Migraine Symptoms: Results of a Survey of Self-Reported Migraineurs

Migraine is an episodic headache disorder associated with various combinations of neurologic, gastrointestinal, and autonomic symptoms. Gastrointestinal disturbances including nausea, vomiting, abdominal cramps, or diarrhea are almost universal. Sensory hyperexcitability manifested by photophobia, phonophobia, and osmophobia are frequently experienced. Other symptoms include blurry vision, nasal stuffiness, tenesmus, polyuria, pallor, and sweating, Our telephone interview survey of 500 self-reported migraine sufferers was performed in 1994. The most common reported symptoms associated with migraine were pain, nausea, problems with vision, and vomiting. Nausea occurred in more than 90% of all migraineurs; nearly one third of these experienced nausea during every attack. Vomiting occurred in almost 70% of all migraineurs; nearly one third of these vomited in the majority of attacks. In those who experienced nausea, 30.5% indicated that it interfered with their ability to take their oral migraine medication; in those with vomiting, 42.2% indicated that it interfered with their ability to take their oral migraine medication. The most important features of a migraine medication were rapid and effective relief of headache pain, decreasing the likelihood of headache recurrence, and not causing nausea. Many migraine patients suffer needlessly because their nausea and vomiting are both unreported to, and unrecognized by physicians. The presence of these symptoms is crucial to diagnose migraine not accompanied by aura.     

Acute migraine attack therapy: comparison of naproxen sodium and an ergotamine tartrate compound

The efficacy of safety of naproxen sodium and ergotamine tartrate were compared for the treatment of acute migraine attack in a randomized, parallel trial with 114 participating patients. At the start of symptoms, patients took either three tablets of naproxen sodium (275 mg each) or one of an ergotamine combination (containing 2 mg ergotamine tartrate, 91.5 mg caffeine, and 50 mg cyclizine chlorhydrate). Patients were followed for three months or until six attacks were monitored, whichever came first. Both medications substantially shortened the duration of migraine attacks and reduced the severity of symptoms. When the test medications were taken within 2 h of onset of attack, naproxen sodium was statistically significantly more effective than the ergotamine combination in reducing the severity of headache pain, nausea, and lightheadedness. The ergotamine combination was associated with significantly more vomiting, need for rescue medication, and side effects than was naproxen sodium. Four patients required discontinuation of the ergotamine combination and one of naproxen sodium. Both patients and investigators rated tolerance for naproxen sodium as superior to tolerance for the ergotamine combination. Naproxen sodium seems to be an effective and safe treatment for migraine attacks.     

Tolerability and efficacy of naratriptan tablets with long-term treatment (6 months)

This open-label study was conducted to examine the long-term tolerability and efficacy of the novel 5HT₁ agonist naratriptan tablets 2.5 mg used to treat all migraine attacks for 6 months. Patients could reduce the dose to 1 mg in the event of intolerable adverse events. The results demonstrate that the majority (median 83%) of attacks treated with naratriptan tablets 2.5 mg were not associated with an adverse event. Among attacks treated with naratriptan tablets 2.5 mg (+optional 2.5 mg for headache recurrence), the most frequently reported adverse event was nausea (4% of attacks after a single naratriptan dose). Both the overall incidence of adverse events and the incidences of specific adverse events were no higher during months 4–6 of treatment compared with months 1–3. Only 5 of 414 patients elected to reduce their naratriptan dose to 1 mg. Headache relief 4 h postdose was reported in a mean of 68% of 6770 moderate or severe migraine attacks treated with naratriptan tablets 2.5 mg. The median number of naratriptan tablets used per attack was 1.0 (mean 1.25); patients treated only a median 7% of attacks (mean 13%) with a 2nd naratriptan tablet for headache recurrence. Patients rated naratriptan tablets as good or excellent in 61% of 7566 treated attacks. In summary, the data from this study demonstrate that naratriptan tablets 2.5 mg were very well tolerated and effective for the acute treatment of migraine for 6 months in a situation closely resembling actual clinical use.     

Naproxen sodium in the treatment of migraine

Seventy patients with classical or common migraine were treated during their attacks with either naproxen sodium or placebo in a randomised, double-blind parallel group study. The initial dose of naproxen sodium was 825 mg followed one hour later by a further 550 mg, if symptoms were the same or had improved. If the migraine symptoms had worsened, patients were offered an escape analgesic combination of 1000 mg paracetamol and 10 mg metoclopramide. Patients were assessed at monthly intervals for changes in the severity and duration of headache, premonitory symptoms (mainly visual disturbances) and photophobia, nausea and vomiting associated with migraine attacks that had occurred since the previous visit. Patients were studied for a maximum of ten attacks and significant improvement was observed in the severity and duration of headache when the patients were on naproxen sodium. Also the premonitory symptoms and photophobia improved significantly on naproxen sodium and significantly less rescue analgesics were required. Patients suffering from common migraine had less severe headaches and photophobia when taking naproxen sodium than when taking placebo and the headaches were shorter in duration and patients took less rescue analgesic. No significant difference was observed between the treatment groups in patients with classical migraine. Ten patients in the placebo group and six in the naproxen sodium group reported side-effects but these were possibly related to the use of rescue medication. Naproxen sodium proved safe and effective in common migraine attacks, but in this study efficacy was not established for classical migraine.     

Tryptophan depletion increases nausea, headache and photophobia in migraine sufferers

Sensitivity to light was investigated 5 and 8 h after consumption of an amino acid drink which contained L-tryptophan (balanced amino acid condition: 19 controls and 22 migraine sufferers) or which produced a short-term reduction in brain serotonin synthesis by omitting L-tryptophan (tryptophan depletion condition: 16 controls and 16 migraine sufferers). Migraine sufferers reported more intense nausea, headache, glare- and light-induced pain than controls. In addition, glare- and light-induced pain were greater in the tryptophan depletion condition than in the balanced amino acid condition, in both migraine sufferers and controls. Eight hours after the amino acid drink, after participants had completed tests of pain sensitivity and motion sickness provocation, tryptophan depletion augmented headache in migraine sufferers and aggravated nausea in migraine sufferers and controls. These findings suggest that a reduction in brain synthesis of serotonin intensifies photophobia and other migrainous symptoms and thus might contribute to the pathogenesis of migraine.     

Nadolol and Propranolol in Migraine Management

SYNOPSIS
The prophylactic effects of nadolol once daily and propranolol b.i.d. were studied in 28 patients with common or classic migraine. Following screening procedures, the subjects entered a 28- to 120-day placebo period, which was followed by a 24-week randomized, double-blind treatment period. The prophylactic effects were evaluated by frequency of migraine attacks, consumption of acute migraine-relief tablets, duration of attacks, ratings of headache and nausea severity, and duration of incapacitation. Compared to placebo, both beta blockers brought about a highly significant (p < 0.01 ) reduction in attack frequency and consumption of acute migraine-relief tablets, while no significant changes were found with regard to the other variables. No significant differences were found between the two beta blockers. The results indicate that nadolol once daily is as effective as propranolol b.i.d. in migraine management and that the main effect of beta blockers in migraine is in preventing attacks from breaking out, while the capacity for reducing the intensity or duration of unsuppressed attacks is less prominent.     

Self-treatment of acute migraine with subcutaneous sumatriptan using an auto-injector device: comparison with customary treatment in an open, longitudinal study

In a multicenter open longitudinal clinical trial where 479 patients suffering from migraine with or without aura were recruited, patients treated at home one to three migraine attacks with their customary treatment, and subsequently, over a 3-month period, one to three migraine attacks with (5 mg sumatriptan sc using an auto-injector. The headache response to customary treatment was 19% at 1 h and 30.5% at 2 h, and was not significantly different when only attacks treated "adequately" according to accepted treatment recommendations were considered: 16% at 1 h and 35% at 2 h. In contrast, 69% and 82% of patients treated with 6 mg sumatriptan sc had mild headache or no headache at 1 and 2 h respectively, regardless of migraine type or duration of symptoms prior to treatment. Other migraine symptoms (nausea, vomiting, photo- and phonophobia) were effectively treated with sumatriptan. Recurrence of migraine was observed in 31% of patients and was well controlled by a second injection of sumatriptan. It is concluded that 6 mg sumatriptan sc, self-administered using an auto-injector, is well tolerated and more effective than most currently used acute treatments for migraine in a population of severely affected patients consulting a neurologist.     

Eletriptan in migraine patients reporting unsatisfactory response to rizatriptan

OBJECTIVE: The objective of this open-label study was to evaluate the efficacy of switching patients who had a previous unsatisfactory response to rizatriptan to eletriptan 40 mg. Background.-The characteristics of individual migraine patients can vary tremendously and can have a significant impact on treatment outcomes. In addition, clinical experience has demonstrated that the triptans are not identical or interchangeable and that patients who respond poorly or who are dissatisfied with one agent can derive benefit by being switched to another agent within the triptan class. METHODS: Patients were eligible if they met International Headache Society criteria for migraine, with a frequency of 1 to 6 migraine attacks per month, and had documented "unsatisfactory treatment response" to rizatriptan within the past year (54% on the melt formulation; 46% on tablets). Reasons for dissatisfaction with rizatriptan (>1 could be cited) included inadequate (84%) or slow onset (50%) of pain relief, high recurrence rate (69%), and lack of improvement in associated symptoms (60%). One hundred twenty-three patients were eligible for treatment. Patients were instructed to take eletriptan 40 mg as soon as they were certain that their headache was a migraine, regardless of level of pain severity (8% treated headaches that were mild). RESULTS: Headache response at 2 hours (first-attack data) was 64%. Absence of nausea (from baseline to 2 hours) increased from 50% to 78%, absence of photophobia from 30% to 72%, and absence of phonophobia from 39% to 77%. Functional response at 2 hours was 63%, with 41% of patients reporting normal functioning. Treatment with eletriptan 40 mg was associated with a 27% to 40% reduction in migraine attack-related functional impairment, as measured by the PQ-7. Recurrence rates were 36.6%. Overall, 72% of patients rated eletriptan as a "good-to-excellent" treatment, and 78% reported overall satisfaction with the degree of headache relief. CONCLUSION: The results of this study suggest that eletriptan is an efficacious treatment option for patients who are dissatisfied with their response to rizatriptan.     

Acupuncture in migraine prophylaxis: a randomized sham-controlled trial

The purpose of the present trial was to evaluate semi-standardized acupuncture efficacy in migraine prophylaxis. Twenty-eight subjects with migraine were randomized to the real or sham acupuncture groups. Semi-standardized and standardized minimal acupuncture were used, respectively, in the two groups of patients. They were all treated with 16 acupuncture sessions in 12 weeks. Both groups exhibited similar reductions in: percentage of patients with reduction of migraine>or=40% and >or=50% regarding frequency of migraine attacks, days with migraine, frequency of migraine attacks, average duration of a migraine attack, rate of rescue medication used, average headache severity rate and other parameters compared with the baseline period. Associated symptoms, such as nausea and vomiting, also showed equal estimates in both groups. These findings showed that semi-standardized acupuncture shows no difference from sham acupuncture in preventing migraine attacks.     

The prevalence of migraine in women aged 40-74 years: a population-based study

The objective of this study was to investigate the age-dependence of the prevalence and characteristics of migraine headache and migraine visual aura. A neurologist interviewed 728 women attending a mammography screening programme. International Headache Society (IHS) criteria were used. The lifetime prevalence of migraine headache was 31.5% and the 1-year prevalence 18.0%. The magnitude of the decline of the prevalence of active (one or more attacks in the previous year) migraine headache was estimated to 50% per decade. The prevalence of active migraine visual aura was 3.8%. This did not vary by age. Except for the pain intensity and the presence of nausea, other characteristics and concomitant symptoms did not change with age. Active migraine headache and migraine visual aura in middle-aged and older women are common and modified differently by age. We suggest that the decline of prevalence of active migraine headache with age is caused by a decrease in pain intensity.     

Tolerability and efficacy of naratriptan tablets in the acute treatment of migraine attacks for 1 year. Naratriptan Long-Term Study Group

OBJECTIVE AND DESIGN: This open-label study was conducted to evaluate the tolerability and efficacy of the 5HT1 agonist naratriptan with repeated use in the acute treatment of migraine attacks for 1 year. Four hundred and seventeen (417) migraine patients treated 15,301 migraine attacks over the course of the study. RESULTS: The results show that 84% of attacks treated with a single 2.5 mg dose of naratriptan were not associated with the occurrence of an adverse event. The percentage of attacks associated with an adverse event did not increase with number of doses used to treat a given attack (1 vs. 2) or duration of use (0-6 months vs. > 6-12 months). The only adverse events experienced in > 2% of attacks throughout the 1-year study were nausea (3% of attacks), hyposalivation (2% of attacks), and drowsiness/sleepiness (2% of attacks). Headache relief 4 h post-dose was reported in a median 70% of moderate or severe attacks and a median 86% of mild attacks treated with naratriptan tablets 2.5 mg. The percentages of patients reporting headache relief did not diminish as a function of increased duration of treatment (0-6 months vs. > 6-12 months) or frequency of use (for > 36 vs. < 36 attacks). The mean number of tablets taken per attack was 1.2. A second naratriptan 2.5 mg tablet was taken for headache recurrence in a mean 16% (median 8%) of attacks. CONCLUSION: The results of this study demonstrate that naratriptan tablets 2.5 mg taken for acute migraine attacks over a 1-year period are well-tolerated and effective.     

Headache Diary in the Diagnosis of Childhood Migraine

The usefulness of a headache diary in the diagnosis of migraine and in the clarification of migraine symptoms was studied in 145 children. These children belong to a 1year age cohort of 5356 children that has been followed since birth. The children were enrolled in the present study according to their headache status in a questionnaire study at the age of 8 to 9 years, at which time 50 children had migraine, 43 had nonmigrainous headache, and 52 did not have recurrent headache. Information on their present headache status was collected with a face-to-face interview at the age of 11 to 13 years and from a headache diary after the interview. The children kept the diary for 2 to 7 months. Altogether, 72 children had migraine according to the International Headache Society criteria for migraine, either in the interview or in the diary. Eight children were diagnosed only according to the diary (11.1%). Thirty-three children had both migraine attacks and nonmigrainous headache episodes according to the diary, even though they were able to report only one type of headache episode in the interview. The duration of headache episodes was underestimated in the interview, compared to the diary in the children with migraine. Many children recognized new aura symptoms, associated symptoms, and characteristics of pain when they started to pay attention to these when filling in the diary during the follow-up period. The headache diary is useful in clarifying the features of headache attacks and in the diagnosis of headache types in children.     

Effects of naratriptan versus naproxen on daily functioning in the acute treatment of migraine: a randomized,double-blind,double-dummy,crossover study

OBJECTIVE: To evaluate the effect of acute treatment on ictal behavioral functioning of patients with migraine via ambulatory accelerometry. BACKGROUND: The inability to carry out daily activities often complicates migraine attacks. Research into the effects of pharmacological drugs on this outcome parameter in the acute treatment of migraine has been based on subjective reports only. METHODS: In a double-blind, double-dummy, crossover study, 12 patients with migraine treated 2 migraine attacks with the nonspecific antimigraine drug, naproxen (500-mg capsule) or the more specific antimigraine drug, naratriptan (2.5-mg tablet). The clinical symptoms of headache, nausea, vomiting, photophobia, and phonophobia, and the subjective symptoms reflecting mood, sleepiness, and level of functioning were measured by use of a daily log. RESULTS: During the first 6 hours after intake of the study medication, the objective behavioral parameters showed no significant effect of time and no significant differences between naproxen and naratriptan, but naratriptan was significantly more efficacious than naproxen in relieving headache, nausea, and vomiting; the interval between treatment and relief was significantly shorter after intake of naratriptan. CONCLUSIONS: Consciously perceived clinical and subjective symptoms do not necessarily run in parallel with their behavioral equivalents. It, thus, may be important to assess the effects of treatment on behavioral functioning in the evaluation of the general efficacy of antimigraine drugs in the acute treatment of a migraine attack.     

Intravenous valproate sodium (depacon) aborts migraine rapidly: a preliminary report

OBJECTIVE: This study was designed to investigate the efficacy and safety of intravenous valproate in the treatment of acute migraine attacks. BACKGROUND: Numerous studies have shown oral valproate therapy to be effective in preventing migraine. To date, no published studies have explored the use of valproate in the acute treatment of migraine. DESIGN/METHODS: After obtaining written informed consent, 61 patients presenting to a clinic with acute migraine were infused with 300 mg of intravenous valproate sodium. Sixty-six attacks were treated. The time at the beginning of infusion; the time at the end of infusion; the time to onset of relief of headache, nausea, and other associated symptoms; the time to meaningful relief; and the time to complete relief were recorded. Patient's pulse, blood pressure, and respiration were monitored. Adverse events were recorded. RESULTS: Mean time to onset of relief was 8 minutes, mean time to meaningful relief was 16 minutes, and mean time to complete relief was 25 minutes. A reduction in pain from severe or moderate to mild or no pain in 30 minutes was reported in 37 of 66 attacks; in 11 attacks, a reduction of more than 50% in headache severity in 30 minutes was reported. Thus, 48 (73%) of 66 attacks had significant improvement. After treatment with valproate, headache severity was significantly decreased (P<.0001); nausea, disability, and photophobia decreased; and patients became more alert. No serious adverse events were reported. CONCLUSION: Intravenous valproate appears to be safe and effective for the acute treatment of migraine. Double-blind, placebo-controlled studies to further investigate the use of this agent in acute treatment of migraine attacks are warranted.     

The natural course of migraine attacks. A prospective analysis of untreated attacks compared with attacks treated with a triptan

This study was designed to document prospectively and explore scientifically the natural course of untreated migraine attacks in detail. A new, integrated, time-intensity method for self-assessment of the intensity of symptoms was tested on 18 adult International Headache Society migraineurs who volunteered to refrain from treatment during one attack. The area under the curves (AUC) during 72 h of untreated attacks was compared with attacks treated with a triptan. Migraine attacks are heterogeneous both inter- and intra-individually. In untreated attacks, the pain can stabilize and fluctuate around a plateau with a wavelength of hours. In general, the symptoms of each separate migraine attack follow a similar temporal course, with only moderate deviations. In some cases photo- and/or phonophobia (hyperexcitability) were not experienced at all, despite severe pain and nausea. Moreover, there was sometimes no nausea despite severe pain and hyperexcitability. Vomiting does not always correlate to the intensity of nausea and is not always followed by decreased headache intensity. Treatment with a triptan usually only temporarily distorts the basic pattern of attacks. Hyperexcitability can respond before pain to treatment. These genuine findings of the classic symptoms of migraine attacks support the notion of a mutual underlying pathophysiological mechanism.     

Can migraineurs accurately identify their headaches as "migraine" at attack onset?

BACKGROUND: While treating migraine early when the headache is mild is believed to link to improved treatment outcomes, it is not clear whether patients can correctly self-identify a headache as a migraine at onset in real-world settings. OBJECTIVE: This study aims to assess the likelihood that patients can correctly self-identify a headache as a migraine at onset, and to evaluate cues that patients use to correctly identify migraine attacks. METHODS: Adult migraineurs were recruited from 14 headache clinics across the United States. Patients recorded their headache experiences via an electronic diary daily over a period of 30 days. On days when they experienced headaches, patients were asked to recall the types of headache they experienced at both onset and peak. Patients also identified cues for deciding whether the headache was a migraine or not. Using identification of migraine at headache peak as the criterion, we examined the sensitivity and specificity of migraine identification at onset. We employed generalized estimating equation (GEE) to evaluate factors identified at headache onset that predicted migraine identified at headache peak. RESULTS: Of the 192 enrolled patients, 182 patients recorded a total of 1197 headache episodes over 30 days. At headache onset, 888 episodes were deemed by patients as migraine and 309 episodes not migraine; a majority (92%) of these early migraine identifications were confirmed at headache peak. Sensitivity and specificity of self-identification of migraine at onset were 91% and 97%, respectively. A number of factors at headache onset were predictive of a migraine identified at peak: sensitivity to light (OR = 3.1, 95% CI: 1.9-5.0), headache severity (OR = 2.0, 95% CI: 1.4-2.8), nausea symptoms (OR = 2.6, 95% CI: 1.5-4.5), and visual disturbance (OR = 2.3, 95% CI: 1.1-4.9). Patients who ruled out tension-type headache at onset were twice (OR = 2.0, 95% CI: 1.5-2.8) as likely to conclude a migraine at peak. CONCLUSIONS: Most migraineurs in tertiary care settings can correctly self-identify a headache as a migraine at onset. Factors such as headache severity, presence of nausea, visual disturbance, sensitivity to light, and no tension-type headache, appeared to augment the correct identification.     

Treating early versus treating mild: timing of migraine prescription medications among patients with diagnosed migraine

INTRODUCTION: Although research suggests that early treatment of migraine headache when the pain is mild results in better outcomes for patients, many patients delay taking their acute-migraine medication until their headaches are moderate or severe. Understanding when and why patients use their migraine medications is an important first step to improve migraine management. METHODS: A prospective observational study, conducted at a major national retail pharmacy chain with stores across the United States between April 2001 and November 2002, enrolled men and women between 18 and 55 years of age with a physician diagnosis of migraine with or without aura. Baseline data on 690 patients included patient demographics, migraine history, medication use, tendency to avoid or delay treatment of a migraine attack, and reasons for delaying treatment. Reasons for delaying treatment were assessed via a checklist of nine potential reasons. In the follow-up survey completed after treatment of the next migraine attack, patients reported the timing of medication use in relation to pain onset and the severity of the migraine headache at the time they took the medication. RESULTS: Despite the severity of their typical migraine attacks, approximately 49% of the respondents answered, "yes" to the question, "Do you often avoid or delay taking your migraine medications when you start to experience a migraine attack?" The two most common rationales for avoiding or delaying treatment were "wanting to wait and see if it is really a migraine attack" (69%) followed by "only want to take medications if it is a severe attack" (46%). In the follow-up survey, regardless of medication used, about 85% of patients did not treat their next migraine attack until the headache pain was moderate or severe, although 74% treated within 1 hour of pain onset. CONCLUSION: These results suggest that patients with migraine often delay their treatment until they have identified their attack as a migraine. In addition, while many patients treated their follow-up headache early, they did not treat when the pain was mild. This suggests that there is an opportunity for physicians to educate their migraine patients on how to differentiate migraine from other headache types and about when and how to use their acute-migraine medication.     

Painful stimulation of the temple during optokinetic stimulation triggers migraine-like attacks in migraine sufferers

To determine whether motion sickness induced by optokinetic stimulation would trigger migraine-like attacks, 27 migraine sufferers and 23 controls attended the laboratory up to three times at intervals of at least 3 weeks. On one occasion subjects experienced up to 15 min of optokinetic stimulation, followed by three 30-s applications of ice to the temple at 4-min intervals. On another occasion, the ice applications preceded and accompanied optokinetic stimulation. On a third occasion, one hand was immersed in ice water for 30 s, three times at 4-min intervals before and during optokinetic stimulation. Subjects recorded headache activity in a diary over the course of the study. None of the controls experienced a migraine-like attack at any stage of the experiment. In migraine sufferers, the incidence of migraine-like attacks was greater than the expected daily incidence of 8% after sessions that involved painful stimulation of the temple during or after optokinetic stimulation (44% and 28% of the group, respectively) (P<0.001). In contrast, migraine-like attacks developed in only 13% of migraine sufferers after the session that involved immersing the hand in ice water during optokinetic stimulation (not significant). The development of nausea and headache during optokinetic stimulation increased the likelihood of migraine-like attacks afterwards. These findings indicate that motion sickness and head pain increase susceptibility to migrainous attacks in migraine sufferers, and suggest that the symptoms of migraine build upon each other in a vicious circle. Thus, targeting multiple symptoms should be more effective than targeting individual symptoms, both for preventing and treating attacks of migraine.     

Unusual visual symptoms in a patient with bilateral vertebral artery dissection: a case report

We present a previously unreported set of symptoms in a patient found to have bilateral vertebral dissections. Although visual symptoms are common in vertebral dissection, their pattern does not typically mimic those that commonly precede or accompany migraine headache. When they do occur, they usually take the form of diplopia or blurred vision. The patient we describe had visual symptoms that varied over three episodes of headache and included transient visual field loss and scintillations ("lightning bolts"), both common in migraine. However, our patient's new visual symptoms represented a change in pattern from those that had accompanied her previous migraines. This detailed history-taking prompted an evaluation for an etiology other than migraine and prevented a further delay in diagnosis and treatment.     

Are Classical and Common Migraine Different Entities?

SYNOPSIS
Classical migraine has been described as a familial disorder characterized by recurrent ; attacks of headache widely variable in intensity, frequency and duration.¹ Attacks are commonly unilateral and are usually associated with anorexia, nausea and vomiting. In classical migraine the headache is preceded or accompanied by transient focal neurological phenomena e.g. visual, sensory or speech disturbances. Nonclassical or common migraine is not associated with sharply defined focal neurological disturbances and occurs more frequently.
Are these two conditions the same or do they differ in some fundamental way? The evidence for and against their being a single entity is discussed. The conclusion reached is that common and classical migraine are probably different aspects of the same disorder.