The headaches are paroxysmal , recurrent and date from adolescence.
Each attack lasts 4-48 hours or longer.
Two phases can often be distinguished
(1)The AURA
Lasts 15-20 minutes.
The commonest aura is visual and consists of glittering zig-zag lines, curved or straight castellated or fortification figures, often in movement in one half of the field of vision (teichopsia, visual spectrum).
There may be a scotoma or himianopia blotting one part of the vision.
Scotoma or scintillations may occur singly or together affecting sometimes one half of the visual field, sometimes the other.
Paraesthesiae constitute a less frequent aura.
If they occur in the right hand and round the lips and tongue in right handed people , there may be transient difficulty in finding words (dysphasia) or in writing (dysgraphia).
Much less commonly transient vertigo or double vision lasting 2-3 minutes are met as a migrainous aura.

(2)The headache succeeds, or is contemporary with the aura; it never precedes it.
Typically the headache starts in one frontal region, spreading to the opposite side of the head; sometimes, however, it remains a hemicrania, confined to one half of the head.
It ia accompanied by photophobia, flushing, pallor, or by vomiting or faint feelings.
The pain lasts 4-48 hours and may leave the patient exhausted if the attack has been unduly prolonged.
During an attack unequal pupils may be observed.
Attacks may be heralded by bouts of euphoria, anxiety or depression.
They may be precipitated by menstruation , eyestrain , or dietetic indiscretions.
Paroxysms occur at varying intervals and may consist of (1)reccurrent headaches, (2)reccurrent headaches with vomiting, (3) the aura with a subsequent headache, or (4) the aura alone.
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