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Up to 90% of the general population reported experiencing headaches at some point in their lives. At any given point in time, up to 10% of the general population seeks medical treatment for the relief of disabling headaches, and over 40% of North Americans have experienced severe headaches at some point in their lives. Headache is a complex phenomenon, the pathophysiology of which is migrain.
Migrain sometimes has dramatic features of transient neurologic deficits, blinding headaches, nausea, and vomiting. Migrain is much more common in women than men, runs in families, and is usually a disorder of young, primarily healthy women. Out of the several categories of migraine headaches.
Migraine with aura and migrain without without aura is far more "common" than migraine with aura. Aura are usually visual, but may Auras should typically last from 5 to 60 minutes in most patients and represent progressive neurologic deficit with subsequent complete recovery. They usually precede the actual headache attack. Migrain headaches commonly begin early in the morning but may occur at any time of the day or night. Nocturnal headaches, awakening the patient from sleep, characteristically occur in cluster headaches but have also been reported with migraine. However, in a patient with the recent onset of nocturnal headaches, brain tumor and glaucoma should be excluded by thorough neurologic and ophthalmologic evaluation and with appropriate imaging studies.
During severe attacks, headache is lateralized in 60-70% of the patients followed by bi-frontal or global headache in up to 30%; occasionally other locations, including bi-occipital headaches are described. Pain is usually associated with nausea, photophobia, phonophobia, and occasional vomiting. Headache is usually gradual in onset and follows a crescendo pattern which persists typically for 4 to 72 hours, with gradual but complete resolution. The headache is usually dull, deep and steady when mild to moderate and becomes throbbing or pulsatile when severe. Migraine headaches are worsened by rapid head motion, sneezing, straining, constant motion or physical exertion thereby leading many migrain sufferers to lie down in a dark, quiet room. Some migraine sufferers can abort their headaches.
Phenomenon of prodrome should be separated from the aura. Prodromes can last from hours to days, and are usually associated with changes in mood, appetite, and fluid retention. Although autonomic features characteristically occur in cluster headaches, they can also occur in 10-20% of migraine patients. These symptoms may include nasal stuffiness, rhinorrhea, tearing, skin color and temperature change, and changes in pupil.