Migraine classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Classification

Migraines have been classified by the International Headache Society which periodically revises their classification.

Defining Severity of Pain

In addition to classifying the type of headache, the International Headache Society defines intensity of pain on a verbal 4 point scale:

• 0 no pain
• 1 mild pain 'does not interfere with usual activities'
• 2 moderate pain 'inhibits, but does not wholly prevent usual activities'
• 3 severe pain 'prevents all activities'

Migraine Without Aura

Aslo known as common migraine or hemicrania simplex is a recurrent headache that lasts 4-72 hours. It is characterized by unilateral location, pulsating quality, moderate to severe intensity, worsens with physical activity and can be associated to nauseas, vomiting and photophobia. In order to diagnose migraine without aura, there must have been at least five attacks not attributable to another cause that fulfill the following criteria

1. Headache attacks lasting 4-72 hours

2. At least two of the following characteristics

• Unilateral location
• Pulsating quality
• Moderate or severe pain intensity
• Aggravation by or causing avoidance of routine physical activity

3. During the headache there must be at least one of the following associated symptom clusters

• Nausea and/or vomiting
• Photophobia and phonophobia

When these criteria are not fully met, the problem may be classified as "probable migraine without aura" but other diagnoses such as "episodic tension type headache" must also be excluded.

Migraine With Aura

Also known as classic migraine, is the second most commonly seen form of migraine: patients who primarily suffer from migraine with aura may also have attacks of migraine without aura. Migraine with aura is a recurrent condition in which the attacks are manifested as reversible focal neurologic signs that progress over 5-20 minutes, lasting for less than 60 minutes. After the aura symptoms the headache with the same description as the headache in migraine without aura starts. Less commonly, the aura may occur without a subsequent headache or the headache may be non-migrainous in type. In order to diagnose migraine with aura, there must have been at least two attacks not attributable to another cause that fulfill the following criteria.

1. Aura consisting of at least one of the following, but no muscle weakness or paralysis

• Fully reversible visual symptoms (e.g. flickering lights, spots, lines, loss of vision)

• Fully reversible sensory symptoms (e.g. pins and needles, numbness)

• Fully reversible dysphasia

2. Aura has at least two of the following characteristics

• Visual symptoms affecting just one side of the field of vision and/or sensory symptoms affecting just one side of the body

• At least one aura symptom develops gradually over more than 5 minutes and/or different aura symptoms occur one after the other over more than 5 minutes

• Each symptom lasts from 5-60 minutes

Where these criteria are not fully met, a diagnosis of "probable migraine with aura" may be considered, although other neurological causes must also be excluded.

If the picture complies with the criteria but includes one-sided muscular weakness or paralysis, a diagnosis of "sporadic hemiplegic migraine" or "familial hemiplegic migraine" should be considered.

Typical Aura With Migraine Headache

Is a typical aura involving visual and/or sensory and/or speech symptoms, lasting no more than 60 minutes. The aura is characterized by complete reversibility of the symptoms, which is associated with headache fulfilling the criteria for migraine without aura. It begins during the aura or follow the aura within 60 minutes and is not attributed to another disorder.

Typical Aura with non-Migraine headache

Is a typical aura involving visual and/or sensory and/or speech symptoms, lasting no more than 60 minutes. The aura is characterized by complete reversibility of the symptoms, which is associated with headache that does not fulfil the criteria for migraine without aura.

Typical Aura without headache

Is a typical aura involving visual and/or sensory and/or speech symptoms, lasting no more than 60 minutes. The aura is characterized by complete reversibility of the symptoms, which is not associated with headache.