MIGRAINE

It is also called as “migraine syndrome” or “migraine headache”

ETIOLOGY:

* Trigeminovascular neuron activation- there is activation of these neurons surrounding a cephalic blood vessel due to vasoconstriction. This will lead to cerebral ischemia followed by compensatory vasodilation with subsequent pain and edema.

* Heriditary- it has got autosomal dominant inheritance pattern.

* Triggering factors- includes dietary factors ( chocolate, missing meal, aged cheese ) , psychogenic ( stress, anxiety, depression ), hormonal ( menstruation, ovulation, oral contraceptive ), sleep disturbance, physical ( glare, flashing light, fluorescent light, odors high attitude ), drugs ( nitroglycerine, histamine, resperine, hydrazine, ranitidine, estrogen).

TYPES:

* Migraine with aura- in this an aura or pre-headache period occurs. This is characterized by visual disturbances like scintillation (seeing sparks), scotoma (partial or complete loss of light perception). There is also aphasia (loss of ability to express thoughts) and numbness over one side of the face and arm.

* Migraine without aura- in this no pre-headache period occurs.

CLINICAL FEATURES:

* Age and sex distribution- it begins at young age, and primarily affects women in a ratio of four to one.

* Location- headache is unilateral (one sided) and felt in temporal, frontal and orbital region.

* Onset- headaches often begin immediately or soon after awakening. The attack may be recurrent or episodic with variable frequency, usually 1-4 in a month.

* Nature of pain- it is started with mild headache which later increases in severity. It is of throbbing quality at the peak.

DIAGNOSIS:

Pre-headache symptoms with presence of trigger zone with throbbing type of pain.

MANAGEMENT:

* Severe attacks- these are controlled by ergotamine tartarate combined with caffeine, aspirin, acetaminophen, belladonna and phenobarbital.

* Mild cases- treated with methergine, beta adrenergic agents and calcium channel blockers and serotonin receptor agonists.

* Drug therapy- drug which is used in treatment of cluster head are ergotamine (2mg sublingual), sumatriptan (50-100mg tab) will give relief from the symptoms. Another drug which can be used are naratriptan (2-5mg tab), almotriptan  (12.5mg tab), rizatriptan (5-10mg tab).

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s