Migraine pain location in adult patients from eastern India

Background: Sparse literature documenting the location of pain at the onset of migraine attacks and during established headaches is available. Objectives: A prospective study (2003-05) on 800 adult migraine patients (International Classifications of Headache Disorders (ICHD), 2: 1.1, 1.2.1 and 1.6.1) was conducted to document (a) sites of onset of pain and (b) location of pain during established attacks (in > 50% occasions) through semistructured interviews. Results: Demography: N = 800; M: F = 144: 656 (1: 4.56); age, 16-42 years (mean, 26 years); duration of migraine, 1-18 years (mean, 6.8 years). 87% of the subjects were ethnic Bengalis from the eastern Indian state of West Bengal, Calcutta being the capital city. Migraine types (on the basis of > 50% headache spells): N = 800; 1.1: 668 (83.5%); 1.2.1: 18 (2.25%); 1.6.1: 114 (14.25%). Location of pain at onset: Unilateral onset was present in 41.38% of the patients; of these, 53.17% had eye pain; 8.16%, frontal pain and 38.67%, temporal pain. In 32.25% of the patients, bilateral/central location of pain, mostly bitemporal or at vertex was noted. Cervico-occipital pain onset was noted in 26.43% patients (predominantly occipital, 14.68%; predominantly cervical, 11.75%). Location of established headaches: In 47.4% of the patients, with unilateral ocular or temporal onset, pain remained at the same site. Pain became hemicranial in 32.9%. In most patients, unilateral frontal onset pain (55.5%) became bilateral or holocranial. Most bilateral ocular (69.4%) and temporal onset (69.7%) pains remained at the same location. However, most bifrontal (55.6%) and vertex onset (56.9%) pains subsequently became holocranial. Most occipital pains at onset became holocranial (45.3%), but cervical pains subsequently became either hemicranial (38.3%) or holocranial (36.2%). Conclusions: This study documents location of pain at the onset and during established headaches in migraine patients largely from a specific ethnic group. Migraine with aura appears to be rare among ethnic Bengalis in eastern India. More than half had onset pain bilaterally/centrally and in the cervico-occipital regions. Only 40.5% experienced only unilateral pain. Cervico-occipital migraine pain appears to be common in ethnic Bengalis.