Classical migraine

Alternative names:

Migraine (classical); migraine headache, migraine with aura

Definition:

A disorder involving repeated or recurrent headache, associated with temporary changes in the diameter of the blood vessels in the head. "Classic" migraine headaches refer to those migraine headaches that are preceded by a visual disturbance called an aura. This type of migraine is to be differentiated from "common" migraines (no warning or aura) or "complicated" migraines (associated with non-visual neurological symptoms such as disturbances in speech, movement, or sensory perception).

Causes, incidence, and risk factors:

Headaches are a frequent cause of lost productivity and a common reason for seeking medical attention. Migraines are a common type of chronic headache, affecting about 6 out of 100 people. Migraines most commonly occur in women with onset between the ages of 10 and 46 years. They appear to run in families in some cases. Classical migraine accounts for about one-sixth of all migraines. Common migraine and other (rare) forms account for the rest.

The symptoms of migraine may occur as a result of changes in blood vessel diameter. Initially, constriction or spasm of blood vessels to the brain and surrounding structures may decrease blood flow to these areas. This can result in neurological symptoms other than headache, including visual changes, difficulty speaking, weakness or numbness of one part of the body, tingling sensations, and others. Many patients with migraine become accustomed to these symptoms prior to a headache (called an aura) and may take measures to reduce the severity of the subsequent headache (see treatment). Minutes to hours later, the blood vessels dilate (enlarge), resulting in the severe headache. Classical migraine specifically refers to those migraines preceded by visual symptoms.

Migraines have a multifactorial etiology. There are clear hereditary factors and environmental triggers contributing to a cascade of events causing abnormal blood vessel caliber and inflammation and resulting in the ensuing symptoms. Attacks of migraine headache may be associated with allergic reactions, bright lights, loud noises, physical or mental stress, changes in sleep patterns, smoking or exposure to tobacco smoke, missed meals, alcohol, caffeine, hormonal fluctuations (related to menstrual cycles or use of birth control pills), and other conditions. Foods associated with migraine include foods containing the amino acid tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, some beans), chocolates, nuts, peanut butter, fruits (avocado, banana, citrus fruit), onions, dairy products, baked goods, meats containing nitrates (bacon, hot dogs, salami, cured meats), foods containing monosodium glutamate ("MSG" - an additive in many foods), and any processed, fermented, pickled, or marinated foods.

Update Date: 05/08/00
Joseph Campellone, M.D., Assistant Professor of Neurology (Department of Medicine) Robert Wood Johnson Medical School, New Jersey. Director, Neurophysiology Laboratory, Cooper Hospital.VeriMed Healthcare Network