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  • Migraine Diagnosis - Migraine
    lasting Non spreading aura Papilloedema Persistent headache in children Occipital headache in association with uncontrolled hypertension Signs or symptoms of ongoing neurological deficit between headaches I H S Diagnostic Criteria Once secondary headache has been ruled out the next step is to make the correct diagnosis of primary headache Headache diagnosis has been made easier by the International Headache Society I H S Diagnostic guidelines first published in 1988 and updated in 2004 More From This Section Diagnostic Resources Diagnosing Migraine Migraine Diagnostic Questionnaire 15 Key Questions GP Migraine Algorithm The Treatment of Migraine Patient Treatment Plan IHS Classification of Headache Disorders NICE Guidelines on read more Diagnosing Migraine I H S Criteria The I H S criteria for diagnosing Migraine are both inclusive certain features must be present and exclusive secondary headaches must first be ruled out The criteria are outlined below Please note that none of the features even headache are read more Tension Type Headache Tension type headache is the most common type of primary headache with a lifetime prevalence of up to 78 However episodic tension type headache requires little intervention from medical professionals as it rarely produces significant disability read more Cluster Headache Cluster headaches are primary headaches consisting of a severe stabbing pain that usually lasts between fifteen minutes and two hours and affect one side of the head usually around the eye Cluster headaches can occur several times per day and read more Chronic Daily Headache Chronic daily headache CDH is a descriptive term rather than a specific diagnosis It can evolve from any primary headache disorder or can be de novo Studies in the US and Europe indicate that 4 5 of the general population are affected by CDH read more Home Health Professionals and Migraine Migraine Diagnosis Migraine Diagnosis Migraine Diagnosis Headache is a very common condition The vast majority of headache resolves without need to consult a doctor In primary care the most commonly encountered headache disorders are Migraine Tension type Headache Chronic Daily Headache Cluster Headache These are all Primary Headache Disorders and account for almost all headache Only a tiny proportion of headache is secondary in nature i e due to a more serious underlying pathology However there are certain symptoms indicative of sinister headache that GPs should watch out for that may need referral Eliminating Secondary headache Warning signs that may indicate possible secondary headache Sudden onset Patients with a subarachnoid haemorrhage typically report having a sudden onset of severe headache The age of the patient Temporal arthritis typically occurs in older people and is extremely rare in individuals younger than 50 Primary headache disorders usually begin at a much younger age Associated symptoms Fever and neck stiffness may indicate Bacterial meningitis or Herpes simplex encephalitis Mental deterioration seizures or weakness of the extremities or face may be symptoms of brain tumors Recent head trauma Headaches soon after trauma to the head may be caused by subdural or epidural hematomas Worst headache Triggered by coughing sneezing Repetitive

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/migraine-diagnosis/ (2014-07-21)
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  • Diagnosing Migraine - Migraine
    3 of all migraine does not fit the standard diagnostic criteria for Migraine with Aura or Migraine without Aura Basilar Migraine Basilar artery migraine is a rare form of Migraine with Aura seen most commonly in young women and has an aura that is believed to be due to vertebro basilar ischaemia Features of the aura may include vertigo dysarthria ataxia diplopia bilateral visual impairment or sensory symptoms The headache associated with Basilar migraine is usually occipital Hemiplegic Migraine Hemiplegic Migraine is a rare form of Migraine and has two separate variations Familial Hemiplegic Migraine FHM which is a genetic condition linked to mutations of specific genes on chromosomes 1 and 19 Sporadic Hemiplegic Migraine SHM has no genetic link Both FHM and SHM usually begin in childhood and cease during adult years They also share the same symptoms Because the symptoms are also indicative of vascular disease a full neurological examination is necessary to rule out other causes and confirm the diagnosis In addition to the symptoms of typical migraine the following symptoms may present Episodes of prolonged aura up to several days or weeks Hemiplegia Impaired consciousness ranging from confusion to profound coma Headache which may begin before the hemiplegia or be absent Ataxia Status Migrainosus In this condition a patient often with a previous history of migraine suffers an unrelenting migraine 72 hours which is refractory to conventional therapy The pain is severe unilateral and throbbing Retinal Migraine Retinal Migraine is a rare form of migraine in which the patient experiences vascular spasm affects the vessels supplying blood to the eye resulting in a fully reversible visual loss Retinal migraine is a diagnosis of exclusion and embolic and other vascular diseases need to be ruled out Home Health Professionals and Migraine Migraine Diagnosis Diagnosing Migraine I H S Criteria Diagnosing Migraine I H S Criteria The I H S criteria for diagnosing Migraine are both inclusive certain features must be present and exclusive secondary headaches must first be ruled out The criteria are outlined below Please note that none of the features even headache are compulsory in order to make a diagnosis so the criteria should be used with a certain flexibility in practice Criteria for Diagnosing Migraine Without Aura A At least five attacks fulfilling B D B Attacks lasting 4 72 hours if untreated or unsuccessfully treated C Headache has at least two of the following characteristics Unilateral location Pulsating quality Moderate or severe pain intensity Aggravation by or causing avoidance of routine physical activity D During headache at least one of the following Nausea and or vomiting Photophobia Phonophobia E Headache not attributable to any other disorder Criteria for Diagnosing Migraine With Aura A At least two attacks fulfilling criteria B D B Aura consisting of at least one of the following but no motor weakness Fully reversible visual symptoms including positive features e g flickering lights spots or lines and or negative features i e loss of vision Fully reversible sensory symptoms including

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/migraine-diagnosis/diagnosing-migraine/ (2014-07-21)
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  • Tension-Type Headache - Migraine
    Tension type headache is the most common type of primary headache with a lifetime prevalence of up to 78 However episodic tension type headache requires little intervention from medical professionals as it rarely produces significant disability It usually presents as a low impact mild to moderate band like featureless headache Patients with frequent episodic tension type headache 1 15 days of TTH per month often have co existing Migraine without aura Patients should be educated to differentiate between the two disorders and encouraged to use a Headache Diary to record individual episodes so that treatment can be maximised and medication overuse headache avoided I H S Criteria for diagnosing episodic tension type headache A At least ten episodes occurring 15 days per month on average and fulfilling criteria B D B Headache lasting from thirty minutes to seven days C Headache has at least two of the following characteristics Bilateral location Pressing tightening non pulsating quality Mild to moderate intensity Not aggravated by routine physical activity D Both of the following No nausea or vomiting No more than one of photophobia or phonophobia E Not attributed to another disorder Home Health Professionals and Migraine Migraine Diagnosis Tension Type Headache Tension Type Headache Tension type headache is the most common type of primary headache with a lifetime prevalence of up to 78 However episodic tension type headache requires little intervention from medical professionals as it rarely produces significant disability It usually presents as a low impact mild to moderate band like featureless headache Patients with frequent episodic tension type headache 1 15 days of TTH per month often have co existing Migraine without aura Patients should be educated to differentiate between the two disorders and encouraged to use a Headache Diary to record individual episodes so that treatment can be maximised

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/migraine-diagnosis/tension-type-headache/ (2014-07-21)
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  • Cluster Headache - Migraine
    Diagnosis Cluster Headache Cluster Headache Cluster headaches are primary headaches consisting of a severe stabbing pain that usually lasts between fifteen minutes and two hours and affect one side of the head usually around the eye Cluster headaches can occur several times per day and characteristically come in clusters of attacks which can last weeks or months Individual clusters can be separated by periods of remission lasting months or years Age of onset is usually between 20 40 years Less than 0 5 of the population are affected and it is 3 4 times more common in men The causes of cluster headache are unclear but biochemical hormonal and vascular changes are known to induce individual attacks Attacks seem to be linked to changes in day length and may also be triggered during clusters only by alcohol tobacco histamine stress or exposure to nitroglycerine Decreased blood oxygen levels can also act as a trigger particularly during sleep About 10 20 of patients with Cluster Headache have Chronic Cluster Headache which is defined as attacks occurring for more than one year without remission or with remissions lasting for less than 1 month I H S Criteria for diagnosing Cluster Headache A At least five attacks fulfilling criteria B D B Severe or very severe unilateral orbital supraorbital and or temporal pain lasting 15 to 180 minutes if untreated C Headache is accompanied by at least one of the following Ipsilateral conjunctival injection and or lacrimation Ipsilateral nasal congestion and or rhinorrhoea Ipsilateral eyelid oedema Ipsilateral forehead an facial sweating Ipsilateral miosis and or ptosis A sense of restlessness or agitation D Attacks have a frequency of one every other day to eight per day E Not attributed to another disorder Home Health Professionals and Migraine Migraine Diagnosis Cluster Headache Cluster Headache Cluster headaches are primary headaches consisting of a severe stabbing pain that usually lasts between fifteen minutes and two hours and affect one side of the head usually around the eye Cluster headaches can occur several times per day and characteristically come in clusters of attacks which can last weeks or months Individual clusters can be separated by periods of remission lasting months or years Age of onset is usually between 20 40 years Less than 0 5 of the population are affected and it is 3 4 times more common in men The causes of cluster headache are unclear but biochemical hormonal and vascular changes are known to induce individual attacks Attacks seem to be linked to changes in day length and may also be triggered during clusters only by alcohol tobacco histamine stress or exposure to nitroglycerine Decreased blood oxygen levels can also act as a trigger particularly during sleep About 10 20 of patients with Cluster Headache have Chronic Cluster Headache which is defined as attacks occurring for more than one year without remission or with remissions lasting for less than 1 month I H S Criteria for diagnosing Cluster Headache A At least five attacks fulfilling

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/migraine-diagnosis/cluster-headache/ (2014-07-21)
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  • Chronic Daily Headache - Migraine
    over a period of at least six months Also known as transformed migraine patients usually have a history of migraine attacks that gradually worsen over a period of months or years The I H S criteria for diagnosing chronic migraine are outlined below Headache pain and the other symptoms usually associated with migraine become less severe as the frequency increases but also become less responsive to treatment As the nature of the headaches transform many patients will experience breakthrough migraine attacks on top of the background headache Like with CTTH the overuse of acute treatments for migraine including analgesics ergot derivatives and triptans can be responsible for transforming migraine into a chronic condition However the transformation may also occur as part of the natural history of the condition In cases of Chronic Migraine attention should be paid to the possible existence of comorbid conditions such as anxiety and depression both of which have been shown to be more frequent in patients who have migraine than in non migraine control subjects It is believed that migraine and depression share the same etiologies rather than the depression resulting from the disability caused by chronic migraine Some features of comorbid depression show improvement when the cycle of CDH is broken Treatment options for chronic migraine include Amitriptyline or Gabapentin The I H S Criteria for diagnosing Chronic Migraine A Headache fulfilling criteria B and C on 15 days a month for 3 months B Headache has at least two of the following characteristics Unilateral location Pulsating quality Moderate or severe pain intensity Aggravation by or causing avoidance of routine physical activity C During headache at least one of the following Nausea and or vomiting Photophobia Phonophobia D Not attributed to another disorder Home Health Professionals and Migraine Migraine Diagnosis Chronic Daily Headache Chronic Daily Headache Chronic daily headache CDH is a descriptive term rather than a specific diagnosis It can evolve from any primary headache disorder or can be de novo Studies in the US and Europe indicate that 4 5 of the general population are affected by CDH It is becoming more frequent in general practice and is a major reason for consultation in Headache Migraine clinics Like migraine CDH can significantly affect an individual s ability to function within the family in society and in the workplace In general headache occurring more often than fifteen days per month over at least six months and lasting for four hours a day can be considered CDH The leading cause is chronic tension type headache followed by chronic migraine Chronic Tension Type Headache People with chronic tension type headache CTTH usually have a history of episodic tension type headache but may have no history of migraine Many patients use excessive amounts of analgesics and they may also have concomitant depression CTTH usually present as diffuse or bilateral and frequently involve the posterior head and neck The I H S diagnostic criteria are outlined below The overuse of analgesics may convert episodic tension type headaches

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/migraine-diagnosis/chronic-daily-headache/ (2014-07-21)
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  • Impact of Migraine - Migraine
    line as well as paper versions are available for both The Headache Impact Test HIT The patient answers six questions relating to the severity and impact of their headache For each question there are five alternatives with a scoring scale from 6 to 13 points The higher the overall score the greater the impact on the patients life There are four levels of impact that an individual can fall under ranging from No Little impact to Very Severe The web based version formulates a personalised report based on the patients individual answers and a pool of collected data An interpretation of the score and suggested action steps are also recommended View Online Headache Impact Test The MIDAS Migraine Disability Assessment Score Consists of seven questions five of which are attributed scores and two that are included to provide qualitative information The five scoring questions calculate the number of days lost by the patient in Work education Household work Non work activities leisure social time The MIDAS score is calculated by adding up the total days lost in the last three months in each of the areas There are four grades of severity defined in terms of the disability suffered Treatment recommendations are given corresponding to each grade MIDAS Questionnaire Why use Impact Tests These tests have a number of key benefits for medical professionals and patients alike They are useful in summarising the effect of headache migraine on the individual Standardised approaches to measuring headache related disability They have both been validated and proved accurate They offer an opportunity to allow better communication between doctor and patient They are both easy to follow and access Patients can use the tests to see if their condition is improving or worsening Home Health Professionals and Migraine Impact of Migraine Impact of Migraine Background Information The impact of migraine is that it is the most common neurological condition in the world It is also the most frequently seen disabling headache in primary care In Ireland 12 15 of the population have migraine Only about half of these 500 000 people are actually diagnosed and even fewer are receiving treatment for their condition Because of this migraine continues to have a huge impact not only on people s professional social and family lives but also on the Irish economy in general Indeed it is this impact that distinguishes migraine from other benign headache disorders It is common for patients with severe migraine to say that the condition has taken control of their lives Many claim that at its height migraine is the worst pain they have ever experienced Despite the severity of the pain involved and the huge personal impact it has some people still do not seek treatment at all in the mistaken belief that headache disorders are untreatable or not recognised as real medical conditions The truth of the matter is that migraine is an increasingly well understood condition that can be effectively managed through primary care in the majority of cases

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/impact-of-migraine/ (2014-07-21)
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  • Diagnosing migraine
    Management Migraine at School Migraine and the Leaving Cert Other Headache Chronic Daily Headache Chronic Tension Headache Chronic Transformed Migraine Medication Overuse Headache Other Primary Headache Sinus Headache Benign Exertional Headache Ice Cream Headache Caffeine Withdrawal Headache Tension Headache Cluster Headaches THE MIGRAINE Association Of Ireland Providing information support and reassurance to migraine sufferers and those with other headache disorders THE MIGRAINE Association Of Ireland Providing information support and reassurance to migraine sufferers and those with other headache disorders Latest News Latest News and Research from the Migraine World 17th July 2014 Read our submission on chronic migraine and medical card eligibility 14th July 2014 Loss of funding may cost MAI one third of staff 26th June 2014 Take this important survey on chronic migraine and medical card eligibility View All News Become a Member Sign up or Log in Events Upcoming Events from the MAI No events View All Events Home Health Professionals and Migraine Migraine Diagnosis Diagnostic Resources Diagnostic Resources Diagnosing Migraine Migraine Diagnostic Questionnaire 15 Key Questions GP Migraine Algorithm The Treatment of Migraine Patient Treatment Plan IHS Classification of Headache Disorders NICE Guidelines on Headache Home Health Professionals and Migraine Migraine Diagnosis Diagnostic Resources Diagnostic Resources Diagnosing Migraine Migraine Diagnostic Questionnaire 15 Key Questions GP Migraine Algorithm The Treatment of Migraine Patient Treatment Plan IHS Classification of Headache Disorders NICE Guidelines on Headache Donate Now Will you help us to continue our work We are only too aware of the devastating impact migraine can have upon a person s life There are half a million migraine sufferers in Ireland and we cannot reach them all without your support Please note that no fundraised money goes towards salaries Below are some of the things your donations will allow us to do Update and reprint our information leaflets

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/migraine-diagnosis/diagnosing-migraine-diagnostic-resources/ (2014-07-21)
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  • The Migraine Attack - Migraine
    World 17th July 2014 Read our submission on chronic migraine and medical card eligibility 14th July 2014 Loss of funding may cost MAI one third of staff 26th June 2014 Take this important survey on chronic migraine and medical card eligibility View All News Become a Member Sign up or Log in Events Upcoming Events from the MAI No events View All Events Home Health Professionals and Migraine The Migraine Attack The Migraine Attack The Migraine Attack The typical migraine attack is split into four phases Prodrome Aura Headache Phase Postdrome Not every patient will experience all four phases and even in patients that do the phases can vary from one attack to the next More From This Section Migraine Prodrome Migraine Prodrome Although the migraine Prodrome occurs hours or even days before the headache begins it is considered to be an integral component of the migraine process It often acts as a warning sign that a migraine is imminent About 60 of read more Migraine Aura Migraine Aura The migraine aura phase involves the occurrence of one or more fully reversible focal neurological symptoms It is experienced by about 20 of migraine sufferers although not all patients with Migraine with Aura will experience read more Headache Phase The headache phase is the most disabling feature of a migraine attack and is the most common reason for consultation Typically the following characteristics apply Headache lasts from 4 72 hours Moderate or severe pain Usually gradual in read more Migraine Postdrome Migraine Postdrome The postdromal or resolution phase follows the headache and may last for up to 48 hours Many of the symptoms of this phase appear initially during the prodrome or with the headache phase Typically these read more Home Health Professionals and Migraine The Migraine Attack The Migraine Attack The Migraine Attack The typical migraine attack is split into four phases Prodrome Aura Headache Phase Postdrome Not every patient will experience all four phases and even in patients that do the phases can vary from one attack to the next More From This Section Migraine Prodrome Migraine Prodrome Although the migraine Prodrome occurs hours or even days before the headache begins it is considered to be an integral component of the migraine process It often acts as a warning sign that a migraine is imminent About 60 of read more Migraine Aura Migraine Aura The migraine aura phase involves the occurrence of one or more fully reversible focal neurological symptoms It is experienced by about 20 of migraine sufferers although not all patients with Migraine with Aura will experience read more Headache Phase The headache phase is the most disabling feature of a migraine attack and is the most common reason for consultation Typically the following characteristics apply Headache lasts from 4 72 hours Moderate or severe pain Usually gradual in read more Migraine Postdrome Migraine Postdrome The postdromal or resolution phase follows the headache and may last for up to 48 hours Many of the symptoms of this

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/the-migraine-attack/ (2014-07-21)
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