My left side has a headache and my eyes hurt too

Headaches are common in daily life. There are many causative factors, some of which occur alone, while others are a manifestation of other diseases. The phenomenon of headache and eye pain on the left side is most likely a migraine. The specific situation of the migraine needs to be understood and a comprehensive judgment made in combination with other physical symptoms. Now let’s look at the situation of migraine.

Migraine

Clinical manifestations

Frequent attacks of migraine will affect the patient's life and work, the most direct impact is sleep. Due to lack of sleep, patients will lack energy during the day and their work will be greatly affected. Moreover, some patients often have an attack when they are working, which is very time-consuming. At the same time, when people suffer from headaches for a long time, their personality changes and they often become irritable. Because the disease cannot be cured for a long time, people's lives are severely affected, they become psychologically fragile and lose confidence, which will have adverse effects on the cardiovascular and cerebrovascular systems over time. Clinically, cerebral thrombosis, hypertension and cerebral hemorrhage are also common after headache attacks. The following are the clinical manifestations of the main types of migraine:

Migraine without aura

Migraine without aura is the most common type of migraine, accounting for about 80% of cases. There may be no obvious precursor symptoms before the onset of the disease. Some patients also experience mental disorders, fatigue, yawning, loss of appetite, general discomfort, etc. before the onset of the disease. Pain can also be induced in women during menstruation, drinking, and hunger. The headache usually worsens slowly, with recurrent unilateral or bilateral frontal and temporal pain that is pulsating. When the pain persists, the symptoms may be complicated by contraction of the neck muscles. It is often accompanied by symptoms such as nausea, vomiting, photophobia, phonophobia, sweating, general malaise, and scalp tenderness. Compared with migraine with aura, migraine without aura has a higher frequency of attacks, which can seriously affect the patient's work and life. It often requires frequent use of painkillers for treatment and is prone to be combined with a new type of headache - "medication-overuse headache".

Migraine with aura

Migraine with aura occurs in about 10% of migraine patients. Prodromal symptoms such as fatigue, inattention, and yawning may occur hours to days before an attack. Before or when a headache occurs, reversible focal neurological symptoms are often present as precursors. The most common are visual precursors, such as blurred vision, dark spots, flashes, bright spots or lines, or distorted vision; the second most common are sensory precursors, which are mostly distributed in the face-hand area; speech and motor precursors are rare. The precursor symptoms usually develop gradually within 5 to 20 minutes and last no more than 60 minutes; different precursors can appear one after another. The headache occurs at the same time as the aura or within 60 minutes after the aura, and manifests as unilateral or bilateral frontal, temporal or retroorbital pulsating headache, often accompanied by nausea, vomiting, photophobia or phonophobia, pallor or sweating, polyuria, irritability, fear of smells and fatigue, etc. Edema of the head and face and protrusion of the temporal artery may be seen. Activity can make headaches worse, but sleep can relieve them. The pain usually reaches its peak within 1 to 2 hours and lasts for 4 to 6 hours or more than ten hours. In severe cases, it may last for several days. After the headache subsides, there are often symptoms such as fatigue, tiredness, irritability, weakness and poor appetite.

(1) Migraine headache with typical aura: This is the most common type of migraine with aura. The aura is characterized by completely reversible visual, sensory or speech symptoms, but no limb weakness. A headache with typical aura is a migraine headache that occurs at the same time as the aura or within 60 minutes after the aura. If the headache that occurs at the same time as the aura or within 60 minutes after the aura does not meet the characteristics of migraine, it is called non-migraine headache with typical aura; when the headache does not occur within 60 minutes after the aura, it is called typical aura without headache. The latter two should be distinguished from transient ischemic attack.

(2) Hemiplegic migraine Hemiplegic migraine: rare in clinical practice. In addition to motor weakness symptoms, the aura must also include one of the three auras: visual, sensory and verbal. The aura symptoms last from 5 minutes to 24 hours, and the symptoms are completely reversible. A headache consistent with the characteristics of migraine occurs at the same time as the aura or within 60 minutes of the aura. If at least one first- or second-degree relative of a patient with hemiplegic migraine has a migraine aura including motor weakness, it is familial hemiplegic migraine; if not, it is called sporadic hemiplegic migraine.

(3) Basal migraine: The prodromal symptoms clearly originate from the brainstem and/or the bilateral cerebral hemispheres. Clinically, dysarthria, vertigo, tinnitus, hearing loss, diplopia, visual symptoms in the nasal and temporal visual fields of both eyes, ataxia, impaired consciousness, and bilateral sensory abnormalities can be seen, but there are no symptoms of motor weakness. A headache consistent with migraine characteristics occurs at the same time as the aura or within 60 minutes of the aura, often accompanied by nausea and vomiting.

Retinal migraine

Retinal migraine is defined as recurrent, fully reversible monocular visual disturbances, including flashes, scotomas, or blindness, associated with migraine attacks with normal ophthalmologic examinations between attacks. Unlike basilar migraine, in which the visual aura often affects both eyes, retinal migraine visual symptoms are confined to one eye and lack neurological deficits or irritation symptoms originating from the brainstem or cerebral hemispheres.

Periodic syndromes in children

Childhood periodic syndromes, which are often the prodrome of migraine, can be regarded as migraine equivalents. Clinically, periodic vomiting, recurrent abdominal pain with nausea and vomiting, namely abdominal migraine, and benign childhood paroxysmal vertigo can be seen. The attack is not accompanied by headache, but migraine may develop over time.

Migraine Complications

(1) Chronic migraine: If migraine attacks occur more than 15 days a month for 3 consecutive months or more, and headaches caused by drug overdose are excluded, it can be considered as chronic migraine.

(2) Status migraineus: A migraine attack lasts ≥ 72 hours and the pain is severe, but there may be brief periods of relief due to sleep or medication.

(3) Continuous aura without infarction: refers to patients with migraine with aura who experience one or more aura symptoms during an attack that lasts for more than one week, usually bilaterally; other symptoms of this attack are similar to previous attacks; neuroimaging is required to rule out cerebral infarction lesions.

(4) Migraine infarction: In very rare cases, ischemic infarction of the corresponding blood supply area in the brain occurs after the migraine prodromal symptoms. This prodromal symptom often lasts for more than 60 minutes, and the ischemic infarction lesions are confirmed by neuroimaging. This is called migraine infarction.

(5) Migraine-induced epileptic seizures: In rare cases, migraine aura symptoms can trigger an epileptic seizure, and the epileptic seizure occurs during or within 1 hour after the aura symptoms.

Ophthalmoplegic migraine

Ophthalmoplegic migraine is clinically manifested by recurrent migraine-like headaches, with ophthalmoplegia on the headache-side occurring simultaneously with or within 4 days of the headache attack. The oculomotor nerve is most commonly affected, often with ptosis and pupil dilation. In some cases, both the trochlear and abducens nerves may be affected. The headache of patients with ophthalmoplegic migraine often lasts for 1 week or more, and the latency period from headache to ophthalmoplegia can be as long as 4 days. In some cases, MRI enhanced scans can show recurrent demyelinating changes in the affected oculomotor nerve. Therefore, there is a tendency not to consider ophthalmoplegic migraine as a subtype or variant of migraine.