Daily Bolus of LR: Migraine Types

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February 7, 2011 by dailybolusoflr

·         Migraine without aura, or common migraine, is the most common type of migraine and constitutes about 80% of migraine type headaches.
·         Migraine with aura, or classic migraine, is seen less frequently.
·         Patients typically develop headache symptoms after the aura has resolved.
·         The only difference between these two types of headaches is the presence of a preceding aura.
o   These auras are typically focal neurologic symptoms and are most commonly visual.
o   They last for 10 to 20 minutes (rarely up to 1 hour) and then fully resolve.
o   They are commonly characterized as a bright rim of light around an area where vision has been lost (scintillating scotomas); a “zigzagged” wall that moves slowly across the field of vision (fortification spectrums); a flash of light or brief spark (photopsias); or simply blurred vision.
Signs and Symptoms
·         Migraine headaches are often described as unilateral, pulsating, and of moderate to severe intensity.
·         Patients often have associated symptoms that can include nausea, vomiting, photophobia (light), phonophobia (sound), osmophobia (odor) or lightheadedness.
·         Cognitive impairment, although rare, can occur. Despite this known occurrence, patients with cognitive impairment should still be evaluated for other more concerning etiologies of altered mental status and headache.

Alternative Types
            Basilar Type
o   Basilar type migraines begin with an aura affecting neurologic functions of the brainstem.
o   These patients may have visual disturbance, at times as severe as blindness, dysarthria, vertigo, tinnitus, paresis and altered levels of consciousness.
o   Like other auras, these symptoms should completely resolve within an hour.
Hemiplegic Type
o   Hemiplegic migraines begin with an aura that causes a hemiplegia, often associated with sensory changes.
o   The motor findings march slowly while affecting additional muscle groups, unlike a stroke, in which the motor function is affected at the same time.
o   These symptoms resolve within the hour and are followed by a classic headache.
Ophthalmoplegic migraines
o   Ophthalmoplegic migraines are a rare type of migraine which involves unilateral headache and ocular nerve findings.
o   The most commonly affected cranial nerve is the third nerve and can lead to both motor deficits and pupillary findings.
o   As in other cases where focal neurologic findings are noted, patients should be evaluated for acute intracranial pathology.
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions

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