common migraine

Last edited 11/2020 and last reviewed 01/2023

The common migraine syndrome is the most common - it is now termed migraine without aura. In this syndrome there is no true aura, but there may be prodromal symptoms.

The headache seen in common migraine has the same features as that seen in classical migraine, i.e. it is a throbbing headache that it is usually localised over one eye, occipitally or generalised.

• recurrent headache disorder manifesting in attacks lasting 4–72 hours
• typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia

Nausea and vomiting are the prominent accompanying features of a common migraine headache.

Diagnostic criteria:

A. At least five attacks fulfilling criteria B–D

B. Headache attacks lasting 4–72 hours (when untreated or unsuccessfully treated)

C. Headache has at least two of the following four characteristics:
1. unilateral location
2. pulsating quality
3. moderate or severe pain intensity
4. aggravation by or causing avoidance of routine physical activity (e.g. walking or climbing stairs)

D. During headache at least one of the following:
1. nausea and/or vomiting
2. photophobia and phonophobia

E. Not better accounted for by another ICHD-3 diagnosis

Notes:

• when the patient falls asleep during a migraine attack and wakes up without it, duration of the attack is reckoned until the time of awakening
• in children and adolescents (aged under 18 years), attacks may last 2–72 hours (the evidence for untreated durations of less than two hours in children has not been substantiated)
  
  
• site of migraine headache:
• migraine headache in children and adolescents (aged under 18 years) is more often bilateral than is the case in adults; unilateral pain usually emerges in late adolescence or early adult life
• s usually frontotemporal
• occipital headache in children is rare and calls for diagnostic caution
• a subset of otherwise typical patients have facial location of pain, which is called ‘facial migraine’ - no evidence that these patients form a separate
  subgroup of migraine patients
  
  
• prodromal symptoms
• may begin hours or a day or two before the other symptoms of a migraine attack without aura
• unclude various combinations of fatigue, difficulty in concentrating, neck stiffness, sensitivity to light and/or sound, nausea, blurred vision, yawning and pallor
• most commonly feeling tired or weary, difficulty with concentration and neck stiffness, may follow resolution of the headache, persisting for up to 48 hours


• menstrul association
• a minority (<10%) of women have attacks of migraine in association with the majority of their menstrual cycles
• most such attacks are without aura
• attacks during menstruation tend to be longer and accompanied by more severe nausea than attacks outside the menstrual cycle

Reference:

• Ashina M. Migraine. N Engl J Med 2020;383:1866-76. DOI: 10.1056/NEJMra1915327
• Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia 2018; 38: 1-211
• NICE (September 2012). Headaches - Diagnosis and management of headaches in young people and adults