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Migraine Criteria

A common migraine headache, also known as a migraine without aura, is defined by the specific criteria found below.

Frequency
The patient must have at least five of these headaches.

Duration
The headache, excluding attendant symptoms or prodromes, must last a minimum of four hours, up to seventy-two hours.  Headaches that last over seventy-two hours generally require immediate medical attention in order to rule out other, more dangerous conditions.

Pain Descriptors
In order to be classed as a migraine a headache must include at least two of four different qualities of pain:

1) The pain is one-sided; the headache is primarily on one side of the head.
2) The pain is not constant; it throbs, pounds, or pulsates.
3) The pain must be of moderate or severe intensity, to the point where the sufferer is inhibited in daily activity, potentially to the point of being temporarily disabled.
4) The pain is increased, sometimes only slightly, by routine physical activity like bending over, climbing stairs, or moving quickly.

Side Effects

Headache pain must be accompanied at least one of four common side effects:
1) Nausea
2) Vomiting
3) Photophobia – sensitivity to light
4) Phonophobia – sensitivity to sound

Secondary Exclusions
Appropriate medical testing, such as a MRI or CAT scan, and/or a physician’s exam must be conducted to rule out other conditions that may have caused the headache.
These criteria have helped simplify the diagnosis of migraine for many.  However, because migraines are historically associated with extremely high levels of pain, people suffering from moderate migraine may not realize that is what they are experiencing.

Migraine Stages

Migraines develop in four stages.  Patients with migraines with aura, also known as classic migraines, are most likely to experience all four stages.  Patients who have common migraines, migraines without aura, will have the same stages, but are not consciously aware of them.  The interval between migraines is sometimes referred to as the fifth stage of a migraine.

Stage One – Prodrome
The prodromal phase usually begins one or two days prior to the actual migraine headache.  Many migraineurs call this the “premonition” phase.  Feelings during this phase are all over the map.  Each migraineur has their own personal prodrome profile.  Some are giddy, happy, and full of energy, far more so than usual.  Others feel a headache start with fatigue, weakness, and irritability.  Anything can herald a migraine and each person has to learn their own prodrome signs if they want to learn to stave off the migraine.

Stage Two – Aura
This phase is skipped by most migraineurs, since most migraineurs suffer from common migraine, migraine without aura.  For those who experience classic migraine with aura, auras can begin anywhere from five minutes to an hour before the headache begins.  Auras are visual effects migraineurs experience.  Objects appear to have bright auras or haloes around them.  Lightning flashes arc over the field of vision until sight is whited out just before the pain begins.

Stage Three -  Headache
This phase lasts anywhere from four to seventy-two hours.  Most common is a one-sided headache with a throbbing or pulsing characteristic.  The headache is frequently accompanied by stomach upset, nausea, vomiting, and sensitivity to light, sound, smell, or some combination of the three.

Stage Four – Postdrome
Coming away from a migraine can be as unpleasant as building up to one.  Postdrome is often characterized by tenderness of the head, neck, and stomach.  Weakness and fatigue are also common in this phase.

These criteria have helped simplify the diagnosis of migraine for many.  However, because migraines are historically associated with extremely high levels of pain, people suffering from moderate migraine may not realize that is what they are experiencing.  

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