Migraine: Causes, Symptoms, Treatment and Prevention
- 02 Oct 21:15
- causes of migraine
- mechanism of headaches in migraine
- Classification migraine pain
- symptoms of migraine
- complicated forms of migraine
- diagnosis of migraine
- Drug treatment of migraine
- treatment of migraine in pregnant and lactating mothers
- prevention of migraine attacks
Migraine - one of the most common formsthe primary headache, which acts as a separate nosological form, and not a symptom of another disease. Migraine suffers from approximately 10-15% of people in the population, with women 2-3 times more likely than men. The peak in the incidence is for the age of 35-40 years, but migraine begins approximately 15-25 years.
Migraine is also called hemicrania, which indicates its clinical features( hemi - half, cranium - skull).Migraine pain has been known since ancient times. The first mention of a special headache and how to treat it date back to 3000 BC.Migraine was sick many famous people, including Freud, Tchaikovsky, Newton and others.
But today, this disease has not lost its relevance - a migraine attack leads to a significant reduction or total disability of more than 70% of patients who are forced to abandon their daily duties and to stay in bed.
Causes of Migraine Development
There are currently no known causes for the development of migraines. Most researchers tend to genetic nature of of this violation. More than 30 genes have been identified and identified, mutations which increase the risk of migraine development in their carriers, and, depending on the type of mutant gene, this risk increases from minimum to high.
Also worth attention is the trigemino-vascular theory of for the development of migraines, which was proposed in 1984.According to this hypothesis triglyceride activation leads to increased allocation of substances with vasodilating ability. This contributes to the expansion of blood vessels and the activation of afferent innervation of the vessels of the brain of the trigeminal nerve. This theory explains the hemicranial localization of pain in migraine.
Additionally, many researchers are paying particular attention to hormonal causes of migraines given that women are ill a few times more likely than men. From this point of view migraine causes an imbalance of sex hormones - a decrease in the number of progesterone and increased estrogen. This theory confirms the relationship between migraine attack and the onset of menstruation in women.
It is necessary to mention the serotonin theory of for the development of migraines. Before an attack in the blood, an increase in serotonin levels is observed. Also, this theory confirms the effectiveness of drugs for migraine from the group of agonists of serotonin receptors( tryptans).
But, as a rule, for the emergence of a migraine attack it is necessary, in addition to the predisposition of the organism, the influence of provocative adverse factors, or triggers.
Factors that activate the migraine attack:
- acute or chronic stress;
- intellectual or physical strain of the body;
- diseases and pathological conditions that are accompanied by a violation of the physiological balance of sex hormones;
- oral contraceptives;
- sleep disturbance - chronic sleep deprivation or, conversely, excessive sleep;
- Changes in weather conditions and climatic zones;
- Alcohol, especially red wine and champagne;
- eating some foods, especially those that are rich in tyramine - chocolate, cocoa, hard cheeses, nuts, fish, canned foods and smoked foods, as well as nutritional supplements, preservatives and dyes, sugar substitutes;
- diseases that affect the cerebral vessels( hypertonic disease, cerebral atherosclerosis, vasculitis);
- Approximation of the period of menstrual bleeding;
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All of the migraine triggers described above need to be known, especially for migraine sufferers. The root cause of headache may be eliminated and will not succeed, but getting rid of migraine risk factors is realistic. And, at times, this will be enough to forget about this problem once and for all.
Migraine headache development mechanism
As you know, migraine is a special kind of headache, the mechanism of development of which is unique and not similar to each other. Therefore, most of the drugs from the headache are ineffective in the case of migraines.
Migraine attack occurs in several consecutive phases:
Despite the available data on the nature of migraine headache, new information is emerging every day, as this problem is actively studied by scientists around the world. For example, according to the latest medical publications, the hypothalamus of the brain plays an important role in the migraine pathogenesis, and this provides new opportunities for the invention of effective medicines for the treatment and prevention of migraines.
Classification of migraine pain
According to the classification of the International Organization for the Study of Headache, migraine is divided into several types:
- migraine without aura, or simple;
- migraine with aura, or associate;
- ophthalmoplegic form of migraine;
- retinal migraine.
Aura in migraines is a complex of focal neurological symptoms that develop shortly before the pain in migraine or at its height. The nature of the symptoms that make up the aura depends on the localization of pathological changes in the vessels( vertebrobasilar or carotid pool) and include visual, tactile, auditory, taste symptoms.
Migraine without aura
This is the most common form of migraine and accounts for 75% of the disease. To establish such a diagnosis, you need to find out a few details.
Migraine Criteria without Aura:
Migraine with aura of
Aura can appear 5-20 minutes before the onset of pain and pass within the first hour.
Criteria for migraine with aura :
Migraine with classical aura is the most common form in this group. The symptoms of the aura include various visual disorders( dots, lines, fights, fog, zigzags, lightning, loss of field of view), numbness, feeling of crawling of the ants in a certain area of the body, linguistic disturbances, hemiparesis.
This is a rare form of migraine, in which, at the very beginning of the attack, various oculomagulous disorders that appear at the height of the headache develop. Symptoms may include ptosis( omission of the century), strabismus, dichotomy in sight, increase in the diameter of the pupil on the side of pain. Usually attacks of ophthalmoplegic migraine are replaced by migraine with a typical aura.
This is a rare migraine, as aura showing temporary blindness to one eye or the appearance of cattle( spot field vision lesions).
Complicated forms of migraine
These are quite isolated cases, but they pose a direct threat to the life of the patient and require urgent medical attention.
May be manifested as a series of severe attacks with an interval of no more than 4 hours or one prolonged attack lasting more than 72 hours. Such a headache can not be eliminated by conventional medicines that have already helped the patient. The pain is accompanied by severe vomiting, which can cause severe dehydration. The headache initially throbbing, then becomes diffuse and rebounding. May be a violation of consciousness.
In this complication, temporary neurological disorders that are caused by local ischemia of the brain at the first stage of migraine development become steady. These symptoms persist for more than 7 days, and when performing CT or MRI of the brain you can visualize specific formations - ischemic cysts. As a rule, all symptoms occur during the first month, but the morphological substrate in the brain tissue remains.
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Diagnosis of migraine
As a rule, diagnosis of migraines is not difficult, since the clinical picture is quite typical. An important point in establishing the true cause of headache is to keep a patient's headache diary, which indicates when the pain with which the patient is associated, the localization and intensity of the headache at the 10-point scale( for migraine, the intensity of the pain is characteristic from 5 to 10 points), which pills were taken and in what amount, the effect of medication treatment.
But, given that there are diseases that can be manifested with a similar headache, each case of migraine requires a detailed examination and exclusion of organic pathology of the brain.
Diagnostic program :
- neurological and therapeutic patient review;
- CT, MRI of the brain;
- angiography of the cerebral arteries;
- ophthalmoscopy - eye day observation;
- skull radiography;
- doppler vessels of the neck;
- Laboratory Survey.
If, after a complete set of tests, organic pathology is not detected, then you can safely diagnose a migraine in case of its typical course.
Medicinal treatment of migraine
Migraine treatment is a rather difficult task, since in each case therapy should be selected individually, because the one that helps one person is not alwaysturns out to be effective in another.
The entire therapeutic process of migraine can be divided into 3 stages:
Aspiration of migraine attack
For this purpose, both specific drug preparations and nonspecific ones are used. The difference between them lies in the fact that the first ones allow to stop the attack of migraines, while they do not have analgesic abilities, but affect the main links of the pathogenesis of migraines. The second group, non-specific, have a direct anesthetic effect.
Non-specific drugs include simple and combined non-narcotic analgesics, as well as non-steroidal anti-inflammatory drugs. Drug analgesics are used only in the case of the development of migraine status.
To help get rid of headaches, Aspirin( 500-1000 mg), Paracetamol( 325-500-1000 mg).Excellent anesthetic result shows combined analgesics - a combination of aspirin and paracetamol with caffeine, with minimal doses of codeine( Citramone, Ascofen, Solpadine, Sedalgin).The group of NSAIDs use Ibuprofen, Naproxen, Ksefokam, Indometacin, Diclofenac and other medicinal substances.
A good effect is the addition to the analgesic of drugs that relieve nausea and vomiting - Metoclopramide, Cerupal, Domperidone, Domrid( a single dose of 10 mg, daily - 30 mg).
Specific drugs for in migraine include 2 groups:
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Treatment of migraine status:
- is undergoing stationary conditions;
- drugs are usually administered parenterally;
- dehydration relief by intravenous administration of saline solutions;
- uses drugs from the following groups - antiemetics, narcotic analgesics, ergotamine preparations, steroid and sedatives, tranquilizers, antipsychotics.
Medication Prophylaxis of Attacks
The purpose of prophylactic treatment of migraine is used if in a single month, the patient has 2 or more migraine attacks and they are intense in nature. To begin with, you need to eliminate, if possible, all the risk factors that can provoke migraine.
As a rule, the appointment of medicines for the prevention of migraines is necessary in 10% of patients, this therapy lasts for several months.
Preparations for prevention of :
- Beta-blockers - Propranolol, Atenolol, Metoprolol. The mechanism of action of these drugs in the case of migraines is not clear to the end, but they are the first choice for these purposes. This treatment is especially effective in people with concomitant arterial hypertension.
- Antidepressants - Amitriptyline. This drug is most often used for this purpose, small doses are prescribed, the treatment begins within 2-3 weeks of regular intake.
- Serotonin reuptake inhibitors - Fluoxetine( Prozac), Paroxetine( Paxil), Sertraline( Zoloft).Assigned to patients with intolerance to tricyclic antidepressants( Amitriptyline).They are usually combined with beta-blockers.
- Calcium channel blockers - Verapamil is most commonly used in this group. These drugs are particularly effective in patients with ophthalmoplegic migraine.
- Anticonvulsants - Carbamazepine, Klonazepam, Valproic Acid, Gabapentin.
Need to remember! All of the above drugs relate to prescription drugs, have many contraindications and side effects. Therefore, they should only be prescribed by the doctor after a thorough examination of the patient.
Treatment of migraine in pregnant and lactating mothers
As a rule, migraine is regressed during pregnancy, as the hormonal background changes in the direction of progesterone predominance. But there are exceptions. Treating headaches in pregnant women has great difficulty since most drugs can not be taken.
The only drug that is allowed to eliminate headaches for women in a position, regardless of the terms of pregnancy, is Paracetamol.
The single dose of the drug is 325-500 mg, the maximum daily dose is 2 g( 4 tablets of 500 mg).It should also be taken into account that the use of paracetamol based combinations is prohibited, as they often include prohibited substances for pregnant women, for example, acetylsalicylic acid( aspirin).
According to individual indications and only on prescription of a doctor, pregnant women may be prescribed other drugs, even specific antimigenous ones. But in this case, the physician should weigh all the benefits to the mother and the damage to the fetus. It is strictly prohibited to accept them individually.
If a migraine headache worries about feeding a mother, then the range of permitted drugs is slightly wider, but still with significant constraints.
Feeding moms can be taken from headaches Paracetamol, Ibuprofen, Naproxen and Ketoprofen. You can also take a pill and SumiGreen, but with certain rules.
Take the medication immediately after feeding, so that the next time in breast milk only a minimum amount of medication was present. Also, if there are instructions in the instructions or if you have received such recommendations from your doctor, it is necessary to separate the baby for a while from the breast( you can transfer it to artificial breastfeeding or feed the baby with pre-seasoned breast milk).For example, when taking Sumi-grena, the period of weaning from the chest should be 12 hours.
The main task in the prevention of migraines is to identify the factors that cause headache attacks just at you.
General preventive measures :
- rational mode of rest and labor;
- is a healthy sleep;
- regular physical activity;
- development of stress resistance;
- Avoiding stress situations and conflicts;
- regular, balanced and healthy eating;
- exclusions from the menu of products-provocateurs;
- abandon alcohol, smoking;
- rational use of analgesics;
- refusal to use oral contraceptives.
Summing up, we can say that migraine is a topical issue in modern medicine, since its symptoms not only reduce the quality of life of the patient, but, at times, pose a direct threat to human life.