Migraine without aura, a particular headache

Migraine without aura is the most common migraine (Ducros 2006). The occurrence of at least five attacks is necessary for the diagnosis of migraine (Géraud et al. 2015). It combines a very characteristic headache , as well as associated secondary symptoms. The headaches set in gradually, from a few hours to a few minutes, most often unilaterally and predominate on the forehead, temples and sometimes on the face. The crisis can occur at any time of the day and night.

Sometimes the pain sits in the occiput and radiates to the cervical; in this case, it can be confused with Arnold's neuralgia , which affects the C2 root. The unilateral character is not obligatory and is more common in adults than in children, where it is often bilateral (Ducros 2006; Dodick et al. 2018). The pain felt is throbbing, increased by physical activity or sometimes simple head movements. Its intensity can vary from patient to patient and from attack to attack. Rest, immobility and occlusion of the eyes are the major elements to reduce the intensity of the pain. In a third of attacks, the patient must lie down and stop all activity (Géraud et al. 2015).

Migraine without aura is not just a headache

Other symptoms accompany the headache. Mostly, it is nausea and more rarely vomiting . Photophobia , that is to say an abnormal sensitivity to light is also a common symptom, as is phonophobia where noises are no longer tolerated by the patient. It is for these reasons in particular that patients withdraw spontaneously into quiet, dark rooms during the crisis. The attack can last from 4 to 72 hours if no treatment is given (Lanteri-Minet et al. 2013). In children, seizures lasting less than four hours are common. However, it is difficult to measure the duration of an attack, because warning symptoms can begin hours or days before the onset of pain.

Patients then describe asthenia, yawning, drowsiness, irritability, feelings of hunger and mood swings, ranging from depression to feelings of euphoria (Géraud 2015). These premonitory symptoms highlight a central dysfunction, certainly at the level of the hypothalamus, insofar as they occur well before the onset of the headache.

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International Headache Society (IHS) diagnostic criteria for migraine without aura

In its latest version, the IHS established precise diagnostic criteria to define migraine without aura (ICHD-3 2018).

Diagnostic criteria for migraine without aura (ICHD-3β: 1.1):

1. At least five seizures meeting criteria B to D
2. Headache attacks lasting 4 to 72 hours (untreated or unsuccessfully treated)
3. Headache having at least two of the following four characteristics:
   1. Unilateral localization
   2. Pulsating quality
   3. Moderate or severe intensity
   4. Aggravated by or causing avoidance of routine physical activity (eg walking or climbing stairs)
4. During the headache, at least one of the following signs:
   1. Nausea and/or vomiting
   2. Photophobia and phonophobia
5. No better definition by another diagnosis of ICHD-3β

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