769–72 |year=2004 |pmid=15364670 |doi=10.1001/archinte.164.16.1769}}</ref> About a third of headaches that patients report as being migraines are truly migraines<ref name="pmid12011270">{{cite journal |author=Lipton RB, Stewart WF, Liberman JN |title=Self-awareness of migraine: interpreting the labels that headache sufferers apply to their headaches |journal=Neurology |volume=58 |issue=9 Suppl 6 |pages=S21–6 |year=2002 |pmid=12011270 |doi=}}</ref>; while about 90% of headaches that are self-reported not to be migraines are truly not migraines.<ref name="pmid12011270"/> The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria":<ref>International Headache Society. [http://ihs-classification.org/en/02_klassifikation/02_teil1/01.01.00_migraine.html Migraine | Migraines are underdiagnosed<ref name="pmid1599358">{{cite journal |author=Lipton RB, Stewart WF, Celentano DD, Reed ML |title=Undiagnosed migraine headaches. A comparison of symptom-based and reported physician diagnosis |journal=Arch. Intern. Med. |volume=152 |issue=6 |pages=1273–8 |year=1992 |pmid=1599358 |doi=}}</ref> and misdiagnosed.<ref name="pmid15364670">{{cite journal |author=Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C |title=Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache |journal=Arch. Intern. Med. |volume=164 |issue=16 |pages=1769–72 |year=2004 |pmid=15364670 |doi=10.1001/archinte.164.16.1769}}</ref> About a third of headaches that patients report as being migraines are truly migraines<ref name="pmid12011270">{{cite journal |author=Lipton RB, Stewart WF, Liberman JN |title=Self-awareness of migraine: interpreting the labels that headache sufferers apply to their headaches |journal=Neurology |volume=58 |issue=9 Suppl 6 |pages=S21–6 |year=2002 |pmid=12011270 |doi=}}</ref>; while about 90% of headaches that are self-reported not to be migraines are truly not migraines.<ref name="pmid12011270"/> The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria":<ref>International Headache Society. [http://ihs-classification.org/en/02_klassifikation/02_teil1/01.01.00_migraine.html IHS Classification ICHD-II Migraine headache]</ref><br/> | ||
*5 or more attacks | *5 or more attacks | ||
*4 hours to 3 days in duration | *4 hours to 3 days in duration | ||
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* [[sensitivity (tests)|sensitivity]] of 81% | * [[sensitivity (tests)|sensitivity]] of 81% | ||
* [[specificity (tests)|specificity]] of 75% | * [[specificity (tests)|specificity]] of 75% | ||
Additional criteria are available.<ref>Ad Hoc Committee on the Classification of Headache of the National Institute of Neurological Diseases and Blindness. [http://jama.ama-assn.org/cgi/reprint/179/9/717 Classification of headache]. JAMA (1962) 179:717–8</ref> | |||
==Treatment== | ==Treatment== | ||
Revision as of 12:28, 9 August 2010
Migraine headaches are "a class of disabling primary headache disorders, characterized by recurrent unilateral pulsatile headaches. The two major subtypes are common migraine (without aura) and classic migraine (with aura or neurological symptoms)."[1] Laymen often use the term for any severe headache, especially with nausea and sensitivity to light and sound, but there are specific criteria. Just as the term is overused in some contexts, however, true migraine has different manifestations, is underdiagnosed, and is sometimes preventable as well as treatable.
Patients with a diagnosis of migraine are called migraneurs.
Classification
- Common migraine (without aura)
- Classic migraine (with aura or neurological symptoms)
Diagnosis
Migraines are underdiagnosed[2] and misdiagnosed.[3] About a third of headaches that patients report as being migraines are truly migraines[4]; while about 90% of headaches that are self-reported not to be migraines are truly not migraines.[4] The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria":[5]
- 5 or more attacks
- 4 hours to 3 days in duration
- 2 or more of - unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity
- 1 or more accompanying symptoms - nausea and/or vomiting, photophobia, phonophobia
For migraine with aura, only two attacks are required to justify the diagnosis.
The mnemonic POUNDing (Pulsating, duration of 4-72 hOurs, Unilateral, Nausea, Disabling) can help diagnose migraine. If 4 of the 5 criteria are met, then the positive likelihood ratio for diagnosing migraine is 24.[6]
The presence of either disability, nausea, or sensitivity to light can diagnose migraine with[7]:
- sensitivity of 81%
- specificity of 75%
Additional criteria are available.[8]
Treatment
Abortive treatment
High dose acetylsalicylic acid (1000 mg) may be as effective as sumatriptan, especially if the acetylsalicylic acid is combined with metoclopramide to reduce nausea and vomiting, according to a systematic review by the Cochrane Collaboration.[9] One of the trials in the review reported that high dose acetylsalicylic acid (1000 mg), sumatriptan 50 mg and low dose ibuprofen 400 mg are equally effective at reducing pain to mild or none at two hours according to a randomized controlled trial; however, sumatriptan was led to more patients being pain free at two hours (37% versus less than 33% for other groups).[10]
Phenothiazines, such as prochlorperazine 10 mg parenterally and chlorpromazine 0.04 to 0.1 mg/kg parenterally, are more effective than placebo and more effective than metoclopramide according to a meta-analysis of randomized controlled trials.[11]
Combination therapy
High dose acetylsalicylic acid (1000 mg) combined with metoclopramide is effective according to a systematic review by the Cochrane Collaboration.[9]
A combination of sumatriptan 85 mg and naproxen sodium 200 mg was better than either drug alone according to a randomized controlled trial funded by the manufacturer of the study drug.[12]
Nonpharmacological treatments
Investigational treatments
Corticosteroids may help prevent recurrence after abortive treatment according to a meta-analyses of randomized controlled trials with number needed to treat of nine[13] or 10[14].
Telcagepant (MK-0974), an oral antagonist of calcitonin gene-related peptide receptor, may be as effective as zolmitriptan but with less drug toxicity according to a randomized controlled trial.[15]
Preventive treatment
Perhaps a third of patients meet consensus criteria for preventive treatment.[16]
A systematic review addresses options.[17] The antiepileptic drug topiramate can increase response among patients with migraine according to a randomized controlled trial.[18]> The relative benefit increase was 113.0%. For patients at similar risk to those in this study (23.0% had response), this leads to an absolute benefit increase of 26%. 3.8 patients must be treated for one to benefit (number needed to treat = 3.8). Click here to adjust these results for patients at higher or lower risk of response.
Prognosis
Migraines with auras in mid-life may be associated with stroke[19] and brain infarcts on magnetic resonance imaging[20].
References
- ↑ National Library of Medicine. Migraine Disorders. Retrieved on 2007-11-02.
- ↑ Lipton RB, Stewart WF, Celentano DD, Reed ML (1992). "Undiagnosed migraine headaches. A comparison of symptom-based and reported physician diagnosis". Arch. Intern. Med. 152 (6): 1273–8. PMID 1599358. [e]
- ↑ Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C (2004). "Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache". Arch. Intern. Med. 164 (16): 1769–72. DOI:10.1001/archinte.164.16.1769. PMID 15364670. Research Blogging.
- ↑ 4.0 4.1 Lipton RB, Stewart WF, Liberman JN (2002). "Self-awareness of migraine: interpreting the labels that headache sufferers apply to their headaches". Neurology 58 (9 Suppl 6): S21–6. PMID 12011270. [e]
- ↑ International Headache Society. IHS Classification ICHD-II Migraine headache
- ↑ Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM (2006). "Does this patient with headache have a migraine or need neuroimaging?". JAMA 296 (10): 1274–83. DOI:10.1001/jama.296.10.1274. PMID 16968852. Research Blogging.
- ↑ Lipton RB, Dodick D, Sadovsky R, et al (2003). "A self-administered screener for migraine in primary care: The ID Migraine validation study". Neurology 61 (3): 375-82. PMID 12913201. [e]
- ↑ Ad Hoc Committee on the Classification of Headache of the National Institute of Neurological Diseases and Blindness. Classification of headache. JAMA (1962) 179:717–8
- ↑ 9.0 9.1 Kirthi V, Derry S, Moore RA, McQuay HJ (2010). "Aspirin with or without an antiemetic for acute migraine headaches in adults.". Cochrane Database Syst Rev 4: CD008041. DOI:10.1002/14651858.CD008041.pub2. PMID 20393963. Research Blogging.
Cite error: Invalid
<ref>tag; name "pmid20393963" defined multiple times with different content - ↑ Diener HC, Bussone G, de Liano H, et al (2004). "Placebo-controlled comparison of effervescent acetylsalicylic acid, sumatriptan and ibuprofen in the treatment of migraine attacks". Cephalalgia : an international journal of headache 24 (11): 947–54. DOI:10.1111/j.1468-2982.2004.00783.x. PMID 15482357. Research Blogging.
- ↑ Kelly AM, Walcynski T, Gunn B (2009). "The relative efficacy of phenothiazines for the treatment of acute migraine: a meta-analysis.". Headache 49 (9): 1324-32. DOI:10.1111/j.1526-4610.2009.01465.x. PMID 19496829. Research Blogging.
- ↑ Brandes JL, Kudrow D, Stark SR, et al (2007). "Sumatriptan-naproxen for acute treatment of migraine: a randomized trial". JAMA 297 (13): 1443-54. DOI:10.1001/jama.297.13.1443. PMID 17405970. Research Blogging.
- ↑ Colman I, Friedman BW, Brown MD, et al (June 2008). "Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence". BMJ 336 (7657): 1359–61. DOI:10.1136/bmj.39566.806725.BE. PMID 18541610. PMC 2427093. Research Blogging.
- ↑ Singh A, Alter HJ, Zaia B (October 2008). "Does the Addition of Dexamethasone to Standard Therapy for Acute Migraine Headache Decrease the Incidence of Recurrent Headache for Patients Treated in the Emergency Department? A Meta-analysis and Systematic Review of the Literature". Acad Emerg Med. DOI:10.1111/j.1553-2712.2008.00283.x. PMID 18976336. Research Blogging.
- ↑ Ho TW, Ferrari MD, Dodick DW, et al (December 2008). "Efficacy and tolerability of MK-0974 (telcagepant), a new oral antagonist of calcitonin gene-related peptide receptor, compared with zolmitriptan for acute migraine: a randomised, placebo-controlled, parallel-treatment trial". Lancet 372 (9656): 2115–23. DOI:10.1016/S0140-6736(08)61626-8. PMID 19036425. Research Blogging.
- ↑ Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF (2007). "Migraine prevalence, disease burden, and the need for preventive therapy". Neurology 68 (5): 343–9. DOI:10.1212/01.wnl.0000252808.97649.21. PMID 17261680. Research Blogging.
- ↑ Pringsheim T, Davenport WJ, Becker WJ (2010). "Prophylaxis of migraine headache.". CMAJ 182 (7): E269-76. DOI:10.1503/cmaj.081657. PMID 20159899. PMC PMC2855933. Research Blogging.
- ↑ Brandes JL, Saper JR, Diamond M, et al (2004). "Topiramate for migraine prevention: a randomized controlled trial". JAMA 291 (8): 965–73. DOI:10.1001/jama.291.8.965. PMID 14982912. Research Blogging.
- ↑ Schürks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T (2009). "Migraine and cardiovascular disease: systematic review and meta-analysis.". BMJ 339: b3914. DOI:10.1136/bmj.b3914. PMID 19861375. Research Blogging.
- ↑ Scher, Ann I.; Larus S. Gudmundsson, Sigurdur Sigurdsson, Anna Ghambaryan, Thor Aspelund, Guthny Eiriksdottir, Mark A. van Buchem, Vilmundur Gudnason, Lenore J. Launer (2009-06-24). "Migraine Headache in Middle Age and Late-Life Brain Infarcts". JAMA 301 (24): 2563-2570. DOI:10.1001/jama.2009.932. Retrieved on 2009-06-24. Research Blogging.