A review of associated symptoms of migraine determined by telephone survey of 500 self-reported migraine sufferers is reported from Temple University School of Medicine and the Comprehensive Headache Center, Germantown Hospital, Philadelphia, PA. Female to male preponderance was 443 to 57; 5.6% were younger than 25 years old. Seventy-one percent took abortive medication, and 26,5% received both abortive and prophylactic medication. Precipitating factors included stress (79%), changes in weather (44%), pre-menstruation (37%), changes in light (34%), and eating certain foods (30%). Symptoms associated with migraine attacks were headache (96%), nausea/vomiting (32%), photophobia (83%), noise sensitivity (60%), dizziness (65%), eye pain, and neck pain (79%). Nausea occurred in one half of attacks in >90% of respondents, and vomiting in one third of attacks in 70%, interfering with oral medication in 30% and 42%, respectively. Many childhood migraineurs have a history of cyclical vomiting, a recognized precursor of migraine. [1]

COMMENT. The authors emphasize the significance of nausea and vomiting as associated symptoms affecting the degree of disability of migraine sufferers. Drugs used to treat migraine often cause nausea and may exacerbate associated symptoms while relieving headache. The treatment or avoidance of nausea may be as important as the relief of headache. The route of administration of migraine medication can alter the prevalence of side-effects. Nausea and/or vomiting occur more frequently with oral administration of ergotamine or sumatriptan than with injection therapy.

Revisions to the International Headache Society classification proposed for pediatric migraine proved more sensitive than existing criteria in a study of 45 children and adolescents at the Palm Beach Headache Center, Florida. For pediatric migraine without aura, the revisions included headache attacks as short as 30 minutes and a bilateral location in addition to unilateral headache. For those pediatric migraines with aura, the only proposed revision was a decrease in duration of headache from 2 - 48 hours to one half - 48 hours. Diagnostic rates increased from 53% to 80%, using the revised criteria. [2]