Case history
Case history #1
A 32-year-old woman presents with a 13-year history of 1-3 attacks per month of disabling pounding pain over one temple, with nausea and sensitivity to light. She says that her headaches can be triggered by lack of sleep and made worse by physical exertion, and are more common during menstrual bleeding. Untreated, they last for 2 days. On four occasions, headaches were preceded by the gradual appearance of a shimmering, zigzag line that enlarged, moved to the peripheral visual field, and then faded away over 45 minutes. Examination is normal.
Case history #2
A 40-year-old man complains of a 1-year history of twice-monthly global headache, worse on the left side in the postauricular region. It comes on gradually and, at its most severe, the vision in his left eye becomes distorted. He often has to stop watching television as the picture becomes "blurry." His nose becomes blocked, although sometimes he has a "runny nose." He takes a nonsteroidal anti-inflammatory drug (NSAID) that helps a little, but he feels that his head is about to explode at times. When the headache occurs, he needs to go into a dark quiet room and sleep until it resolves. He reports the problem is "really getting him down," and he is having difficulties with his employer due to loss of work time.
Other presentations
Typical migraine aura (a complex of reversible visual, sensory, or speech symptoms) is pathognomonic of migraine, but occurs in only 15% to 30% of patients.[1][2] Aura typically occurs just before or at onset of headache, developing over 5 to 20 minutes and lasting less than 60 minutes, but it may not occur every time. Aura can also occur during the headache. Aura includes positive phenomena (visual sparkles, flashing lights, tingling) and negative phenomena (visual loss or scotomata, numbness, speech disturbance).[3][4]
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