Migraine Definitions

Site hosted by Angelfire.com: Build your free website today!

Michael Poon's Shrine of Neurology

HOME

CONTENTS

CONTACT US

Migraine Definitions

05 November 2004

ATTACHMENT A

HEADACHE RED ALERTS

Onset over age 50	consider giant cell arteritis, mass lesion, stroke
Very sudden onset	consider SAH, pituitary apoplexy, haemorrhage into mass lesion
Onset following head trauma	consider subdural/epidural haemorrhage
Progressively increasing frequency severity over weeks - months	consider mass lesions / subdural / analgesic rebound
new onset in patient with HIV or cancer	consider meningitis / abscess / metastasis
signs of systemic illness (fever, neck flexion stiffness, rash)	consider systemic infection / meningitis / encephalitis / vasculitis
focal neurological symptoms / signs (except typical aura)	consider mass lesions/stroke
first ever headache with focal neurological symptoms or signs (especially persisting for >1 hour)	consider stroke
papilloedema	consider mass lesion, pseudotumour cerebri

ATTACHMENT B

MODIFIED CRITERIA FOR MIGRAINE

1. History of recurrent headache in past, with several episodes showing

A. at least moderate severity (stops ongoing activities)

B. Untreated duration 4-72 hrs, and either 2) or 3)

2. At least one of A, B, or C

A. throbbing quality

B. unilaterality

exacerbation by physical activity/head movement

AND at least one of D or E

C. nausea and/or vomiting

D. photophobia/phonophobia

3. Typical aura with at least 2 attacks, with all of following features

A. develops or spreads over 4-60 minutes

B. lasts < 60 minutes

C. fully reversible

D. followed by headache within 60 minutes of resolution

ATTACHMENT C

CRITERIA FOR CLUSTER HEADACHE

Several similar previous attacks, each consisting of

1. Severe unilateral orbital/supraorbital/temporal pain lasting 15 min - 3 hrs untreated, with

II. at least one of the following unilateral signs on the same side as the pain:-

A. conjunctival injection

B. lacrimation

C. nasal congestion/rhinorrhoea

D. miosis

E. ptosis

F. eyelid oedema

G. forehead and facial sweating

and

III. A frequency of attacks from one every 2nd day to 8 per day

Notes-

i) A previous bout lasting 1 week to 1 year (usually 2 weeks to 3 months), with a headache-free period of at least 2 weeks (usually months to years) before the current bout adds certainty to the diagnosis.

ii) Typical cluster headache patient is male (5-8: 1), with onset between 20 & 50 years.