Migraine Headaches

Epidemiology

The reasons

Kinds

How does migraine flow

Diagnostics

Symptoms that should alert

Treatment

Complications

Prevention and prognosis

Migraine is included in the group of nervous diseases.

Synonyms:   migraine, migraine with aura, hemicrania, migraine attack. 
ICD-10 code: G43

Migraine pains – intense, intermittent and throbbing. More often occur in one half of the head.

Characteristically, the migraine is not associated with traumatic brain injuries, brain neoplasms or stroke. Migraine headaches are almost always accompanied by any of the types of disorders or their combinations:  

  • vegetative (nausea, vomiting);
  • sensory (increased sensitivity to light, sounds);
  • motor (violation of movement, speech);
  • mental   disorders (anxiety).

Epidemiology

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According to WHO data, 10-14% of people in the world suffer from migraine, and in some countries the rate reaches 30%. Migraine is included in the list of 19 diseases that violate the social adaptation of the individual. In two thirds of cases, the pathology makes its debut in persons younger than 30 years old, the peak of the first cases of the disease falls on the age segment of 18-20 years. Also migraine can manifest itself for the first time at the age of 30-35 years. With age, the pathology fades away and is rarely observed in persons over 50.

The disease is 2 times more often diagnosed in women than in men. Cases of migraine have been reported in children 5–8 years old and even in infants. In 70% of people suffering from migraines, whose parents had the disease. American researchers claim that 10% of schoolchildren experience migraine attacks.

The reasons

Currently, the mechanism of development of migraine is not well understood. Researchers identified several phases in the pathogenesis of a migraine attack:

  • Spasm of the arteries of the brain. Causes short-term hypoxia of the brain substance, with what is the development of the aura.
  • The subsequent expansion of the cerebral vessels. Dilatation of the veins and arteries of the brain occurs unevenly after their previous narrowing, which determines the occurrence of pulsating pain.
  • Swelling of the vascular walls. The edematous walls of the veins / arteries interfere with the contraction of the vessels, which explains the duration of the headache.
  • Recovery phase. At this stage, the edema of the vessels decreases, their diameter returns to the initial one, and the patient develops post-migraine syndrome, characterized by weakness, fatigue, and inhibition.

The exact causes of migraine pain has not been established, but a number of provoking factors are highlighted:

  • Nutritional factors. The consumption of certain foods and drinks (low alcohol, chocolate, etc.), violation of diet (skipping meals), poor diet or strict diet.
  • Hormonal factors. The phases of the menstrual cycle change under the action of certain hormones, in particular, progesterone, so seizures often develop in women on the eve of menstruation, in the ovulatory phase, when using oral contraceptive drugs and hormones for the treatment of gynecological diseases, in the postpartum and lactation periods, in premenopause.
  • Environmental factors. Radical climate change, a big difference in time zones.
  • External factors. Extraneous noises, loud noises, flickering lights / flashes, bright artificial lighting, unpleasant, persistent or intense odors, smoking, including passive.
  • Factors associated with sleep disorder. Insomnia, sleep deprivation or remission (migraine of the day off), later falling asleep and awakening, restless, intermittent sleep.
  • Psychophysiological factors. Significant emotional stress, at the end of a stressful situation (passing the exam, concluding a contract), anxiety, prolonged stress, stress, excessive exercise in sedentary people, nervous breakdowns. It is noted that the listed triggers often provoke attacks in people with ambitions and perfectionists.
  • Medications. In addition to taking hormones, an attack can cause taking nitroglycerin, ranitidine, reserpine and a number of other drugs.

Kinds

The international classification of diseases identifies the following types of migraine:

  • simple or ordinary, proceeds without aura, 3/4 of patients suffer;
  • classical, the attack is preceded by an aura;
  • migraine status – seizures follow one after another, the intervals between them are less than 4 hours;
  • complicated with loss of consciousness, nausea / vomiting, epileptic seizures;
  • chronic migraine, seizures are characterized by regularity, with each new intensity of pain increases;
  • unfinished.

How does migraine flow

In the symptoms of classical migraine there are several phases that replace each other:

Phase of prodrome or precursors

Sometimes it may be missing. Symptoms begin to appear in a couple of hours or even a day before the attack. Sudden irritability, sleeplessness at night and sleepiness during the day, appetite changes. The ability to concentrate is also impaired, unmotivated fatigue is noted, sensitivity to external stimuli is intensified (bright light, smell, noise).

Aura

It is a complex of neurological symptoms that appear 10-60 minutes before an attack. Accompanied by

  • visual impairment in the form of flashing of flies, blurring of objects, the appearance of spots before your eyes or loss of areas of vision,
  • tactile (goosebumps, numbness, tingling in the legs / arms),
  • olfactory
  • sound disturbances (perversion of smells, a quiet sound is perceived as loud).
  • Numbness of the extremities and trunk affects half the opposite to the localization of the headache.
  • Speech disorders (dysphasia) are possible in the form of speech confusion, its length and coordination problems (unsteady gait, instability).

Pain phase or immediate attack

It lasts from several hours (usually 2-3 hours) to several days. The intensity of the pain can increase over 10 minutes or within a few hours. By nature, migraine pain is pulsating or pressing, extends to half of the head, capturing the eye, part of the forehead and the back of the head. Localization of pain with its unilateral manifestation changes with a new attack (first, the right side of the head ached, then the left or the back of the head).

During an attack, photophobia, rejection of sounds (any), nausea may occur, with a vomiting attack occurring at its peak, which does not bring relief, vision and sense of smell are disturbed. Many patients have an overwhelming desire to squeeze their heads with their hands. In the pain phase, blood pressure surges are possible. With its increase, the pain is arching, with a decrease in pulsating or squeezing.

Resolving phase or ending an attack

The pain gradually fades away, the patient sinks into a deep sleep. Often there is swelling of the face and limbs due to urinary retention.

Recovery phase

It is characterized by polyuria (an increase in the volume of urine), frequent urination, fatigue and apathy. It lasts from several hours to several days.

Simple migraine proceeds in the same way with the exception of the aura phase.

Diagnostics

In the diagnosis of pathology matter carefully collected history and complaints of the patient, the frequency and duration of seizures, their symptoms, indicators of neurological examination. Criteria for migraine:

  • The presence of 5 or more attacks of headaches, which lasted from 3 hours to 3 days without taking painkillers. The headache is described by the patient as one-sided, throbbing, intense, disrupting the habitual way of life, depends on physical exertion.
  • The presence of aura. Only suitable for classic migraine. The signs of aura are reversible, appear consistently and last no more than 60 minutes, after the aura, or a headache is formed on its background.
  • Accompanying the attack with vegetative, sensory, motor, visual impairment and sensitivity disorder.
  • The absence of symptoms of other diseases that occur with headache (brain tumors, mental disorders, spinal pathology, cardiovascular diseases, etc.).

Neurological examination does not detect local changes in the nervous system (reflexes, loss / distortion of sensitivity, impaired coordination, etc.). In doubtful situations, the specialist designates:

  • electroencephalography , rheoencephalography – assessment of bioelectric activity and brain rhythms (with a number of pathologies, including with migraines, there is an accelerated frequency of oscillations, their high amplitude);
  • MRI   – allows you to assess the vessels of the brain, neck, identify multiple foci of ischemic origin;
  • CT   – provides an opportunity to exclude / identify brain tumors, cysts and aneurysms.

If necessary, an x-ray of the spine and skull is prescribed.

Symptoms that should alert

The following symptoms require treatment to a neurologist to clarify the diagnosis and the exclusion of various serious pathologies:

  • headache occurred for the first time over the age of 50 years or in a child up to 10 years
  • pain occurred for the first time in a patient with cancer or HIV infection
  • headaches worse from an attack or an attack
  • sudden onset of headaches (like & amp; quot; roll of thunder & amp; amp; quot;) – this condition requires an immediate appeal to a neurologist
  • headaches began to be accompanied by neurological or physical disorders unusual for the patient — for example, with a migraine without an aura, its sudden appearance, the duration of the aura is more than an hour (normally it should pass within an hour), the appearance of weakness during movements
  • headaches are clearly aggravated by bending, moving – i.e. in situations of increasing intracranial pressure
  • headache is accompanied by causeless fever

What can be confused with migraine pain

Differentiating migraine pains is necessary with the following:

  • Toothache. There is a throbbing pain in the right or left side of the face, then it spreads to the temporal and occipital areas. Aura and precursors are absent.
  • Cervical osteochondrosis . In addition to headache and dizziness, it is accompanied by a crunch and pain when moving the head, pain in the neck, chest and shoulders.
  • Cluster headache. Accompanied by congestion of the ear, acute pain behind the eye, its redness, tearing, blockage of the nose, sweating and flushing of the face. There is a seasonality of the disease.
  • Temporal arteritis. Accompanied by headache in one half of the head, pain in the hairy part of the affected area during palpation, redness and swelling of the skin of the temple, fever, pain in the neck and upper extremities.
  • Headaches caused by neoplasms in the brain.

Treatment

Migraine therapy is performed by a neurologist.

Therapeutic activities are aimed at

  • relief of migraine attack,
  • taking medications in the interictal period, which allows to reduce the incidence of headache and its intensity,
  • preventive actions.

The following medications provide relief for migraine headache:

NSAIDs

  • Ibuprofen
  • paracetamol,
  • diclofenac

NSAIDs are able to relieve headaches with a mild and moderate migraine attack.

Due to the high risk of side effects, taking Analgin is not recommended.

The use of paracetamol during pregnancy (extract from the instructions for use)

Paracetamol penetrates the placental barrier. To date, no negative effects of paracetamol on the fetus in humans have been observed.

Paracetamol is excreted in breast milk: the content in milk is 0.04-0.23% of the dose taken by the mother.

If paracetamol is used during pregnancy and lactation (breastfeeding), the expected benefit of therapy for the mother and the potential risk to the fetus or baby should be carefully weighed.

In experimental studies, the embryotoxic, teratogenic and mutagenic effects of paracetamol have not been established.

Triptans

Gold standard for relief of migraine pain. Eliminate headache even with severe migraine. Should be taken either at the beginning of the attack, or in the final aura. The most effective are the second-generation drugs – naratriptan and zolmitriptan.

Triptans should be chosen according to individual sensitivity. This means that the drug is selected by brute force. The drug is considered ineffective in the absence of effect 2 hours after the onset of a headache.

Important!   Triptan preparations suppress only migraine pains and are ineffective for other types of headaches.

Adjuvant therapy

  • To prevent and suppress vomiting, metoclopramide and domperidone are prescribed, the latter has less pronounced side effects and can be used by children.
  • Some experts recommend taking diuretics – they increase urination, prevent the appearance of edema and accelerate their disappearance after an attack (furosemide). However, the effectiveness of diuretics in migraine is very individual.

Intericidal therapy

It is indicated in patients with frequent and long-lasting attacks, complicated by the course and in chronic migraine. For the treatment of used:

  • beta blockers (propranolol);
  • antidepressants – not only prolong the action of triptans and analgesics, but also reduce anxiety and depression (Velafex, Simbalta);
  • anticonvulsants (topiramate, apilepsin).

Food for migraine

Dieting will reduce the frequency of attacks of migraine pain and facilitate their flow. Nutrition principles include:

  • Fractionality Meal is carried out in small portions up to 4-5 times a day. Eliminate overeating and skipping meals.
  • Liquid. The amount of fluid consumed should not be limited.
  • Bad habits. Stop drinking and smoking.
  • Limiting animal fats and simple carbohydrates.

The list of prohibited foods includes: coffee, cocoa, confectionery, cheese, chocolate, smoked meats, pickles / marinades, citrus fruits, liver, fatty meats / fish, sausages, milk, eggs, legumes.

The permitted products include: low-fat meats (rabbit, veal) and sea fish, chicken (without skin), vegetable oils, low-fat sour-milk products, bran bread, dried fruits, walnuts, sesame, flax / pumpkin seeds, herbal drinks , juice, buckwheat, oatmeal.

Docking off at home

If an aura or an attack caught the patient at home, the following techniques will help prevent a headache or ease its course:

  • Reception of weak sweet tea. Effectively with aura, it is useless when a headache occurs.
  • Creating a comfortable environment. Darken the room (turn off the lights, close the curtains), remove irritating smell factors, eliminate noise sources (turn off the TV / telephone, close the window and the door to the room), refuse contact with relatives. If possible, go to bed.
  • Massage. Independently perform acupressure exercises (2-4 fingers to press points on the back of the head and temple from the side of pain, repeat up to 10 times on the exhale) or massage the location of the carotid artery on the neck (press the artery from the side of pain for 2-3 seconds, repeat up to 5 -6 times).
  • Compress. Attach a towel with ice cubes to the frontal and temporal areas.

Complications

Pathology can be complicated by the following conditions:

  • Chronic migraine. Often occurring complication. The number of attacks every month is more than 15. Headache occurs immediately after waking up, does not disappear in a dream. The patient suffers from insomnia and weakness, increases depression, anxiety.
  • Migraine status. It refers to severe complications, often develops in patients with hypertension. It is characterized by a series of painful attacks, lasting several days or by an attack that lasts for 3 days. Accompanied by severe neurological symptoms, intense and arching pain in the head, repeated vomiting and dehydration. It is fraught with the development of other serious complications.
  • Migraine stroke. Treats rare, but heavy complications. Accompanied by persistent headaches, visual impairment, numbness / tingling in the head. Confirmed by MRI, CT.
  • Persistent Aura It occurs as a classic migraine, but the collection of signs of aura is more than 7 days. It occurs in 1-2% of cases.
  • Convulsive fit. A quarter of epilepsy sufferers suffer from migraines. Migraine attack increases the likelihood of an epileptic seizure 4 times.

Prevention and prognosis

Compliance with preventive measures will help reduce the frequency of attacks and their intensity:

  • the prohibition of alcohol, smoking;
  • refusal to accept coffee, Coca-Cola, energy drinks;
  • normalization of sleep (at least 8 hours, bedtime until midnight);
  • exclusion of food factors provoking an attack;
  • moderate physical exertion, frequent exposure to fresh air;
  • regulation of mental stress, prevention of stress, nervous stress, refusal of emergency work;
  • adherence to the principles of healthy eating;

In the presence of rare and short-term attacks, the appointment and compliance with adequate treatment and prevention measures, the prognosis for this disease is favorable.

Migraine therapy in severe cases lasts from 3 months to a year with a gradual decrease in the dosage of drugs and their cancellation. Specialist conducts adjustment of treatment every 2-3 months.

Self-medication is fraught with the occurrence of complications and the transition of pathology to chronic.

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