Migraine without aura: Symptoms and diagnosis.
Migraine Without Aura: Symptoms and Diagnosis
Migraine without aura is the most common type of migraine, accounting for the majority of migraine cases. Unlike migraines with aura, this type does not involve the sensory disturbances or neurological symptoms that precede the headache phase. However, it can still be debilitating and significantly impact a person’s quality of life.
Symptoms of Migraine Without Aura
The symptoms of migraine without aura can vary in intensity and duration, but they generally include the following:
1. Headache Pain
- Location: Typically, the pain is unilateral (occurring on one side of the head), but it can affect both sides in some cases.
- Quality: The pain is often described as throbbing or pulsating, which distinguishes it from other types of headaches like tension headaches.
- Intensity: The pain ranges from moderate to severe and can worsen with physical activity, such as walking, climbing stairs, or any other exertion.
2. Associated Symptoms
- Nausea and Vomiting: Nausea is a common symptom, and it can be accompanied by vomiting or a feeling of queasiness.
- Photophobia: Sensitivity to light, where even normal light levels can be uncomfortable or painful.
- Phonophobia: Sensitivity to sound, where everyday noises can feel excessively loud and distressing.
- Osmophobia: Sensitivity to smells, where normal odors become overwhelming and unpleasant.
- Neck Stiffness or Pain: Some individuals experience tension or discomfort in the neck during a migraine.
- Fatigue: Fatigue or exhaustion often accompanies a migraine attack and can linger after the headache subsides.
3. Prodrome (Pre-Headache Phase)
- Mood Changes: Irritability, depression, or euphoria may occur hours or days before the migraine begins.
- Food Cravings: Some people experience unusual cravings for certain foods.
- Neck Stiffness: A feeling of tightness or discomfort in the neck may occur.
- Increased Thirst or Urination: These can be early signs that a migraine is approaching.
- Yawning: Frequent yawning, unrelated to tiredness, can be an early symptom.
4. Postdrome (Post-Headache Phase)
- Fatigue and Weakness: After the headache resolves, many people feel drained and fatigued.
- Cognitive Difficulties: Difficulty concentrating, feeling “foggy,” or confusion can occur after the migraine.
- Mood Changes: Some individuals feel unusually happy or euphoric after a migraine, while others may feel depressed or irritable.
Diagnosis of Migraine Without Aura
Diagnosing migraine without aura typically involves a thorough medical history, a detailed description of symptoms, and a physical and neurological examination. The diagnosis is often made based on specific criteria outlined by the International Classification of Headache Disorders (ICHD).
Diagnostic Criteria for Migraine Without Aura (ICHD-3)
According to the ICHD-3, a diagnosis of migraine without aura requires the following:
- At least five attacks fulfilling the following criteria:
- Duration: The headache lasts 4 to 72 hours (untreated or unsuccessfully treated).
- Headache characteristics: The headache has at least two of the following features:
- Unilateral location (on one side of the head).
- Pulsating quality (throbbing or beating).
- Moderate or severe pain intensity.
- Aggravation by or causing avoidance of routine physical activity (e.g., walking, climbing stairs).
- During the headache, at least one of the following:
- Nausea and/or vomiting.
- Photophobia and phonophobia (sensitivity to light and sound).
- Exclusion of other disorders: The headache is not better accounted for by another diagnosis. This often involves ruling out other causes of headaches, such as tension-type headaches, cluster headaches, or secondary headaches caused by underlying medical conditions.
Additional Considerations
- Medical History: The doctor will ask about the frequency, duration, and characteristics of the headaches, as well as any associated symptoms. Family history of migraines is also important, as migraines often run in families.
- Physical and Neurological Exam: A neurological examination is usually normal in individuals with migraine without aura, but it’s important to rule out other conditions.
- Imaging: In most cases, brain imaging (MRI or CT scan) is not necessary unless there are unusual symptoms, an atypical headache pattern, or other concerning features that suggest a different underlying condition.
Conclusion
Migraine without aura is a common and often debilitating type of migraine. It is characterized by throbbing, unilateral headache pain accompanied by nausea, photophobia, and phonophobia, without the preceding aura phase. Proper diagnosis relies on meeting specific clinical criteria and ruling out other potential causes of the symptoms. If someone experiences frequent or severe headaches, they should consult a healthcare provider for an accurate diagnosis and appropriate treatment plan.
