Migraine: symptoms and treatment, aura + how to relieve the pain of an attack

This disease is known since ancient times. It is believed that the migraine suffered the procurator of Judea Pontius Pilate, who commanded the crucifixion of Jesus Christ. At the time, this disease was called "hemicrania", which means "pain in the head half".

Of course, such suffering, which has very characteristic complaints that is not contagious, and which is peculiar to well-off people( to cause not a barber, but a doctor) was described quite early in the literature, and has come down to us unchanged since ancient times.

Pain in the half of the head is not the only, but one of the most characteristic signs of migraine.

We will stipulate that by "half of the head" we mean either the left or the right half of it. It's not about the "bottom" or "upper" half, but only about the mirror-symmetrical sides.

Migraine - what is it?

Migraine is a form of primary headache that has its own coding in the section of neurological diseases( G 43).The modern definition says that migraine is a form of headache that has a vascular nature, which proceeds with characteristic clinical symptoms in the form of pulsating seizures, with or without an aura, with the possible presence of nausea or vomiting( see photo).

In this case, the pain is completely reversible, functional, and is not a consequence of stroke, volumetric process in the brain or traumatic lesion of the central nervous system.

Migraine has recently been listed among 19 diseases that cause significant socioeconomic losses due to impairment, and also disrupt the work adaptation of patients.

About the causes of

The disease is much more common in women than in men, and is polyethiologic, as there are many reasons for migraine. The most famous of them are:

• Hereditary predisposition, which was proved by the study of identical twins;
• Stress, hypodynamia, intense mental work in conditions of hypoxia;
• Physical overvoltage;
• Eating food products containing tyramine( cheese, nuts, chocolate, red wine, beer and champagne);
• In women, one of the leading factors in the development of migraine is the prolonged intake of oral hormonal contraceptives;
• Meteorological dependence when there is a weather change.

Most often, the disease is a manifestation of many of the described factors in their various combinations.

Symptoms of migraine

Headache with migraine differs in its character and its attendant characteristics. So, a simple form is characterized by the following features:

• Repeated attacks of headaches that occur in the form of attacks, from 4 to 72 hours total duration;
• Pain is localized only to the left or just to the right;
• The nature of pain - pulsating, classical irradiation - in the eyeball;
• Severity of pain is significant;
• With physical exertion, the pain intensifies, which, together with the character and localization, distinguishes it from the tension headache. Therefore, this pain, which has arisen during physical exertion, may require the cessation of any work, which in a number of cases leads to "avrales" in production.
• Migraines accompany symptoms such as photophobia and phonophobia. This is manifested by photophobia and intolerance of not only loud sounds, but also sounds of medium intensity, which the patient seems to be loud. These signs increase as the headache intensifies. In practice, this is expressed by the fact that the patient has a strong desire to retire, fall asleep, lie with closed eyes in a quiet, dark, and preferably cool room;
• During an attack a person's mood changes very much: the patient becomes depressed, or, on the contrary, irritable and quick-tempered;
• There is also a special hypersensitivity to odors( hyperosmia), and even aversion to some of them;
• Migraine often develops progressive nausea, which is combined with an intolerable headache. Vomiting, as a rule, arises "at the height" of the headache, and is a quick sign that the pain will decline. Therefore, patients with a large "experience" of migraine perceive vomiting as a sign of a quick escape from suffering;
• Migraine is a type of headache in which relief is achieved with a tight bandage. Therefore, a headache tied with a kerchief by a suffering aristocrat is a direct indication of a migraine.

Symptoms of migraine that do not stop within 72 hours are called migraine status. This condition of requires urgent hospitalization of , since such prolonged pain can lead to swelling and swelling of the brain, development of convulsive seizures, or the appearance of focal neurologic symptoms characteristic of ischemic stroke.

Symptoms of migraine( photo) - what is an aura?

Migraine with aura is a slightly more complicated disorder than a simple migraine. Aura are certain neurological reversible symptoms that build up for some time, usually 5 to 20 minutes, and last no more than an hour in any form.

As a rule, when an aura occurs, the patient already understands that a migraine attack will follow, and there is time to prepare, or take the medicine. Sometimes the aura arises entirely on the "level ground", and the pain appears afterwards.

In some cases, the symptoms of aura with migraines appear against the background of a beginning headache. Morphologically the aura coincides with the development of inadequate blood circulation in various areas of the brain.

This hypoperfusion of various departments associated with vasospasm, and manifests itself in the form of symptoms of "stealing" the blood of various structures.

The typical symptoms of the aura , uniquely associated with a subsequent headache, include:

• Visual symptoms( flickering of streaks, spots, "flies" before the eyes, blurriness, fuzziness, the appearance of sparkling "zigzags" and cattle, ortemporary loss of vision by foci and fields);
• Sensitive disorders in the limbs( sensation of numbness and tingling, feeling of "crawling").These disorders capture one half of the body and spread to the corresponding half of the face;
• Speech disorders. There are difficulties in the form of blurred speech( dysphasia).

As a rule, visual disorders first appear as the thinnest, then sensory sensory and speech disorders appear.

Patients should know their type of aura, because in some cases it is difficult to distinguish from a transient ischemic attack, which can itself be a manifestation of a stroke.

Therefore, patients suffering from migraine need to keep a diary, which reflects the specific features of the aura signs and the connection with various factors of the external environment.

In some cases, patients may have a developed aura, but there is no headache, or be of a minor nature. This type of "headless migraine" is common in men.

Rareer types of migraine

In addition to the classic pain attack and a set of precursors, called aura, there are atypical forms of migraine, for example:

• Basilar migraine. Its signs are the aura that originates from the brainstem: speech disorders, dizziness, tinnitus, double vision, hearing loss, impaired consciousness, and bilateral sensitivity disorders in the limbs as paresthesias;
• Hemiplegic migraine. This form is very similar to a stroke, because there are violations of the movements by the type of motor weakness in the limbs.

It should be added that, even before the aura, sometimes a day or two before the attack of migraine, prodromal symptoms appear - tension in the neck muscles, impaired concentration, yawning or pale skin, as well as blurred vision or weakness.

As a rule, then they are replaced by an aura or a classic attack of migraine pain.

Treatment of migraine

Treatment of this disease presents certain difficulties, especially the treatment of migraine in women. According to modern data, the predisposition to this type of headache in the beautiful half of humanity is due to the influence of estrogens.

Treatment of migraines is reduced to recognizing and timely relief of attacks, reducing their incidence, reducing the time of attacks.

In the case of a radical cure, attacks completely disappear, and do not disturb the patient for a year. Nevertheless, the main task has always been and remains the arrest of an attack.

Sometimes, with a good relationship between the doctor and the patient, the correct treatment tactics, a radical change in lifestyle, arresting the seizure becomes simply unnecessary, as they become very rare and can disappear altogether.

How to relieve a migraine attack?

Most often, migraine is explained by alternating vascular spasm with subsequent expansion. If you describe the development of migraine in plain language, then initially spasm of cerebral vessels and the dura mater, which proceeds asymptomatically, develops. Spasm is provoked by the factors described above.

Then, as a compensatory reaction, there is a resolution of the spasm, and the overgrowth of the vessels is more normal. This stretching causes the reaction of pain receptors, which leads to the appearance of characteristic pain.

To relieve a migraine attack, you need to increase the tone of the vessels or, more simply, get them spasm. This can be done with the help of many drugs: from coffee and cognac to preparations from the class of triptans.

Serious preparations for arresting an attack are issued in the form of a nasal spray or rectal suppositories, as ongoing vomiting can prevent absorption of the drug in the body.

How to treat an easy migraine attack?

If the attack is of low intensity, and the patient's condition is satisfactory, you can use non-drug therapies: an ice pack or dry heat.

"Light" drugs from the group of non-steroidal anti-inflammatory drugs help with medications: from "Analgin" and "Paracetamol" to "Nurofen", "Tempalgina" or "Ketanov", which is the most powerful analgesic.

Of course, when treating a mild migraine attack with these drugs, you need to remember about the harm to the gastric mucosa, and together with them to give omeprazole to reduce ulcerogenic risk.

How to relieve pain with migraine of moderate and severe intensity?

If a typical attack and non-steroidal medications do not help relieve migraine pain, it is better to take prescription analgesics containing codeine or caffeine. To such medicines carry "Kaffetin", "Solpadein", "Pentalgin".

If a person has a severe headache, accompanied by nausea and repeated vomiting, then you can use a prescription drug such as "Zaldiar" containing tramadol. This drug is prescription, but not narcotic, and any doctor can prescribe it.

Triptans are also used, which are injected as a spray into the corresponding nasal passage on the side of the appearance of the headache.

• Of the triptans show sumatriptan( Imigran).These drugs are better to stop slowly growing headache. In tableted form the preparation is produced under the name "Amigrenin", "Sumygamren", and also in candles - "Trimigren".
• The next generation of triptans( Naramig, Zomig) are better tolerated.

It is important that you can take triptans in any form only after the headache begins. Their reception without pain, against a background of aura is contraindicated. Also, they can not be used for prophylaxis, as they cause a vasospasm, and, on the contrary, can trigger a migraine attack.

You can also take anti-emetic drugs( "Cerucal", "Motilium").In the case of severe vomiting, it is advisable to intramuscular administration of drugs.

Modern preparations for migraine may also belong to ergot alkaloids. In some cases, antidepressants and anticonvulsants are also used, but for prevention.

Prevention of migraine

Migraine and the problem of "how to relieve pain" is not the only one, but it begins a long way to recovery. To prevent attacks, very different drugs are used, which are used between attacks.

These drugs include beta - adrenoblockers( Anaprilin, Obzidan), anticonvulsants( Topamax).But, before you start using them, you need to modify all the risk factors that can be changed: body weight, rejection of bad habits, a healthy lifestyle, proper nutrition.

Migraine, the symptoms and treatment of which we have dismantled, refers to functional disorders. But, under certain conditions, it can bring a person to stroke and cerebral edema, and severe migraine status can be the cause of death.

Therefore, it is necessary to take timely measures to diagnose and treat this widely known vascular dysfunction at the earliest possible time.