The term migraine is derived from the Greek word hemikrania. This term was corrupted into low Latin as hemigranea, which eventually was accepted by the French translation as migraine.
Migraine was previously considered a vascular phenomenon that resulted from intracranial vasoconstriction followed by rebound vasodilation. Currently, however, the neurovascular theory describes migraine as primarily a neurogenic process with secondary changes in cerebral perfusion.
Approximately 70% of patients have a first-degree relative with a history of migraine. In addition, a variety of environmental and behavioral factors may precipitate migraine attacks in persons with a predisposition to migraine.
The classic migraine episode is characterized by unilateral head pain preceded by various visual, sensory, motor symptoms, collectively known as an aura. Most commonly, the aura consists of visual manifestations such as scotomas, photophobia, or visual scintillations (eg, bright zigzag lines).
In practice, however, migraine headaches may be unilateral or bilateral and may occur with or without an aura. In the current International Headache Society (IHS) categorization, the headache previously described as classic migraine is now known as migraine with aura, and that described as common migraine is now termed migraine without aura. Migraines without aura are the most common, accounting for more than 80% of all migraines.
The diagnosis of migraine is clinical in nature, based on criteria established by the International Headache Society. A full neurologic examination should be performed during the first visit; the findings are usually normal. Neuroimaging is not necessary in a typical case.
Migraine treatment involves acute (abortive) and preventive (prophylactic) therapy. Patients with frequent attacks usually require both. Measures directed toward reducing migraine triggers are also generally advisable.
Acute treatment aims to stop or prevent the progression of a headache or reverse a headache that has started. Preventive treatment, which is given even in the absence of a headache, aims to reduce the frequency and severity of the migraine attack, make acute attacks more responsive to abortive therapy, and perhaps also improve the patient's quality of life.
Medication Summary
Pharmacologic agents used for the treatment of migraine can be classified as abortive (ie, for alleviating the acute phase) or prophylactic (ie, preventive).
Abortive medications include the following:
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Selective serotonin receptor (5-HT1) agonists (triptans)
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Ergot alkaloids
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Analgesics
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Nonsteroidal anti-inflammatory drugs (NSAIDs)
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Combination products
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Antiemetics
Prophylactic medications include the following:
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Antiepileptic drugs
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Beta-blockers
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Tricyclic antidepressants
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Calcium channel blockers
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Selective serotonin reuptake inhibitors (SSRIs)
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NSAIDs
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Serotonin antagonists
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Botulinum toxin
