Migraine Chapter Introduction, B.Todd Troost

Headache in a variety of forms is one of the most common complaints presenting to the clinician. A classification of headache has been proposed by the International Headache Society (IHS).{1}

Table 1. International Headache Society Classification of Headache

1.0 Migraine	8.0 Headache associated with substances or their withdrawal
1.1 Migraine without aura	8.1 Headache induced by acute substance use or exposure
1.2 Migraine with aura	8.2 Headache induced by chronic substance use or exposure
1.3 Ophthalmoplegic migraine	8.3 Headache from substance withdrawal (acute use)
1.4 Retinal migraine	8.4 Headache from substance withdrawal (chronic use)
1.5 Childhood periodic syndromes that may be precursors to or associated with migraine	8.5 Headache associated with substances but with uncertain mechanism
1.6 Complications of migraine	9.0 Headache associated with noncephalic infection
1.7 Migrainous disorder not fulfilling above criteria	9.1Viral infection
2.0 Tension-type headache	9.2 Bacterial infection
2.1 Episodic tension-type headache	9.3 Headache related to other infection
2.2 Chronic tension-type headache	10.0 Headache associated with metabolic disorder
2.3 Tension-type headache not fulfilling above criteria	10.1 Hypoxia
3.0 Cluster headache and chronic paroxysmal hemicrania	10.2 Hypercapnia
4.0 Other Headaches	10.3 Mixed hypoxia and hypercapnia
4.1 Idiopathic stabbing headache	10.4 Hypoglycemia
4.2 External compression headache	10.5 Dialysis
4.3 Cold stimulus headache	10.6 Headache related to other metabolic abnormality
4.4 Benign cough headache	11.0 Headache or facial pain associated with disorder of cranium, neck, eyes, ears, nose sinuses, teeth, mouth, or other facial or cranial structures
4.5 Benign exertional headache	11.1 Cranial bone
4.6 Headache associate with sexual activity	11.2 Neck
5. Headache associated with head trauma	11.3 Eyes
5.1 Acute posttraumatic headache	11.4 Ears
5.2 Chronic posttraumatic headache	11.5 Nose and sinuses
6. Headache associate with vascular disorders	11.6 Teeth, jaws, and related structures
6.1 Acute ischemic cerebrovascular disorder	11.7 Temporomandibular joint disease
6.2 Intracranial hematoma	12. Cranial neuralgias, nerve trunk pain, and deafferentation pain
6.3 Subarachnoid hemorrhage	12.1 Persistent (in contrast to tic-like) pain of cranial nerve origin
6.4 Unruptured vascular malformation	12.2 Trigeminal neuralgia
6.5 Arteritis	12.3 Glossopharyngeal neuralgia
6.6 Carotid or vertebral artery pain	12.4 Nervus intermedius neuralgia
6.7 Venous thrombosis	12.5 Superior laryngeal neuralgia
6.8 Arterial hypertension	12.6 Occipital neuralgia
6.9 Headache associated with other vascular disorder	12.7 Central causes of head and facial pain other than tic douloureux
7.0 Headache associated with nonvascular intracranial disorder	12.8 Facial pain not fulfilling criteria in groups 11 or 12
7.1 High CSF pressure	13. Headache not classifiable
7.2 Low CSF pressure
7.3 Intracranial infection
7.4 Intracranial sarcoidosis and other noninfectious inflammatory diseases
7.5 Headache related to intrathecal injections
7.6 Intracranial neoplasm
7.7 Headache associated with other intracranial disorder

Olesen J. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgia, and facial pain. Cephalalgia 1988;8(suppl 7):1-96.

This chapter addresses the neuro-ophthalmologic aspects of migraine and provides a brief review of other common headaches, facial and ocular pains. Migraine is a periodic and paroxysmal protean disorder that affects more than 17% of women and 6% of men in the United States.{2,3} Neuro-ophthalmologic symptoms and signs are common in migraine and should be recognized by the clinician. The term hemicrania evolved from a variety of older descriptions and was one of the first names for this disorder; this was later contracted by the French in the 13th century to the word "migraine." More than 300 years ago, Thomas Willis wrote the first modern description of migraine and its possible causes. Historical figures believed to have had migraine include Julius Caesar, Emmanuel Kant, Alexander Pope, and Sigmund Freud. Throughout the 18th and 19th centuries descriptions of the clinical phenomena and suggestions for therapy continued to appear in the writings of many prominent men in the medical professions. Sacks{4} pays homage to Edward Liveing's masterful treatise On Megrim, Sick Headache, and Some Allied Disorders (1873) as an unequaled description of the disorder. Further detailed clinical descriptions are found in the writings of Gowers.{5}

In contemporary medicine, Dalessio, Raskin, Sacks, Silberstein, Lipton, Stewart, Saper, and Welch, are among those who could be singled out for their contributions to the study of migraine. One central theme seems to decry the simplistic view that migraine is defined by a unilateral (hemicranial) headache. As Sacks{4} wrote, "It is necessary to state that headache is never the sole symptom of a migraine, nor indeed is it the necessary feature of migraine attacks." Another quote emphasizes this belief: "Migraine is diagnosed by the entire history, not by physical findings or by the presence of headache alone".{6} It is unfortunate that many have limited their concept of migraine to a stereotyped syndrome of visual disturbance followed by unilateral throbbing headache, which is diagnosed by the response to ergot preparations. Migraine gives rise to a number of well-recognized syndromes, as well as a variety of "equivalents" less commonly considered as migraine. The symptom-complexes or syndromes of migraine include migraine without aura, migraine with aura, ophthalmoplegic migraine, retinal migraine, as well as the others listed in Table 1 The clinical features of migraine will be discussed according to the formal criteria published by the International Headache Society (IHS) in 1988.{7}
Other conditions and syndromes discussed include cluster headache, trigeminal neuralgia, atypical facial pain, temporal arteritis, and the headaches produced by intracranial mass lesions, muscle contraction, trauma, vascular anomalies, and ocular lesions.