Migraine

ICHD-3(beta) subdivides migraines into whether or not the patient experiences an aura. Migraine without aura is typically experienced in adults as a pulsating head pain of moderate to severe quality in a specific spot (sometimes on the face), but the pain may be across the cranium in children. Physical activity can worsen the attack, and nausea, photophobia and/or phonophobia are usually present.3

Reversible aura lasting around an hour happens in 10-30% of cases, and can precede or accompany head pain.3,6 Over 90 per cent of auras are visual, usually seen as a scintillating, expanding zigzag shape in the field of vision, with the central area temporarily blurred (scotoma). Parasthesia (pins and needles) is the next most common aura type, affecting one side of the body, face or tongue. Less common are speech disturbances, muscle weakness and impaired movement.3

A study of 1,298 patients carried out in German pharmacies suggests patients may not recognise migraine symptoms. Among those who were later assessed by the ICHD criteria as having migraine, 54 per cent had self-diagnosed migraine, but 30 per cent thought they had non-migraine headache. The rest were uncertain about any specific headache type. While 10 per cent of people with TTH reported experiencing nausea, or light/sound sensitivity, 96 per cent of people with migraine reported one or more of these symptoms.7

Migraine in children

Children may experience migraine differently to adults, with episodes of motion sickness, or sleep walking, night terrors or bruxism. Abdominal migraine may occur with no head pain, but present as a dull, non-specific moderate to severe pain lasting from two hours to three days. There may be cyclical vomiting syndrome with nausea and vomiting happening several times an hour.3

Vertigo can come on suddenly or there may be times when the child’s head tilts or rotates to one side from a few minutes to possibly days (benign paroxysmal torticollis). This is usually accompanied by gastric symptoms, a lack of coordination, or mood change.