Complications
A debilitating migraine attack lasting for more than 72 hours. It is important to look for medication overuse as a possible cause, and to manage this appropriately.[3][222]
Good-quality evidence about the best treatment approach is lacking; existing data suggest the use of intravenous fluids, corticosteroids, magnesium sulfate, anticonvulsive drugs, non-steroidal anti-inflammatory drugs (NSAIDs), anti-emetics, and serotonergic agents.[223]
Presence of one or more migrainous aura symptoms is associated with an ischaemic brain lesion in appropriate territory, as demonstrated by neuroimaging.[3][227]
True migrainous infarction is a rare complication of migraine with aura, and is diagnosed when a typical aura lasts longer than 1 hour and neuroimaging demonstrates an infarction in a relevant area.[228]
Treatment is the same as for ischaemic stroke. This includes urgent supportive care and consideration of thrombolysis, followed by active rehabilitation (see Ischaemic stroke).
Seizures are a known trigger for headaches, which can be migraine-type or tension headaches. Patients with headache just prior to the onset of seizure activity should be investigated for focal non-convulsive seizures (ictal epileptic headache). Focal seizure activity can cause headaches as the only symptom, prior to generalised seizure activity and convulsive seizure.[232]
Depression, suicide ideation and attempts, and anxiety are significantly associated with migraine.[11][220]
Evidence has been presented for shared genetically determined biological mechanisms underlying migraine and major depressive disorder.[221] Treatment choices for migraine should take account of any mood disorders.[39]
Defined as migraine headache occurring on 15 or more days per month for more than 3 months in the absence of medication overuse.
Usually starts as migraine without aura that gradually loses its typical presentation.
It is important to look for medication overuse as a possible cause, and to manage this appropriately.[3]
Aura symptoms persist for more than 1 week without radiographical evidence of infarction.
Symptoms are often bilateral and may last for months or years.
Reliable treatments are not known, but valproate and acetazolamide may help.[233][234]
Migrainous infarction should be excluded by a magnetic resonance imaging scan.[3]
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