Classical Migraine
Migraine is a medical condition that involves severe, recurring headaches and associated symptoms. It occurs in stages and can last for hours to days, can be so intense to affect persons daily life and activities
Definition of classical migraine
Migraine with aura, it is a recurring headache that strikes after or at the same time as sensory disturbances called the aura. Aura can start within an hour before the headache begins and generally lasts less than 60 minutes. Sometimes there can be the only Aura with little or no headache.
Aura can be
Visual signs and symptoms
Temporary signs and symptoms which tend to start in the center of the field of vision and spread outward which might include :
1.Blind spots, which are sometimes outlined by simple geometric designs.
2.Zig Zag lines float gradually across the field of vision.
3.Shimmering spots or stands.
4.Changes in vision are vision loss.
5.Flashes of lights.
Aura can also be :
1.Numbness
2.Tingling in hands, face, limbs.
3.Speech language difficulties.
4.Muscle weakness, nausea, vomiting, ringing in ears, chills, Hot flushes.
Diagnostic criteria for migraine
Repeated attacks of headache: lasting for 4-72 hours, that have the following features and normal findings on physical Examination
At least 2 of – unilateral pain, throbbing pain, aggravated by movement.
At least 1 of – photophobia and phonophobia, nausea and Vomiting.
Types of migraine with aura
1.Migraine with aura: with or without headache is also called a classic migraine.
2 .Migraine with Brain stem aura: This is the aura that starts in the base of the brain.
3.Hemeplegic migraine: rare type and associated with weakness on one type of the body.
4.Retinal Migraine: Associated with vision changes in one eye which start before the migraine.
Etiology and pathogenesis
Several chemical mediators play a role in migraine, according to the theory, a wave of nerve cell activity spread across the brain and triggers trigeminal neuralgia, there is the release of a variety of neurotransmitters ultimately causing an inflammatory process and pain, waves moving across the part of the brain which process signals produce an aura.
Predisposing risk factors
- Age:10-40 yrs
- Sex: a young woman has three times more risk than men
- Family history of migraine
- Other medical conditions like depression, anxiety, bipolar disorder, epilepsy, sleep disorders
Triggering factors
- Menstrual cycle
- Foods like cheese, alcohol, nitrates
- Skipping meals
- Caffeine: too much caffeine or sudden withdrawal from caffeine
- Changes in weather
- Loud noises, bright lights, strong smells
- Medications like vasodilators
- Sleep disturbances
- Tobacco
Diagnosis
- Clinical history
- Eye examination
- CT, MRI ,EEG
Prevention
- Identify and avoid triggering factors
- Stress management and relaxation techniques
- Proper diet habits
- Adequate fluid intake
- Rest
- Regular physical exercise
Prophylactic Medicines
B blockers : propranolol , metaprolol
Anticonvulsants : valproate, gabapentin etc
Antidepressants : Amitriptyline, nortriptyline
Serotonin antagonists : Methysergide
Acute Migraine (oral medication) management
NON SPECIFIC TREATMENT
Aspirin -900 mg
Acetaminophen- 1000 mg
Naproxen- (250 -500) mg
Ibrufen- (400- 800) mg
SPECIFIC TREATMENT
Ergotamine – 1-2 mg
TRIPTANS
Sumatriptan : 50-100 mg
Naratriptan : 2.5 mg
Rizatriptan : 10 mg
Zolmitriptan : 2.5 mg
Electriptan : 40 – 80 mg
Amlotriptan : 12.5 mg
DITANS
Almotriptan
Electriptan
Frovatriptan
OPIODS
ANTI EMETICS : chlorpromazine , Metaclopromide, prochloroperazine
NON PHARMACOLOGICAL TREATMENT
1 Adequate sleep and rest
2 Adequate fluids
3 Transcranial magnetic stimulation
4 Gama core which is a Vagus nerve stimulator
REFERENCES
1 Wall and Melzack , text book of pain
2 Bonica , management of pain 5th Edition
3 Simon Rp, et all , Headache and facial pain in clinical neurology
4 Wed.MD Medical reference
