Definite Migraine Research Articles

The prevalence, burden and cognizance of migraine in adolescent girls

Migraine represents a common neurological condition, which frequently affects adolescent girls. This cross sectional study aimed to evaluate the prevalence, impact and fund of migraine knowledge among adolescent girls. Students attending randomly selected high schools were recruited into the study by signing a consent form and completing a validated survey designed for this purpose. The survey assessed the participants fund of knowledge about migraine in five domains: migraine epidemiology, symptoms, triggers, auras and treatment options. The participants were evaluated for headache characteristics according to the International Classification of Headache Disorders, 2nd edition criteria, and categorized as having definite migraine or probable migraine. Additionally, the survey evaluated headache disability by implementing the headache impact test-6, and collected information regarding the use of over-the-counter medication. In a cohort of 309 girls, 14-18 years old, 18% fulfilled the criteria for definite migraine and 25% for probable migraine, with mean headache impact test-6 scores of 62.5 and 55.2, respectively ( P< 0.0001). Furthermore, the students fund of knowledge was substantially limited in regards to migraine auras and moderately limited in regards to symptoms, triggers and treatments. A significant portion of the migraineurs self-medicated using over-the-counter medications. The prevalence of migraine in late adolescent girls is very close to that of adult women. The information regarding the cognizance of migraine ought to be used as a guideline for designing educational tools for this population.

Investigation of the Coherence of Definite and Probable Vestibular Migraine as Distinct Clinical Entities

Investigation of the Coherence of Definite and Probable Vestibular Migraine as Distinct Clinical Entities

Investigation of the Coherence of Definite and Probable Vestibular Migraine as Distinct Clinical Entities

To investigate the following: 1) associations between vestibular symptoms and migraine in a well-characterized cohort of tertiary neurotology patients, 2) effects of comorbidity on clinical presentations, and 3) validity of proposed definitions of definite (dVM) and probable vestibular migraine (pVM). Retrospective chart review. Tertiary neurotology center. All 228 subjects with headache were selected from a larger investigation of 410 patients with vestibular symptoms who underwent comprehensive medical, surgical, and behavioral neurotologic consultations. Subjects had at least one of 4 diagnoses: dVM/pVM, Ménière's disease, benign paroxysmal positional vertigo, or chronic subjective dizziness. Subjects were divided into migraine (n = 164) and nonmigraine headache (n = 64) groups by International Headache Society criteria, then subdivided by those with vestibular symptoms related or unrelated to headache. Subjects meeting proposed criteria for dVM (n = 46) and pVM (n = 42) were identified. Statistical analyses investigated discriminating features and cohesiveness in each group, with or without comorbidity. Characteristics of dVM and pVM. Migraine, particularly migraine with aura, was more often related to vestibular symptoms than nonmigrainous headache. dVM and pVM groups did not differ in demographics, clinical histories, examinations, or vestibular testing. Numerous differences existed between dVM/pVM subjects with and without comorbid Ménière's disease, benign paroxysmal positional vertigo, or chronic subjective dizziness. The pVM group contained 4 subtypes. These results support an association between vestibular symptoms and migraine but not proposed distinctions between dVM and pVM. pVM does not appear to be a coherent diagnostic entity. Comorbid conditions are important causes of vestibular symptoms in patients with migraine.

Vestibular migraine – validity of clinical diagnostic criteria

Clinical recognition of vestibular migraine (VM) is still hampered by the lack of consensus diagnostic criteria. The aim of this study is a long-term evaluation of clinical criteria for definite (dVM) and probable (pVM) vestibular migraine. We re-assessed 75 patients (67 women, age 24-76 years) with dVM (n=47) or pVM (n=28) according to previously published criteria after a mean follow-up of 8.75±1.3 years. Assessment included a comprehensive neurotological clinical examination, pure tone audiometry and caloric testing. dVM was confirmed in 40 of 47 patients with a prior diagnosis of dVM (85%). Fourteen of 28 patients initially classified as pVM met criteria for dVM (50%), nine for pVM (32%). Six additional patients with dVM and two with pVM had developed mild sensorineural hearing loss, formally fulfilling criteria for bilateral Menière's disease (MD), but had clinical features atypical of MD. Seven of these also met criteria for dVM at follow-up. The initial diagnosis was completely revised for four patients. Although VM diagnosis lacks a gold standard for evaluation of diagnostic criteria, repeated comprehensive neurotological evaluation after a long follow-up period indicates not only high reliability but also high validity of presented clinical criteria (positive predictive value 85%). Half of patients with pVM evolve to meet criteria for dVM. However, in a subgroup of VM patients with hearing loss, criteria for dVM and MD are not sufficiently discriminative.

Vestibular rehabilitation for vestibular migraine

AbstractThere are indications that vestibular rehabilitation might be an effective treatment for vestibular migraine. However, randomized controlled trials addressing the subject are lacking. The aim of this study was to describe two patients, one with definite vestibular migraine and one with probable vestibular migraine, their assessment and treatment. Both patients were treated with vestibular rehabilitation and both experienced a reduction in symptoms after only a short period of rehabilitation. This suggests that vestibular rehabilitation might be a cheap and non-invasive treatment for vestibular migraine. Even though this study has a single-case design, we hope that it can be useful for physiotherapists and doctors who meet these patients in their practice.

Migraine in women with chronic pelvic pain with and without endometriosis

To examine the prevalence of migraine in women with chronic pelvic pain with and without endometriosis. Prospective study of headache, pelvic pain, and quality of life before laparoscopic surgery for pelvic pain. Endometriosis was diagnosed pathologically. Headaches were classified as migraine or non-migraine using International Headache Society criteria. Clinical research hospital. 108 women in a clinical trial for chronic pelvic pain (NCT00001848). Laparoscopy to diagnose endometriosis, assessment by neurologist to assess headaches. Prevalence of migraine and other headaches in women with chronic pelvic pain with or without endometriosis. Headache frequency, severity and relationship to pelvic pain and endometriosis. Lifetime prevalence of definite or possible migraine was 67% of women with chronic pelvic pain. An additional 8% met criteria for possible migraine. Migraine was no more likely in women with endometriosis than those without. Women with the most severe headaches had a lower quality of life compared with those with pelvic pain alone. Migraine headache is common in women with chronic pelvic pain, regardless of endometriosis, and contributes to disability in those with both conditions. The strong association suggests a common pathophysiology.

Migraine headaches following catheter ablation for atrial fibrillation

Atrial septal defects (ASD), including patent foramen ovale, have been linked to an increased prevalence of migraine headaches in the general population. A similar association with migraine is speculated for iatrogenic ASD due to atrial septal puncture during catheter ablation for atrial fibrillation (AF). A total of 2,069 patients who underwent catheter ablation for AF at Mayo Clinic, Rochester, MN between January 2001 and December 2008 were scheduled for follow-up at least at 3months and annually thereafter. Data were collected from the questionnaires patients answered at follow-up inquiring about presence and characteristics of any headaches following the procedure and further chart review. Definite migraine was diagnosed based on clinical features per the International Classification of Headache Disorder-II definition. Twenty-two patients (1.1%) had a new-onset definite migraine, 12 (0.6%) had a new-onset probable migraine, ten (0.5%) with a previous history of migraine had worsened headaches, and four (0.2%) had headache due to an alternate identifiable cause; a total of 48 patients (2.3%) reported post-procedural headaches. Nineteen of 22 patients (86%) with definite migraine had complete resolution of symptoms at 1- to 2-year follow-up. New-onset migraine is an uncommon and usually temporary side effect of catheter ablation for AF. The mechanism for post-procedure headache remains unclear.

Sensory dysmodulation in vestibular migraine

To seek evidence of sensory dysmodulation in auditory brainstem reflexes in patients with vestibular migraine by studying suppression of otoacoustic emissions (OAEs) by contralateral noise. A prospective case-control study. The authors measured contralateral suppression of OAEs in a group of 33 interictal patients with definite vestibular migraine (migrainous vertigo) according to the strict diagnostic criteria of Neuhauser (2001), and compared them with 31 nonmigrainous controls with matching age and sex distributions. Suppression values were then compared with previously published departmental normative data. In three patients, recordings were compared in the ictal and interictal states. OAE suppression was reduced in 11/33 patients, and 3/31 controls (P = .022 chi(2) test). Binary logistic regression analysis confirmed that the presence of vestibular migraine was significantly associated with abnormal suppression, but no such relationship was seen for symptoms of phonophobia or disease duration. The amplitude of variability between the ictal and interictal state was out of the normal range in 2 out of the 3 patients in whom such recordings were made. These results provide support for the notion of interictal auditory sensory dysmodulation in an as yet unidentified subset of migraineurs with vestibular migraine.

Comprehensive Assessment of The Relative Frequency of Sleep Disorders in Migraine and Non Migraine in 6- To 14-Year-Old Children

ObjectiveHeadaches are common during childhood. In addition, sleep disorders are common problems in children, too. Although it is commonly thought thatheadache and sleep problems are related, there is not enough evidence to confirm this relationship. Finding evident relations between these problemswould help practitioners a lot to make earlier diagnosis and plan treatment modalities for both problems as soon as possible. This study aimed to assess the relative frequency of sleep disorders in migraine and non migraine children.Material & MethodsIn a cross sectional study, 148 children were enrolled in migraine (60) and non migraine (88) groups. They were aged 6 to 14 years. Migraine group consistedof patients who had definite migraine according to IHS (International Headache Society) criteria. Ten sleep problems (snoring, nightmares, sleep walking, sleeptalking, bedtime struggle, bruxism, sweating during sleep, excessive daytime sleepiness, insomnia in early or mid night and sleep apnea) were comparedbetween 2 groups. Fisher exact and chi square tests were used for making comparisons.ResultsWe found relationships between night sleep and daytime headaches. Some of these relationships were easy to explain but for some others, finding complicated explanations are necessary.Our findings showed that bruxism, sleep walking, early and midnight insomnia was significantly higher in migraine children. There was a common etiology forheadache and sleep disorders. Also, parents and migraine children were well familiar with the effect of relaxation on decreasing migraine episodes .Theyprovided appropriate facilities for night sleep for this reason.Conclusionwe found relationships between night sleep and daytime headaches. Some of these relationships were easy to explain but for some others, finding complicated explanations are necessary.

“Vestibular migraine”: effects of prophylactic therapy with various drugs

Vertigo is frequently associated with migraine, and sometimes it is the cardinal symptom. This type of migraine is called "vestibular migraine", "migrainous vertigo", or "migraine-associated vertigo". Earlier findings on effective prophylactic medication for such migraine attacks and their clinical features are few and insufficient. Our aim was to study the influence of prophylactic therapy on this type of migraine and to specify its clinical features. In a retrospective approach 100 patients (median age 47 years, range 21-72 years) with definite or probable vestibular migraine were divided into two groups: those with (74 patients) and those without drug prophylaxis (26 patients). They were then interviewed by telephone at least 6 months after beginning therapy. All patients receiving medical prophylaxis showed a decrease of duration, intensity, and frequency of episodic vertigo as well as nearly all its associated features (p < 0.01). The group without medical prophylactic therapy showed only a reduction of vertigo intensity. Only 39 % of the 100 patients met the current IHS criteria for a basilar-type migraine. Thus, we propose that a new category--"vestibular migraine"--should be added to the HIS criteria. Furthermore, our data show that prophylactic medication may be effective for treating vestibular migraine and its associated symptoms; therefore, patient's response to medical therapy may provide guidance in the diagnostic process of vestibular migraine.

Review of Pediatric Migraine Headaches Refractory to Medical Management

The surgical treatment of migraine headache is a recent innovation that has broadened the potential patient population who may benefit from craniofacial surgical techniques to millions of affected adults. However, the population at risk in the pediatric age group has not been clearly established. The present retrospective review was performed to provide demographic information of the adolescent migraine in a major children's hospital. This information is essential before considering surgical treatment of migraine in this age group. Five hundred eighty-eight charts of patients aged 12 to 18 years who presented to the pediatric neurology clinic with headache in 2006 were retrospectively reviewed to evaluate for the diagnosis of migraine. Data collected included headache location, frequency, duration, intensity, associated migraine symptoms, and headache precipitants, as well as the response to medical treatment. Two hundred ten (36%) of 588 patients had the diagnosis of migraine headache, and 51 patients (24%) were considered refractory to the medical treatment offered. In 101 of the 210 migraine patients, anatomic location of the headaches could be identified. Thirty-nine children (19%) with refractory migraines (mean age, 14.7 years [SD, 0.3 years]) reported definitive migraine triggers. A significant percentage of pediatric patients with migraine headache remain refractory to medical treatment. At present, there is no good treatment regimen for migraine headaches in the pediatric population. We believe that surgical treatment of migraine headaches may be a realistic option for these patients.

The Prevalence and Impact of Migraine on US Military Officer Trainees

To determine the prevalence and impact of migraine in US Army officer trainees. The prevalence of migraine in military officer trainees, frequency of diagnosis, pharmacologic management, and the impact of migraine on military training has not been previously determined. We sought to elucidate the above and also to identify trainee characteristics associated with impaired training performance because of the disabling effects of migraine. An anonymous voluntary migraine questionnaire was administered to 1389 consecutive US Army Reserve Officer Training Corps cadets upon completion of 5 weeks of military training. Headaches were classified as definite migraine or possible migraine. Migraine frequency, prior diagnosis, number of missed or suboptimal training days attributable to migraine, patterns of analgesic use, and trainee characteristics associated with impaired training performance were identified. In total, 741 of 1389 (54%) officer trainees completed the migraine questionnaire, including 582 males and 159 females. The prevalence of definite migraine was 18% in all cadets including 14% in males and 31% in females. Migraines had been previously diagnosed in only 10% of trainees meeting criteria for definite or possible migraine. During training, male trainees experienced a mean of 0.70 migraines/month compared with female trainees at 1.4 migraines/month. Only 3% of trainees meeting criteria for definite or possible migriane had ever been prescribed triptans. Eight percent of cadets experienced impaired training performance because of migraine resulting in 63 days of suboptimal or missed training. Characteristics associated with impaired training performance included a prior diagnosis of migraine, screening positive for definite migraine vs possible migraine, and a higher baseline frequency of migraine. Migraine is common yet underdiagnosed and undertreated in US Army officer trainees and adversely impacts military training. We identified characteristics which place military trainees at risk for impaired training performance. We predict that improved diagnosis and treatment of migraine would result in improved training performance.

The Use of Questions to Determine the Presence of Photophobia and Phonophobia During Migraine

To investigate whether the use of more detailed close-ended questions as part of the routine headache history is helpful when patients initially deny that they are sensitive to light and noise during migraine headaches. According to the International Headache Society 2004 criteria, the diagnosis of migraine requires the presence of at least one of the following during a headache: (1) nausea and/or vomiting, (2) photophobia and phonophobia. Evans anecdotally noted that many patients answer the question, "does light or noise bother you during a headache," with a "no" when the answer is really "yes" if they are asked more detailed close-ended questions. Consecutive patients fulfilling International Headache Society 2004 criteria for migraine or probable migraine presenting to a headache clinic and a neurology clinic were asked the following questions: "does light bother you during a headache?" If "no," they were then asked, "during a headache, would you prefer to be in bright sunlight or in a dark room?""does noise bother you during a headache?" If "no," they were then asked, "during a headache, would you prefer to be in a room with loud music or in a quiet room?" Eighty-five consecutive patients with migraine or probable migraine were questioned, 71 females (83.5%) and 14 males (16.5%). There was denial of light and sound sensitivity in 24% of patients with routine questioning and then awareness of sensitivity in 93% with the further questioning. A total of 7.1% of the patients were diagnosed with probable migraine. However, if the additional questions were not asked, 8% more of the patients with definite migraine would have been incorrectly diagnosed as probable migraine. When patients initially deny light and noise sensitivity during migraine headaches, additional questions should be asked to ensure that their answer is accurate. Not asking the additional questions may result in the over-diagnosis of probable migraine.

Most Cases Labeled as “Retinal Migraine” Are Not Migraine

Monocular visual loss has often been labeled "retinal migraine." Yet there is reason to believe that many such cases do not meet the criteria set out by the International Headache Society (IHS), which defines "retinal migraine" as attacks of fully reversible monocular visual disturbance associated with migraine headache and a normal neuro-ophthalmic examination between attacks. We performed a literature search of articles mentioning "retinal migraine," "anterior visual pathway migraine," "monocular migraine," "ocular migraine," "retinal vasospasm," "transient monocular visual loss," and "retinal spreading depression" using Medline and older textbooks. We applied the IHS criteria for retinal migraine to all cases so labeled. To be included as definite retinal migraine, patients were required to have had at least two episodes of transient monocular visual loss associated with, or followed by, a headache with migrainous features. Only 16 patients with transient monocular visual loss had clinical manifestations consistent with retinal migraine. Only 5 of these patients met the IHS criteria for definite retinal migraine. No patient with permanent visual loss met the IHS criteria for retinal migraine. Definite retinal migraine, as defined by the IHS criteria, is an exceedingly rare cause of transient monocular visual loss. There are no convincing reports of permanent monocular visual loss associated with migraine. Most cases of transient monocular visual loss diagnosed as retinal migraine would more properly be diagnosed as "presumed retinal vasospasm."

Do Children with Benign Rolandic Epilepsy Have a Higher Prevalence of Migraine than Those with Other Partial Epilepsies or Nonepilepsy Controls?

Prior studies have given conflicting data concerning the association of benign rolandic epilepsy of childhood (BREC) and migraine but were limited by lack of sensitive, diagnostic criteria for childhood migraine. By using revised International Headache Society (IHS-R) criteria, we compared the prevalence of migraine in children with BREC with that of those (a) with cryptogenic/symptomatic partial epilepsy and (b) without epilepsy. Three cohorts of children, gender and age matched (within 1 year) were identified: (a) BREC, (b) cryptogenic/symptomatic partial epilepsy, and (c) no history of seizures. Parents were queried in a standardized interview about migraine and migraine equivalents in their child, and in either biologic parent. Migraine was defined by using the IHS-R (for children) and IHS criteria (for parents). Children with headache were divided into definite (meeting IHS-R criteria), probable (recurrent, throbbing headaches with nausea, vomiting, photophobia or phonophobia, not meeting IHS-R criteria), possible (recurrent headaches with throbbing character or associated nausea/vomiting), or nonmigraine groups. chi(2) analysis was used to determine whether the cohort with BREC had a higher prevalence of definite, definite or probable, or definite, probable, or possible migraines or migraine equivalents than the other two cohorts. Each cohort consisted of 53 children (mean age, 9.8-9.9 years, M/F ratio, 35:18). Those with BREC had higher rates of definite and probable (p = 0.05), of definite, probable, and possible migraine (p = 0.05), and of migraine equivalents excluding motion sickness (p < 0.005) than did those without seizures; however, they did not differ significantly from the cryptogenic/symptomatic partial epilepsy cohort. Partial epilepsy, regardless of etiology, is associated with higher rates of migraine in children. The pathophysiologic link between epilepsy and migraine is unknown.

Does This Patient With Headache Have a Migraine or Need Neuroimaging?

In assessing the patient with headache, clinicians are often faced with 2 important questions: Is this headache a migraine? Does this patient require neuroimaging? The diagnosis of migraine can direct therapy, and information obtained from the history and physical examination is used by physicians to determine which patients require neuroimaging. To determine the usefulness of the history and physical examination that distinguish patients with migraine from those with other headache types and that identify those patients who should undergo neuroimaging. A systematic review was performed using articles from MEDLINE (1966-November 2005) that assessed the performance characteristics of screening questions in diagnosing migraine (with the International Headache Society diagnostic criteria as a gold standard) and addressed the accuracy of the clinical examination in predicting the presence of underlying intracranial pathology (with computed tomography/magnetic resonance imaging as the reference standard). Two authors independently reviewed each study to determine eligibility, abstract data, and classify methodological quality using predetermined criteria. Disagreement was resolved by consensus with a third author. Four studies of screening questions for migraine (n = 1745 patients) and 11 neuroimaging studies (n = 3725 patients) met inclusion criteria. All 4 of the migraine studies illustrated high sensitivity and specificity if 3 or 4 criteria were met. The best predictors can be summarized by the mnemonic POUNDing (Pulsating, duration of 4-72 hOurs, Unilateral, Nausea, Disabling). If 4 of the 5 criteria are met, the likelihood ratio (LR) for definite or possible migraine is 24 (95% confidence interval [CI], 1.5-388); if 3 are met, the LR is 3.5 (95% CI, 1.3-9.2), and if 2 or fewer are met, the LR is 0.41 (95% CI, 0.32-0.52). For the neuroimaging question, several clinical features were found on pooled analysis to predict the presence of a serious intracranial abnormality: cluster-type headache (LR, 10.7; 95% CI, 2.2-52); abnormal findings on neurologic examination (LR, 5.3; 95% CI, 2.4-12); undefined headache (ie, not cluster-, migraine-, or tension-type) (LR, 3.8; 95% CI, 2.0-7.1); headache with aura (LR, 3.2; 95% CI, 1.6-6.6); headache aggravated by exertion or a valsalva-like maneuver (LR, 2.3; 95% CI, 1.4-3.8); and headache with vomiting (LR, 1.8; 95% CI, 1.2-2.6). No clinical features were useful in ruling out significant pathologic conditions. The presence of 4 simple historical features can accurately diagnose migraine. Several individual clinical features were found to be associated with a significant intracranial abnormality, and patients with these features should undergo neuroimaging.

Clinical Features, Classification and Prognosis of Migraine and Tension-Type Headache in Children and Adolescents: A Long-Term Follow-Up Study

We performed a long-term follow-up examination in children and adolescents with migraine and tension-type headache (TTH) in order to investigate the evolution of clinical features and headache diagnoses, to compare International Classification of Headache Disorders (ICHD)-I and ICHD-II criteria and to identify prognostic factors. We re-examined 227 patients (52.4% female, age 17.6 +/- 3.1 years) 6.6 +/- 1.6 years after their first presentation to a headache centre using identical semistructured questionnaires. Of 140 patients initially diagnosed with migraine, 25.7% were headache free, 48.6% still had migraine and 25.7% had TTH at follow-up. Of 87 patients with TTH, 37.9% were headache free, 41.4% still had TTH and 20.7% had migraine. The number of subjects with definite migraine was higher in ICHD-II than in ICHD-I at baseline and at follow-up. The likelihood of a decrease in headache frequency decreased with a changing headache location at baseline (P < 0.0001), with the time between baseline and follow-up (P = 0.0019), and with an initial diagnosis of migraine (P = 0.014). Female gender and a longer time between headache onset and first examination tended to have an unfavourable impact. In conclusion, 30% of the children and adolescents presenting to a headache centre because of migraine or TTH become headache-free in the long-term. Another 20-25% shift from migraine to TTH or vice versa. ICHD-II criteria are superior to those of ICHD-I in identifying definite migraine in children and adolescents presenting to a headache centre. The prognosis is adversely affected by an initial diagnosis of migraine and by changing headache location, and it tends to be affected by an increasing time between headache onset and first presentation.

Characteristic and Overlapping Features of Migraine and Tension‐Type Headache

This epidemiological survey was conducted to investigate comprehensive characteristic and overlapping features of migraine and tension-type headache (TTH) disorders classified based on International Classification of Headache Disorders-II. The stratified cohort of this study was composed of 2504 schoolchildren aged 10 to 17 years. A 38-item questionnaire inquiring all characteristic features of primary headache syndromes mandatory for classification was applied to selected 483 children with recurrent headache in the last 6 months. Migraine was diagnosed in 227 (47.0%) of 483 children and TTH in 154 (31.9%). Out of 125 children with definite migraine, 73 (58.4%) reported tension-type symptoms and 94 (68.1%) of 138 children with definite TTH reported migraine-type symptoms. Pressing pain (21%) and lack of aggravation of pain by physical activity (34%) were the major tension-type features in patients with migraine. Throbbing quality (43%) and aggravation by physical activity (30%) determined the main migraine-type features in patients with TTH. The frequent co-occurrence of migraine and TTH symptoms suggests the presence of a common pathogenesis.

The presence of four simple history features can diagnose migraine accurately

Can the clinical assessment distinguish patients with migraine from those with other types of headache? Systematic review of diagnosis studies. The MEDLINE database was searched for the years 1966 to November 2005. This was supplemented by citation tracking and inspection of bibliographies of texts. Two authors independently assessed study eligibility, study quality, and extracted data. Studies were eligible for inclusion if they assessed diagnostic accuracy of history and physical examination tests, alone or in combination, and the reference standard was the diagnosis of a migraine-type headache made by a neurologist following the International Headache Society criteria. Diagnostic accuracy was expressed as likelihood ratios (LR) with 95% CI. Four eligible studies were located, two studying patients referred to headache specialists and two studying primary care patients. The two specialist studies were of very low methodological quality and there were concerns about data analysis and adequacy of the reference standard. The first primary care study was of high quality and evaluated a screening tool comprising five criteria: P ulsatile quality, duration 4–72 h O urs, U nilateral location, N ausea/vomiting, D isabling intensity (mnemonic = POUND ). The presence of four or more features provided a LR of 24 (95% CI 1.5 to 388) in diagnosing definite or possible migraine and a LR of 5.8 (95% CI 2.7 to 12) for a diagnosis of definite migraine. Including the features photophobia, phonophobia, and exacerbation with the five POUND criteria algorithm did not improve diagnostic accuracy. The other primary care study was of fair quality and found that the presence of two or more of the features: disabling headache, nausea, and sensitivity to light, gave a LR+ of 3.2 (95% CI 2.7 to 3.9) and LR– of 0.25 (95% CI 0.22 to 0.28). A screening tool comprising five criteria: P ulsatile quality, duration 4–72 h O urs, U nilateral location, N ausea/vomiting, D isabling intensity, remembered using the mnemonic ‘POUND’, can accurately diagnose migraine.

Magnetic resonance angiography of the circle of Willis in migraine patients

We analysed records of 244 consecutive adult outpatients who presented at our neurological polyclinic between 1996 and 2001 with migraine and who underwent a MRA of the circle of Willis. In 80 cases, a definitive migraine diagnosis according to the International Headache Society criteria (1988) could be retrieved from the patient records. Of these, 63 patients had migraine without aura and 17 patients had migraine with aura. Two MRA procedures were abrupted because of claustrophobia and another two MRA studies were unreliable because of movement artefacts. In only one patient of the remaining 240, an aneurysm was suspected with MRA. However, a conventional angiography did not confirm any cerebrovascular abnormality. All other exams were considered normal. This retrospective study argues against a systematic screening of migraine patients with MRA.