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][221]
Good-quality evidence about the best treatment approach is lacking; existing data suggest the use of intravenous fluids, corticosteroids, magnesium sulfate, anticonvulsive drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), antiemetics, and serotonergic agents.[222]
Presence of one or more migrainous aura symptoms is associated with an ischemic brain lesion in appropriate territory, as demonstrated by neuroimaging.[3][226]
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.[227]
Treatment is the same as for ischemic stroke. This includes urgent supportive care and consideration of thrombolysis, followed by active rehabilitation (see Ischemic 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 nonconvulsive seizures (ictal epileptic headache). Focal seizure activity can cause headaches as the only symptom, prior to generalized seizure activity and convulsive seizure.[231]
Depression, suicide ideation and attempts, and anxiety are significantly associated with migraine.[11][219]
Evidence has been presented for shared genetically determined biologic mechanisms underlying migraine and major depressive disorder.[220] 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 radiographic evidence of infarction.
Symptoms are often bilateral and may last for months or years.
Reliable treatments are not known, but divalproex sodium and acetazolamide may help.[232][233]
Migrainous infarction should be excluded by a magnetic resonance imaging scan.[3]
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