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Other names: Benemid

THE HEADACHE PHASE OF CLASSICAL MIGRAINE
Usually within fifteen to twenty minutes after the preheadache symptoms begin, they diminish. It is at about this time that the headache develops. At first the headache may be mild, but it gradually worsens. The pain may initially be felt on only one side, but as it intensifies, it may spread to involve most of the head. The pain can develop on both sides simultaneously, and the scalp, face, and neck may be tender to touch. The ache is frequently dull, deep, and throbbing, and often begins in the forehead, ear, jaw, or in or around an eye or temple.
Shoulder and neck pain may develop. In part this is due to muscle spasm resulting automatically from the pain around the neck and head or as part of an attempt to hold the painful head motionless, since migraine pain is frequently worsened by head movement, bending over, sneezing, or coughing. It is not unusual, understandably, for a muscle-spasm-type headache to be superimposed on the migraine.
Nausea, vomiting, mental cloudiness, total body achiness, abdominal pain, chills, and cold hands and feet commonly accompany the headache.
The actual attack of classical migraine usually lasts from one hour to more than a day. Following it, sore muscles, total body exhaustion, and a continued mild mental cloudiness may persist for days.
These attacks do not all follow the same pattern. Occasionally, the headache of the classical migraine variety is mild in intensity and not particularly debilitating. If the pain is either mild or absent and is not mentioned to the physician, it may become very difficult to establish a correct diagnosis. In rare cases, the headache phase precedes the other symptoms in classical migraine. The following example illustrates the difficulty in diagnosing a classical migraine when the features of an attack vary from the usual:
A 22-year-old student at a nearby university experienced recurring episodes of “I can’t understand what I am reading.” These attacks usually occurred after he had been concentrating for several hours, especially on biophysics problems. Without warning, he would realize that he could no longer see the letters and numbers in the papers and book, but he could see images on either side of them. His central field of vision was blurred and out of focus. A year before, when these attacks first began, he had studied his face in a mirror to see if anything was wrong with his eyes. To his great concern, he could see his ears and cheeks but not his eyes or nose. He attributed this visual impairment to eyestrain and made a practice of going to sleep soon after the onset of each episode. Upon awakening, he ordinarily felt “perfectly okay.”
On the day I was called to the emergency room to examine this patient, he had experienced another episode of visual impairment, but instead of going to sleep as was customary, he decided to attend a lecture. About one hour after the onset of the visual difficulties, the patient developed a severe pain in his right eye. According to the patient, this was the first time that pain had occurred.
Aspirin did not help to alleviate the pain and he concluded that the severe pain resulted from “an insufficient supply of blood to my brain.” Treating himself, he tried to remedy this deficient blood supply by placing his head lower than the rest of the body to “increase the brain’s blood supply.” This maneuver only intensified the pain, but he realized that his visual impairment was no longer present. Soon he fell asleep, and on awakening he had only a mild headache. Although the headache had passed, he was very concerned and decided to go to the hospital for treatment.
When he was first questioned about experiencing a headache in connection with the visual episodes, the answer was no. But later, he remembered that on a few occasions, when he had not fallen asleep immediately after the beginning of the visual problems, he had developed a mild and not particularly bothersome discomfort around the eyes.
The diagnosis in this patient was classical migraine, and this case demonstrated two problems in establishing a diagnosis. The first was the practice of falling asleep soon after the onset of visual disturbances so that the victim was actually unaware of the headache phase of his attacks. Secondly, the patient’s initial description of his visual symptoms reflected the mistaken belief that he was having a problem with his ability to understand the material he was studying rather than impairment of vision being responsible for his inability to read.
The current research in migraine headache suggests that individuals with frequent attacks of classical migraine, particularly those headaches associated with significant neurological symptoms, may be more likely than the nonmigraine person to suffer from strokes and heart attacks later in life. This tendency may be related to an abnormality of the blood particles called platelets that play an important role in the normal clotting process. An increase of platelet stickiness or other abnormalities of the platelets can account for this clotting tendency, and current research is looking into the possibility that treating classical migraine sufferers with medications that decrease the platelet stickiness may improve the long-term health of migraine patients. Plain aspirin is one such medication.
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