Clinical Features

Migraine is characterized by recurrent attacks and may occur with aura (∼ 25% of cases) or without aura (∼ 75% of cases). A typical migraine attack passes through four stages, and the aura (if present) typically occurs before the headache. However, migraine patterns may differ and not follow the characteristic stages.

• 24–48 hours before the headache starts

• Excessive yawning

• Difficulties with writing or reading

• Sudden hunger or lack of appetite

• Mood changes

Paroxysmal, focal, neurological symptoms that precede (or, in some cases, occur during) the headache.

• Typical aura [9][10]

  • Visual disturbances, sensory and/or speech symptoms (positive and/or negative )

    • Scintillating scotoma: an arch-shaped scotoma that starts centrally and shifts peripherally (appears for ∼ 15–30 minutes)

    • Central scotoma

    • Flashing lights

    • Distorted color perception

    • Fortification spectra: star-like, zigzag figures

    • Sensory deficits, paresthesia

    • Aphasia

  • No motor symptoms

  • Develops gradually

  • Completely reversible

  • Symptoms last ≤ 60 minutes each

• Atypical aura

  • Paresis

  • Dizziness

  • Persistent or long-lasting symptoms

• Localization

  • Typically unilateral, but bilateral headache is possible

  • Especially frontal, frontotemporal, retro-orbital

• Duration: usually 4–24 hours (rarely over 72 hours)

• Course: progression of pulsating, throbbing, or pounding pain

• Exacerbated by physical activity

• Accompanying symptoms: photophobia, phonophobia, and nausea/vomiting

• Feeling of exhaustion or euphoria

• Muscle weakness

• Anorexia or food cravings

The typical migraine headache is “POUND”: Pulsatile, One-day duration, Unilateral, Nausea, Disabling intensit