Migraine

The cause of Migraine is unknown, but evidence indicates a
functional disturbance of cranial circulation. Prodromal
symptoms (e.g. flashes of light) are probably due to
intracerebral vasoconstriction, and the head pain to
dilation of extracerebral cranial arteries.
 
Migraine may occur at any age, usually beginning between
ages 10 and 30. Women are affected more frequently than
men. Remission not uncommonly occurs after age 50. 

Headache is usually the presenting symptom. It may be
preceded by a short period of depression, irritability,
restlessness, or anorexia, and in a few cases by visual
field defects. These symptoms may disappear shortly before
the headache appears or they may persist and merge with it.
Pain is usually generalized but not infrequently is
confined to one side of the head. Symptom in an individual
case are apt to follow a pattern, except that a patient
with unilateral headache often has the pain on the right
side in some attacks, on the left in others. Patients may
have attacks daily or only once in several months. 

An untreated attack of migraine may last for hours or days.
Nausea, vomiting are common. The extremities are cold and
the patient is irritable and desires seclusion. 

Various procedures have been recommended for decreasing the
frequency of attacks ( foreign protein infections, diet,
hormones, histamine, sedatives and operative procedures on
cranial arteries). None is specific, and relief depends
largely o the enthusiasm of the physician and the patient's
confidence in him/her. The most effective prophylaxis is
systematic psychotherapy.
 
Aspirin or codeine may alleviate mild attacks. In severe
attacks, only ergot derivatives offer relief and usually
only if taken before the headache has lasted 2 hr.