A 25-Year-Old Pregnant Woman With Worsening Headaches

Nancy Hammond, MD


June 07, 2018


This young woman suffers from migraine with aura (classic migraine). The International Headache Society defines migraine with aura as starting with the gradual development of visual, sensory, or speech symptoms lasting less than 1 hour.[1] Symptoms may occur alone or in combination but must be fully reversible. Motor, brainstem, and retinal symptoms should be absent. Headache follows the initial neurologic symptoms within 60 minutes. Patients with migraine often describe a prodrome of fatigue, nausea, irritability, excessive thirst, irritability, or depressed mood that can occur hours to days prior to the headache.

Migraine headaches are often moderate to severe in intensity and unilateral, although they can be present bilaterally. The headache is often described as pulsating in quality and aggravated by routine physical activity. Nausea or vomiting and photophobia or phonophobia usually accompany the headache. Without treatment, migraine headaches last hours to days. Estimates of migraine prevalence vary widely throughout the world. In the United States, around 15%-20% of women and 5%-8% of men have migraine.[2] Incidence of migraine with aura peaks between age 12-13 years in females.

Tension headaches are usually less severe than migraine. They are often described as a bandlike, squeezing pain around the head. Associated symptoms can include mild nausea and photophobia or phonophobia. Cluster headaches are characterized by sudden onset of unilateral, retro-orbital, stabbing pain accompanied by autonomic symptoms ipsilateral to the pain of ptosis, conjunctival injection, tearing, and rhinorrhea. Occipital seizures can present with a visual aura but are usually shorter in duration than the visual symptoms of migraine with aura.


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