Migraine is characterized by recurrent, hemicranial pulsating, moderate to severe headaches lasting for 2-72 hours associated with nausea, vomiting, photophobia, phonophobia, osmophobia and disability.

Associated symptoms of transient visual changes, pulsatile tinnitus, neck and back pain, nausea, vomiting, photo/ phonophobia, and findings of abducens nerve palsy or papilledema--while nonspecific--should raise suspicion for elevated ICP and IIH, especially in women who are obese.

Table 1: Distribution of associating factors in migraine Migraine type; n=228 (%) Total Associating factors MWA MA CM Nausea 55 (76.39) 14 (19.44) 3(4.16) 72 (100) Vomiting 44 (75.86) 13 (22.41) 11 (18.97) 58 (100) Photophobia 23 (69.67) 8 (24.24) 2 (6.06) 33 (100) Phonophobia 19 (76) 1 (4) 5 (20) 25 (100) Lacrimation 9 (100) 0 (0) 0 (0) 9 (100) Giddiness 0 (0) 4 (80) 1 (20) 5 Paresthesia 3 (100) 0 (0) 0 (0) 3 (100) Uneasiness 1 (100) 0 (0) 0 (0) 1 (100) Lightheadedness 0 (0) 0 (0) 1 (100) 1 (100) Nasal congestion 0 (0) 0 (0) 0 (0) 0 (0) Nasal discharge 0 (0) 0 (0) 0 (0) 0 (0) Scalp Tenderness 0 (0) 0 (0) 0 (0) 0 (0) Conjunctiva congestion 0 (0) 0 (0) 0 (0) 0 (0) Nil 0 (0) 0 (0) 0 (0) 0 (0) Data is expressed as no of patients (%).

Hypertension could be linked to onset of a migraine-like attack (photophobia, phonophobia, headache, and vertigo) and headache affecting driving skills.

There was no distal coldness, crying, or pallor, no feeling of dizziness, nausea, emesis, photophobia, phonophobia, or autonomic symptoms, no relationship with valsalva, or associated with exercise.

So far as, symptoms and precipitating factors are concerned; vomiting (81.94%), nausea (75%), photophobia (52.22%), phonophobia (38.88%), and vertigo (38.88%) were major symptoms in chronic migraine whereas past four symptoms (nausea 82.5%, photophobia 47.5%, phonophobia 46.66%, and vertigo 40%) were major presenting symptoms associated with CTTH, whereas light and fasting were major responsible precipitating factors for chronic migraine and stress and sound were more commonly associated with CTTH as a precipitating factor Tables 2 and 3.

Previous studies had revealed that obesity was related with migraine patients with high frequency, greater severity, and some increased associated symptoms: higher disability grades, aura and an increased frequency of photophobia and phonophobia [3-5].

The limitations of using the HIT-6 are that it fails to address other important aspects of headache such as triggers, headache days per month, pain quality, temporal factors, presence of aura, associated symptoms (e.g., photophobia, phonophobia, visual changes, scleral injection, etc.), and exacerbating and alleviating factors.

The questions asked about the onset age of their headache, the exact region of pain, type of headache (e.g., pulsating or headache attack), the triggering factors (e.g., coughing, physical activity, sport, sneezing, sexual activity, thirst or voiding), the time interval between exposure to the triggering factors and onset of headache, and other side effects (nausea, vomiting, photophobia, phonophobia).

Although the visual auras experienced by migraineurs are often accompanied by a severe headache, nausea, photophobia and / or phonophobia, this is not always the case.

Four days prior to admission, he had become progressively sleepy and experienced a sudden and severe stabbing frontal headache with vomiting and phonophobia. At physical examination, he had a normal level of consciousness, fever up to 38 degrees Celsius, and no neurological abnormalities.

Frontal cephalalgia was described as stabbing; photosensitivity, phonophobia, nausea, and vomit were absent.

When it was severe, it was accompanied by dizziness, nausea, photophobia, phonophobia and blurred vision.

Migraines are more extreme in every regard, marked by a pulsating, throbbing feeling in one's head and can be accompanied by other symptoms such as nausea and/or vomiting, photophobia (sensitive to light) and/or phonophobia (sensitive to sound).