Recent astonishing basic science discoveries are altering our concepts of migraine at a breathtaking pace. Migraine is now considered a genetic disorder influenced by other internal and external factors. The neurologic disorder we call migraine results from altered neurochemical, electrical, and vascular changes in the nervous system. While headache is the most common and usually the most dramatic manifestation, remember, there is more to migraine than headache. Occasionally, the visual symptoms, nausea, vomiting, or frightening focal neurological symptoms, such as blurred vision and weakness, are more distressing to the patient than the headache itself. Little wonder that the clinical manifestations of migraine can be so variable across a broad spectrum of symptom presentations.
At one end of this spectrum is the most common clinical syndrome called migraine without aura, and at the other end are rare and complex disorders like familial hemiplegic migraine and basilar migraine, which are discussed later in the article. Even migraine without aura presents with a range of variable symptoms, frequency, and duration of attacks—not only between patients but between different attacks in the same patient—a spectrum within the larger spectrum.
Migraine With and Without Aura
The two most common patterns of migraine are migraine with aura, formerly called classic migraine, and migraine without aura, or common migraine. Approximately 18 percent of women and six percent of men in the USA are plagued by migraine, and 15 to 30 percent will experience an aura, described below, with some of their migraine attacks.
Five phases of migraine
There are five phases of migraine that are not universally present, and may variably occur during different attacks in the same individual, underscoring the concept of a clinical spectrum of migraine. The first phase, or prodrome, occurs in 40 to 60 percent of migraineurs. This consists of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food like chocolate, all of which suggest origin of these symptoms in the hypothalamus of the brain. These symptoms usually precede the headache phase of the migraine attack by several hours or even days, and experience teaches the patient or observant family that the migraine attack has begun.
