Neurology · MU Sofia

87. Migraine and other forms of primary headaches

Covers primary headache disorders, with migraine as the main focus: its neurovascular pathophysiology, the without-aura and with-aura types, clinical features, duration, associated symptoms, triggers, diagnosis and acute and preventive drugs. Also outlines tension-type headache and cluster headache, including the autonomic signs and the oxygen and verapamil treatments specific to cluster headache.

Inside: 4 sections · 16 flashcards · 2 min

Topic 87 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 4 sections, about 282 words (2 min of reading), with 16 flashcards.

In this note

  1. Migraine and other forms of primary headaches
  2. Migraine
  3. Tension-Type Headache
  4. Cluster Headache (Trigeminal Autonomic Cephalalgia)

Migraine and other forms of primary headaches

Definition: Primary headaches are headache disorders not caused by structural, metabolic, or systemic disease. The main types are:

  • Migraine: Tension-type headache. Trigeminal autonomic cephalalgias (e.g., cluster headache)

Migraine

Definition: Migraine is a recurrent, neurovascular headache disorder characterized by moderate to severe, usually unilateral, pulsating headache, often associated with nausea, vomiting, and sensitivity to light and sound.

Pathophysiology

  • Trigeminovascular system activation
  • Release of CGRP (calcitonin gene-related peptide)
  • Neurogenic inflammation
  • Cortical spreading depression (especially in aura)

Types of Migraine

1. Migraine without aura (most common): Recurrent headache attacks. No neurological symptoms before headache

2. Migraine with aura

  • Aura precedes headache: Visual (flashes, zigzag lines). Sensory (tingling). Speech disturbance
  • Clinical Features: Headache Characteristics. Unilateral (can become bilateral). Pulsating/throbbing. Moderate to severe intensity
  • Duration: 4–72 hours
  • Worsened by physical activity
  • Associated Symptoms: Nausea. Vomiting. Photophobia. Phonophobia
  • Aura (if present): Visual disturbances (most common). Sensory symptoms. Motor symptoms (rare)

Examination: Usually normal neurological examination. May show photophobia during attack

Triggers: Stress. Sleep deprivation. Hormonal changes (menstruation). Certain foods (chocolate, alcohol). Bright light

Diagnosis: Clinical diagnosis (based on ICHD criteria). Neuroimaging only if atypical features

Treatment

  • Acute Treatment: NSAIDs. Triptans (e.g., sumatriptan). Antiemetics
  • Preventive Treatment: Beta-blockers (propranolol). Antiepileptics (topiramate). Antidepressants (amitriptyline). CGRP inhibitors

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