MIGRAINE WITHOUT AURA   ( Common Migraine) The IHS classification has improved the diagnosis of headaches. It has also facilitated clinical research on migraine. In order to establish a diagnosis of migraine without aura, five attacks are needed as presented in Table 2: Table 2. Migraine without aura 1.1 Migraine without aura Previously used terms: common migraine, hemicrania simplex Diagnostic criteria A. At least five attacks fulfilling B through D B. Headache lasting 4 to 72 h (untreated or unsuccessfully treated) C. Headache has at least two of the following characteristics: 1. Unilateral location 2. Pulsating quality 3. Moderate or severe intensity (inhibits or prohibits daily activities) 4. Aggravation by walking stairs or similar routine physical activity D. During headache at least one of the following: 1. Nausea and/or vomiting 2. Photophobia and phonophobia E. At least one of the following: 1. History, physical, and neurologic examinations do not suggest one of the disorders listed in groups 5 through 11 2. History and/or physical and/or neurologic examinations do suggest such disorder, but it is ruled out by appropriate investigations 3. Such disorder is present, but migraine attacks do not occur for the first time in close temporal relation to the disorder Each attack must last 4 to 72 hours and have two of the following four paincharacteristics: unilateral location, pulsating quality, moderate to severe intensity, and aggravation by routine physical activity. In addition, the attacks must be associated with at least one of the following: nausea, vomiting, or photophobia and phonophobia. With these criteria, no single characteristic is mandatory for a diagnosis of migraine. A patient who has severe pain aggravated by routine activity, photophobia and phonophobia, meets these criteria as does the more typical patient with unilateral throbbing pain and nausea. Migraine usually lasts several hours or the entire day. When the migraine persists for longer than three days, the term "status migrainosus" is used. Frequency of attacks varies widely from a few per lifetime to several per week.{9} The average migraineur experiences from one to three headaches a month.{3} A precise location ascribed to migraine, such as unilateral or temporal, is misleading, for as Wolff{24} wrote: The sites of migraine are notably temporal, supraorbital, frontal, retrobulbar, parietal, postauricular, and occipital...They may as well occur in the malar region, in the upper and lower teeth, at the base of the nose, in the median wall of the orbit, in the neck, and in the region of the common carotid arteries and down as far as the tip of the shoulder. The prodromes of common migraine are vague, preceding the attack by hours or days, and include psychic disturbances (such as depression or hypomania), gastrointestinal manifestations and changes in fluid balance. Usually the onset of the common migraine headache is unilateral, but the pain often becomes holocephalic. In an individual patient the headache is commonly more prominent on a single side, with occasional or rare alternation. Some individuals always experience a unilateral headache, while in approximately one-third the headache is diffuse from onset. The character of the headache is traditionally described as throbbing, but this may be a feature only at onset, with the discomfort soon changing to a steady ache. The victim can often relieve unilateral headache by carotid artery or temporal artery compression, only to experience resurgence of the pain following release. Nausea in some degree almost always accompanies common migraine. Vomiting can occur at the height of an attack, sometimes with relief of the headache, but more often only signals an intensifying phase of the episode, which continues for many minutes or hours. Usually the migraine sufferer becomes pallid and seeks seclusion, darkness, quiet, and a cold towel or ice bag for the head. Frequently at the time of nausea with vomiting, a diuretic phase with polyuria ensues, the consequence of fluid retention which occurred in the hours or days preceding the acute headache. Ocular signs and symptoms may occur in common migraine, such as conjunctival injection, periorbital swelling, excessive tearing, foreign body sensation, and photophobia; however, these phenomena are more prominent in cluster headache.