Classification and clinical symptomatology of migraine

1. Big picture

Migraine is a common primary headache disorder characterized by recurrent attacks of moderate-to-severe headache, usually with nausea, vomiting, photophobia, phonophobia, and worsening with physical activity.

The key exam idea:

Migraine = recurrent headache lasting 4–72 hours, usually unilateral, pulsating, moderate/severe, aggravated by activity, with nausea/vomiting or photo-/phonophobia.

Migraine is not just “a bad headache.” It is a neurovascular brain disorder involving the trigeminovascular system, brainstem activation, neuropeptide release, and, in aura, cortical spreading depression.

The most important classification:

• **Migraine without a