Although migraine is thought by many to be a severe headache, the term is actually used for a characteristic presentation thereof involving a throbbing headache, phonophobia (fear of sounds), photophobia (fear of light), and vomiting that lasts between 4 and 72 hours. The pain is aggravated by movement. A prodrome of behavioral changes, irritability, and malaise is experienced by some patients, with as many as 20% of the patients also experiencing a visual or sensory aura. Migraine tends to occur before middle age with greater prevalence in women (20% of all women) than men (6% of all men).
Avoidance of identified triggers is essential for preventing attacks. Acute attacks of migraine are managed with NSAIDs such as aspirin; antiemetics such as domperidone and metoclopramide may be required when nausea is also present. Severe migraine is usually treated by increasing the number of ‘triptans’, with drugs such as sumatriptan offering oral, subcutaneous, and nasal administration pathways.