![]() ![]() Fully reversible visual symptoms including positive features (flickering lights, spots, or lines) and/or negative features (ie, loss of vision)Ģ. Must fulfill criteria for migraine listed above, and in addition, at least 2 attacks fulfilling the following criteria:Īura consisting of at least 1 of the following, but no motor weakness:ġ. Recurring headache with at least 5 attacks fulfilling the following criteria:Īttacks last 4–72 h (untreated or unsuccessfully treated)Īt least 1 of the following during attack: 7 The IHS Diagnostic Criteria for Migraine with Aura are depicted in Table 1. Headache with the features of migraine without aura usually follows the aura, although less commonly, the headache may lack migrainous features or be completely absent. 9 According to the ICHD II criteria, migraine with aura is a recurrent disorder manifesting in attacks of reversible focal neurologic symptoms that develop gradually over 5 to 20 minutes, and last for less than 60 minutes. 8 Visual symptoms are the most common aura, and are a feature of 99% of auras. Neurologists have long hypothesized that a phenomenon called cortical spreading depression (waves of altered brain function triggered by changes in cellular excitability) is responsible for migraine aura. 6 Aura specifically describes a complex of neurologic symptoms that occur just before or with the onset of migraine headache, and most often resolves completely before the onset of headache. Migraine with aura has a 1-year prevalence rate of 5% in women. Migraine With Aura (Previously Known as Complex Migraine) ![]() Finally, we provide information about the effect of hormonal fluctuations on headache, and recommendations regarding contraception counseling in patients who experience headache while taking hormonal contraception. Society recommendations for hormonal contraception initiation and continuation in women with these diagnoses are emphasized. This review outlines key differences among headache, migraine, and migraine with aura, and describes the strict diagnostic criteria. ![]() 4 Separate from the risk of unintended pregnancy, women who discontinue hormonal contraceptives due to headaches are unable to reap the noncontraceptive benefits of these medications, including relief of chronic pelvic pain, and endometrial protection in polycystic ovary syndrome and other anovulatory states. 3 Contraceptive discontinuation is thought to account for 20% of the 3.5 million unplanned pregnancies in the United States annually. In addition, headache is a frequently reported side effect of hormonal contraception and a leading reason cited for contraceptive discontinuation. It is critical for physicians prescribing hormonal contraception to distinguish among common headache, migraine, and migraine with aura, to decide when the use of estrogen-containing contraception is appropriate. Key considerations include physician selection of appropriate candidates for initiation of hormone-containing contraceptives, and decision making about method continuation in patients complaining of headache while taking hormonal contraceptives. 2 Given the significant proportion of reproductive-age women affected by migraine, there are several clinical considerations that arise when considering hormonal contraceptives in this population. 1 During these reproductive years, hormonal contraception is the most prevalent form of birth control used, with 43% of contracepting US women using hormone-containing pills, patches, ring, shots, implants, or intrauterine devices. 1 The prevalence of migraine increases with age: 22% of women age 20 to 24 years, 28% age 25 to 29 years, 33% age 30 to 34 years, and as many as 37% of women age 35 to 39 years are affected. Forty-three percent of women in the United States are affected by migraine. ![]()
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