Migraine headache is characterized by recurring episodes of throbbing head pain, frequently unilateral.
Up to 79% of patients with migraines have premonitory symptoms (not to be confused with aura) in the hours or days before headache onset. Neurologic symptoms (phonophobia, photophobia, hyperosmia, and difficulty concentrating) are most common, but psychological (anxiety, depression, euphoria, irritability, drowsiness, hyperactivity, and restlessness), autonomic (eg, polyuria, diarrhea, and constipation), and constitutional (eg, stiff neck, yawning, thirst, food cravings, and anorexia) symptoms may also occur.
A migraine aura is experienced by approximately 25% of patients with migraines. Aura evolves over 5–20 minutes and lasts less than 60 minutes. Headache usually occurs within 60 minutes of the end of the aura. Visual auras can include both positive features (eg, scintillations, photopsia, teichopsia, and fortification spectrum) and negative features (eg, scotoma and hemianopsia). Sensory symptoms such as paresthesias or numbness of the arms and face, dysphasia or aphasia, weakness, and hemiparesis may also occur.
Migraine headache may occur at any time but usually occurs in the early morning. Pain is usually gradual in onset, peaking in intensity over minutes to hours and lasting 4–72 hours. Pain is typically in the frontotemporal region and is moderate to severe. Headache is usually unilateral and throbbing with GI symptoms (eg, nausea and vomiting) almost invariably accompanying the headache. Other systemic symptoms include anorexia, constipation, diarrhea, abdominal cramps, nasal stuffiness, blurred vision, diaphoresis, facial pallor, and localized facial, scalp, or periorbital edema. Sensory hyperacuity (photophobia, phonophobia, or osmophobia) is frequent. Many patients seek a dark, quiet place.
Once the headache pain wanes, a resolution phase characterized by exhaustion, malaise, and irritability ensues.