Migraine
Migraine Complications
Two Categories of Migraine
Treatment of Migraine
headache
Introduction
Cluster headache
Headaches-Rigidity and persistent day by day complications
Tension (headaches) complications
Traction headaches
Vascular headaches
Six million migraine attacks occur per
year in South Africa.
From 10% to 30% of migraines occur
with an aura.
Migraines
are more common in adult women than in men.
Migraine is less common in children.
The incidence of migraine decreases
with pregnancy.
Migraine is a disorder marked by extraordinarily painful recurring headaches,
generally with nausea and vomiting. Migraine attacks may occur each day or as
occasionally as annually, however they mostly occur a few times a month. An
assault is commonly triggered by an external stimulus, comparable to stress,
hormonal modifications that happen just before or during menstruation, or the
ingestion of certain meals and drinks, comparable to alcoholic beverages. A
minority of people with migraine experience preliminary warning symptoms, known
as an aura, that precede the headache by as much as an hour; there could also be
illusions of flashing lights, loss of imaginative and prescient, dizziness,
numbness, or non permanent defects in speech or movement. Early symptoms subside
in 10 to 30 minutes and are adopted by a throbbing headache on one side of the
top; less generally the headache is bilateral. The headache is reasonable to
severe in intensity and can be intolerable in some sufferers. Motion, vibrant
lights, and physical activity tend to irritate the pain. In typical cases, the
migraine attack lasts for 12 to 24 hours or extra except relieved by medication
early in its course.
The underlying reason for migraine stays uncertain. The illness may be
hereditary; about 75 to 90 % of all migraine victims have a household historical
past of the disorder. About two-thirds of all migraine sufferers are women.
Migraines also happen with unusually high frequency in persons who're
characteristically hardworking and who set high and demanding requirements for
themselves. Migraine may be caused by an abnormality in the regulation of
serotonin, a chemical involved in transmitting impulses in the brain.
One fundamental therapeutic step in treating migraine is to find out which
stimuli, if any, set off the assaults, as a way to avoid them in the future.
Most of the remaining therapies involve the usage of various medications. Drug
therapies for migraine include abortive measures, which purpose at stopping or
alleviating an attack as it is starting or soon afterward, and preventive
measures, which involve every day doses of medications to reduce the intensity
or frequency of migraine assaults or eradicate them altogether. Aspirin,
acetaminophen, and such nonsteroidal anti-inflammatory medicine as ibuprofen and
naproxen are effective in aborting mild migraines. Migraine attacks of better
severity can generally be treated in the beginning with ergotamine, sumatriptan,
dihydroergotamine mesylate (DHE-forty five), or caffeine; all of these
medication improve the impact or supply of serotonin throughout the brain. Sure
different medicines are used on a every day, lengthy-time period foundation if
migraines have grow to be extremely painful or have reached a frequency of one
per week.
Medicine
can be used either to relieve symptoms or prevent attacks.
What are
migraines?
This is
the most common type of vascular headache. Migraine headaches can be divided
into two main types:
Migraine with aura (classic migraine)
Migraine
without aura (common migraine)
From 10% to 30% of migraines occur with an aura, which is a
collection of symptoms that usually occurs 15 to 30 minutes before a migraine
headache begins. The most common symptoms are visual disturbances, such as
flashing lights, distortion in the size or shape of objects (zigzagging), or
blind or dark spots in your field of vision. An aura may also include symptoms
affecting your nervous system, such as numbness or tingling in your face or arm,
strange smells or sounds, or weakness on one side of your body.
Migraines are more common in adult women than in men, often occurring just
before or during menstrual periods and usually waning after menopause. A
migraine sufferer usually has his or her first attack between the ages of 19 and
30 years.
A
migraine may occur several times a week or might only happen once every few
years.
What are
the causes?
Instability of the vascular system
One of these theories means that certain arteries in our brain contract and
trigger a reduction blood circulate to the visible space of our brain. It is
prompt that this discount of blood move leads to the visible and other symptoms
that accompany a migraine.
Then, when blood vessels expand and put stress on the nerves in the artery wall,
there is pain. The underlying causes of these contractions and dilations of the
cortroid arteries are extra obscure. Susceptibility tends to run in households
and impacts more ladies than men.
Migraine sufferers are more liable to fainting when standing up suddenly than
other folks, and they are additionally more delicate than other individuals to
the vasodilatory effects of bodily and chemical agents.
Magnesium Deficiency
Another theory proposes that nerve cells within the brain start to lose function
which causes a discount in blood circulate, which reduces ranges of magnesium,
which in flip provides to lowering nerve cell function and that this dysfunction
spreads in a wave like fashion to all effected areas.
Blood platelet dysfunction
Blood platelet disorder has also been implicated, with the platelets of migraine
sufferers aggregating more readily than normal platelets in response to
neurotransmitters comparable to serotonin and adrenaline, the "stress" hormone.
Serotonin
Many researchers feel that serotonin, an vital mind chemical may gas migraines.
Platelets (components of our blood) comprise all the serotonin usually present
in blood, and, after they combination, (clump together) serotonin is launched,
leading to a potent constricting effect on the arteries.
You may trigger a release of serotonin by eating sure meals, consuming certain
beverages, stressing out or sometimes just oversleeping. When this happens, the
blood vessels in your head narrow. As your kidneys course of the serotonin and
the level of this hormonelike substance drops, the vessels dilate rapidly,
urgent on surrounding nerves and causing ache and inflammation. The ache can
last for hours or days because the swelling lingers after the blood vessels
return to normal.
The nervous system Disorders
The nervous system itself might also be implicated, because it releases
particular neurotransmitters, possibly in response to chronic stress.
Meals
Sure foods contain chemical compounds-amines-that dilate the blood vessels,
inflicting a rebound vasodilation and should thus precipitate an attack.
Different individuals are delicate to foods containing MSG, the flavor enhancer,
or nitrates, that are generally present in bacon, sizzling canines, and
different preserved meats.
Some individuals are delicate to artificial sweeteners like Aspartame, which is
found in Nutrasweet.
Meals Allergy
You might allergic or sensitive
to certain foods. And this will begin a migraine.
Food allergy has also been implicated as an necessary consider migraine. In a
single examine, 60 sufferers who had been affected by frequent migraines for a
imply length of about 20 years adopted an exclusion weight loss program for five
days. During that time, only two low-danger foods (normally lamb and pears) and
spring water had been consumed. Migraines disappeared typically by the fifth
day. Each affected person then tested one to three common meals per day, looking
for reactions. The mean variety of meals causing symptoms was 10 per patient
(vary, 1 to 30). The foods most often causing signs and/or pulse adjustments
were wheat (seventy eight%), orange (65%), egg (45%), tea and occasional (forty%
every), chocolate and milk (37% each), beef (35%), corn, cane sugar and yeast
(33% each), mushrooms (30%), and peas (28%). When the offending meals were
prevented, all patients improved. The variety of complications within the group
fell from 402 to six per 30 days, with 85% of the sufferers becoming headache
free. This research offers sturdy evidence that identification and avoidance of
allergy inflicting meals is an effective procedure for a large proportion of
sufferers with continual recurrent migraines.
Low Blood Sugar or Hypoglycemia
For most individuals, low blood sugar caused by fasting or irregular meals
usually brings on a headache; nevertheless it quickly disappears following a
meal. However for people vulnerable to migraines, the low blood sugar may begin
off a series response that a belated meal will not stop.
In one examine, a five-hour glucose tolerance take a look at was performed on 74
sufferers who experienced migraines within the mid-morning or mid-afternoon. Six
sufferers (8%) were classified as diabetic and fifty six (seventy six%) had a
sample in step with reactive hypoglycemia (a large drop in blood sugar after a
meal). Following dietary therapy with a low-sucrose, six-meal regimen, all
patients with a diabetic glucose curve and fifty six% of these with reactive
hypoglycemia (low blood sugar) had an improvement of better than 75% in the
frequency and severity of migraines.
Balanced meals eaten on an everyday schedule are a should for those affected by
migraines. Many migraine victims find that they have to eat one thing each few
hours to forestall headaches. Chromium may help stabilize the blood sugar.
Meals Containing Tyramine
Foods containing tyramine, particularly, are recognized to trigger attacks. A
small proportion of migraine patients will react to tyramine, a chemical found
in aged cheese, yogurt, beer, wine, liver, yeast and sure different foods.
In these patients, avoidance of tyramine-containing meals will typically
forestall recurrences of migraine.
Estrogen Level Fluctuation in Women
Girls suffer from migraines way more incessantly than men. Latest analysis has
pointed to fluctuating levels of estrogen as a factor of their development. For
these girls, complications can disappear during pregnancy, when estrogen levels
are constant. For those who get a headache every month just earlier than your
period, it could possibly be as a result of your blood-sugar ranges are
dropping. Take chromium as supplement to remedy this. Muscle cramping can even
contribute to period-related headaches. Calcium and evening primrose oil are
helpful. Menopause can convey full relief from headaches, or, for some girls,
make them worse. Contraception capsules affect migraines as well.
Many women find that certain stimulants reminiscent of alcohol which have no
effect on them often can trigger an attack if they're consumed just earlier than
a menstrual interval or on the time of ovulation. In case you are a menstruating
woman who suffers from migraines, be sure to make observe of your menstrual
cycle in your headache diary. Check to see if headaches happen simply earlier
than you start to menstruate or when you ovulate, and note any triggers
throughout these times. In case you are a postmenopausal women on estrogen
remedy, you may find that a change in your hormone treatment will help your
headaches. Talk about this with your doctor.
Stress, Nervousness and Excitement
Stress, nervousness, and pleasure promote the discharge of hormones and
neurotransmitters, which might provoke a migraine attack. While it might be
troublesome to keep away from stress, it can be alleviated by exercise. One
researcher reported that several of his sufferers grew to become migraine-free
after jogging 7 to 9 miles a day, at a speed of seven to 9 minutes per mile. In
fact jogging shouldn't be appropriate for everyone, but even average train can
relieve pressure and stress. Adopt an everyday train program even if it is just
a brisk half-hour stroll four or five days a week.
Different factors which have been identified to precipitate migraines are:
Modifications in routine, comparable to late rising on a vacation or change of
working hours;
Changes in climate, excessive winds, loud or excessive-pitched sounds;
Brilliant sunlight and bright artificial mild, comparable to fluorescent; and
Extended staring at television, film, or laptop screens.
Weather
Canadian researchers say heat winds may set off migraines. The report appeared
in the Jan. 25 situation of the scientific journal Neurology. Dr. Wernher Becker
and a team of scientists at the College of Calgary studied the effects of heat
westerly winds known as "chinooks" on seventy five migraine patients. Nearly
half of the sufferers gave the impression to be affected by a change in the
climate with the arrival of the chinook.
Older sufferers were probably the most susceptible. Some patients have been more
more likely to get migraines through the days earlier than the entrance moved
through. Others suffered worst on days when wind speeds reached more than 24
mph.
Elements In Combination
Identifying the factor accountable for your migraine may be complicated by the
truth that there could also be more than one. As an illustration, skipping
breakfast may not affect you most days, but it could set off a headache in case
you are also drained and under stress. Getting up unusually early might normally
be no problem, however in the event you rise before dawn on the day before your
interval, it may plunge you right into a migraine. Conserving a diary of
activities, together with what and while you eat, is admittedly the easiest way
to pinpoint the causes of your migraines.
Different Triggers for Migraine
Triggers for migraines are extremely individual but sturdy feelings of anger,
excitement or nervousness are common. Whiplash, sleep deprivation, jet lag,
oversleeping, excessive smoking and strong odors like perfumes and tobacco can
also trigger migraine.
An iron deficiency often causes migraine headaches attributable to inadequate
oxygenation of the brain. Much less frequent and controversial migraine triggers
include spinal misalignments (correctable by osteopathic or chiropractic
adjustments), temperomandibularjaw (TMJ) syndrome and toxic heavy metallic
hypersensitivity, akin to from mercury dental fillings.
Indicators And Symptoms of Migraine
A migraine is characterised by flashes of sunshine that appear across the sight
view, problems with speech, numbness or dizziness. Migraine pains are typically
intense and, at their worst; are debilitating, with weak point, nausea, sweating
and vomiting. The senses are heightened and the slightest noise, light or motion
unbearable.
Often, the ache is localized or especially intense on one facet of the pinnacle
or over one eye. The particular person may additionally suffer from
irritability. He or she usually needs to be left alone and out of any direct
light.
About one in 5 migraine sufferers will experience an "aura" minutes before the
onset of a headache. Girls report seeing flashes of light and zigzag patterns
and typically experiencing speech impairment, confusion and numbness of their
faces and limbs.
From beginning to end, migraine attacks might last for hours to days. In
addition to the signs described, patients with migraine (with or with out aura)
might expertise a prodrome, or signs which happen up to 48 hours before the
actual migraine assault begins. Some patients, for instance, may have food
cravings, modifications in mood, irritability, drowsiness, issue concentrating,
nausea, diarrhea or extreme yawning.
Course
During
the initial stage of a migraine, the nervous system reacts to a trigger, and
causes a spasm in the arteries at the base of the brain, which are rich in
nerves. The spasm constricts several arteries which supply blood to the brain
and reduces its blood flow. Serotonin, which constricts arteries, is released
and further reduces the blood flow to the brain. A reflex vasodilatation
sometimes follows this process.
How is a
diagnosis made?
The
history and physical exam are all that is needed to diagnose migraine headaches.
Additional tests are only needed to help diagnose other conditions which may
cause similar symptoms. See Diagnosis under Headaches.
Treatment
Medication
Medicine can be used either to relieve symptoms or prevent attacks.
Different drugs are used in each approach, but none cure the underlying
disorder.
Medication
to treat an attack
Medication
to prevent an attack
Medication to treat an attack
In most people, migraine headaches can be relieved by a mild
painkiller - for example, paracetamol, aspirin or naproxen (NSAID) - if taken in
high enough doses and if taken early enough at the time of an attack. Stronger
analgesics, containing codeine, are often necessary. If nausea or vomiting
accompany the migraine, tablets may not be absorbed sufficiently from the gut.
Effervescent tablets or suppositories are then often more effective.
Anti-nausea medication can help to reduce accompanying nausea and vomiting.
Ergot
alkaloids (made from a fungus that grows on grain), such as Cafergot or Migril,
might help many if taken early enough, but are not effective once the headache
is established. In excess, especially with poor timing, these medications may
exacerbate rather than alleviate a headache. Ergotamine has a number of
side-effects. Care should be taken not to exceed the recommended dose.
Sumatriptan (Imigran) is an effective remedy that works on the serotonin and
5-HT neurotransmitter systems, thought to be involved in migraine. The
medication is available on prescription and can be used at any stage of a
migraine bringing rapid relief in about half an hour in approximately 80% of
patients. It is available in tablet form, by injection (often given by patients
themselves), or of recent, in a nasal spray preparation. However, it is
expensive and may have adverse effects in those with cardiovascular problems.
Similar-acting drugs which have recently become available, are:
Naratriptan (Naramig)
Zolmitriptan (Zomig)
Rizatriptan (Mexalt)
A new
Rapidisc preparation has recently become available in South Africa. The Rapidisc
is placed on the tongue and dissolves rapidly.
Narcotics, such as pethidine injections, should be avoided because of the high
potential of addiction.
Medication to prevent an attack
If attacks occur more often than three times a month, drugs to
prevent attacks should be prescribed. Various prophylactic treatments are
available. No one treatment has an advantage over another and its often a
case of trial and error to find a drug which is most effective in a particular
patient. Drugs to prevent migraine include:
beta-blockers,
such as propranolol (i.e. Inderal) which will reduce blood vessel dilatation;
pizotifen
(Sandomigran) unfortunately often associated with weight gain;
anti-depressants,
such as amitriptyline;
clonidine
which inhibits blood vessel contraction and dilatation;
flunarizine (Sibelium) methysergide;
cyproheptadine
(Periactin).
Prophylaxis is usually given for up to six months. Treatment is then
stopped. In many cases, the attacks do not re-occur, and if they do, it is often
with a reduced frequency and severity.
Identifying triggers
Eliminating the foods that could trigger a migraine attack can help a
small percentage of migraine sufferers. An anti-migraine diet is structured by
means of elimination of known triggers specific to an individual. It is a good
idea to keep a migraine diary which will provide useful information regarding
the pattern of your headaches.
Other
Relaxation training (where you learn to relax mind and body), can be
combined with biofeedback, a technique which can teach people better control
over indicators of bodily functions such as blood pressure, heart rate,
temperature, muscle tension and brainwaves.
General
stress-reducing techniques include: yoga, jacuzzi baths, enjoyable exercise
(good choices being swimming and brisk walks), listening to soft music or
whatever else helps you to unwind.
Researchers have found that migraine sufferers mentally trained to raise the
temperature of their hands developed fewer and less severe headaches.
Applying
cold packs can give temporary relief. Pressing on the bulging artery in the
temple area can also provide relief.
Caffeine
can help to offset an attack - provided it is taken as soon as a migraine attack
is expected.
| 
