January, 2019
Migraine includes a group of nervous diseases.
Synonyms: migraine, migraine with aura, cluster, migraine attack.
ICD-10 code: G43
Migraine pain - intense, periodic and pulsating. More likely to occur on one side of the head.
Characteristically, the migraine is not associated with craniocerebral injury, brain tumors or stroke. Migraine headaches almost always accompanied by some of the types of disorders or combinations thereof:
- vegetative (nausea, vomiting);
- sensory (increased sensitivity to light, sound);
- motor (violation of movements, speech);
- psychiatric disorders (anxiety).
Epidemiology
According to the WHO in the world suffer from migraine 10-14% of people, and in a number of countries figure reaches 30%. Migraine is a list of 19 diseases that violate an individual's social adaptation. In two thirds of cases of pathology debut in individuals younger than 30 years, the peak of the first cases in the age interval 18-20 years. Migraine also can manifest itself for the first time at the age of 30-35 years. With age, the pathology is eroding and is rarely seen in people over 50.
The disease is in 2 times more often diagnosed in women than in men. Cases of migraine in children 5-8 years and even infants. In 70% of migraine affects people whose parents had the disease. American researchers claim that 10% of school children suffer migraine attacks.
Causes
At present, the mechanism of migraine has not been studied. Researchers have identified several phases in the pathogenesis of migraine attack:
Spasm of cerebral arteries. Short-term hypoxia causes brain matter, what has caused the development of aura.
Subsequent expansion of the cerebral vessels. Dilation of the veins and arteries of the brain is not uniform after the preceding their restrictions, which determines the appearance of a pulsating pain.
Edema vascular walls. Edematous wall veins / arteries prevent reverse vasoconstriction, which accounts for the duration of the headache.
The recovery phase. In this step vascular edema subsides, the diameter returned to baseline, and the patient develops postmigrenozny syndrome characterized by weakness, fatigue, lethargy.
The exact cause of migraine pain is not established, but identified a number of precipitating factors:
Nutritional factors. Consumption of certain foods and beverages (low-alcohol beverages, chocolate, etc.), violation of the diet (skip meals), poor diet or strict diets.
Hormonal factors. Changing the phases of the menstrual cycle occurs under the action of certain hormones, such as progesterone, so the attacks often occur in women on the eve of menstruation, in ovulatory phase at the use of oral contraceptives and hormone preparations for treating gynecological diseases, and puerperal lactation periods in premenopausal women.
Environmental factors. A radical change of climate is a big difference in time zones.
External factors. Extraneous noises, loud noises, flickering lights / flares, bright artificial light, nasty, persistent or intense odors, cigarette smoking, including passive.
Factors associated with sleep disorders. Insomnia, lack of sleep or a material transfer (weekend migraine), later falling asleep and waking, restless, fitful sleep.
Psychophysiological factors. A significant emotional burden, at the end of a stressful situation (exam, contracting) anxiety, prolonged tension, stress, excessive physical activity in sedentary people nervous disruptions. It is noted that these triggers often provoke seizures in people with ambition and perfectionists.
Medications. In addition to receiving the hormones can cause an attack of nitroglycerin, ranitidine, reserpine, and a number of other medicines.
Kinds
International Classification of Diseases identifies the following types of migraine:
- simple or normal flows without aura, 3/4 patients suffer;
- classic, attack is preceded by an aura;
- migraine status - attacks follow one another, the spacing between them is less than 4 hours;
- Complications proceeds with loss of consciousness, nausea / vomiting, seizures;
- chronic migraine attacks are different regularity, with each pain intensity increases;
- neutonchennuyu.
How is migraine
The symptoms of classic migraine are several phases, replacing each other:
Prodrome phase, or precursors
Sometimes it may be absent. Symptoms begin to appear in a few hours or even a day before the attack. The possibility of sudden irritability, insomnia at night and sleepiness during the day, a change in appetite. Also disrupted the ability to concentrate, marked unmotivated fatigue aggravated sensitivity to external stimuli (bright lights, smell, noise).
Aura
Is a complex neurological symptoms which appear after 10-60 minutes before the attack. accompanied
- visual impairment in the form of flickering flies, blurring objects of spots before the eyes, or loss of land,
- tactile (tingling, numbness, tingling in the feet / hands)
- olfactory,
- sound disorders (a distortion of smell, the quiet sound is perceived as loud).
- Numbness of the limbs and trunk captures half opposite the localization of the headache.
- Possible speech disorders (dysphasia) as slurred speech, its tightness and problems with coordination (staggering gait, instability).
Pain phase or directly attack
It lasts from several hours (usually 2-3ch) to several days. The intensity of the pain may increase for 10 minutes or within a few hours. By the nature of migraine pain throbbing or pressing, it covers half of the head, capturing the eyes, the forehead and the back of the head. Localization of pain with unilateral manifestation of its changes with a new attack (first hurt the right side of the head, then left and back of the head).
Photophobia may occur during the attack, the rejection of sounds (any), nausea, with the peak occurring at the vomiting, which does not bring relief, impaired sight and smell. Many patients experience an irresistible urge to squeeze his head. The pain may blood pressure phase jumps. With his increasing pain is bursting with character, with a decrease in pulsating or compressing.
Resolving phase or ending attack
The pain gradually eroding, the patient is immersed in a deep sleep. Often there is a swelling of the face and extremities due to urinary retention.
recovery phase
Characterized by polyuria (increase in urine volume), frequent urination, weakness and apathy. It lasts from several hours to several days & amp.; amp; nbsp;
Simple migraine proceeds in the same way except aura phase.
Diagnostics
In the diagnosis of pathology matter carefully collected history and complaints of the patient, the frequency and duration of attacks and their symptoms, neurologic examination performance. Criteria indicating migraine:
The presence of 5 or more attacks of headaches, which lasted from 3 hours to 3 days without taking pain. Headache is described by the patient as a one-sided, throbbing, intense, breaking the usual way of life depends on the exercise.
The presence of an aura. Only suitable for classical migraine. aura reversible signs manifest themselves consistently and do not last more than 60 minutes after the aura or headache formed on its background.
Accompanying attack autonomic, sensory, motor, visual disturbances and sensitivity disorder.
The absence of symptoms of other diseases that occur with a headache (brain tumors, mental disorders, spinal pathologies, heart disease, etc.).
Carrying out a neurological examination can not detect local changes in the nervous system (reflexes, loss / distortion sensitivity, loss of coordination, etc.). In doubtful situations, the expert shall appoint:
- electroencephalography, Rheoencephalography - evaluation and bioelectric activity of brain rhythms (with several pathologies, including migraine, express observed oscillation frequency, their amplitude is high);
- MRI - to evaluate the cerebral blood vessels, neck revealed multiple foci of ischemic origin;
- CT - makes it possible to exclude / identify brain tumor, aneurysm and its cysts.
If necessary, appointed by radiography of the spine, skull.
Symptoms that should alert
The following symptoms require treatment to a neurologist for further diagnosis and exclusion of various serious pathologies:
- headache first arose over the age of 50 years old or a child up to 10 years
- pain arose for the first time in a patient with cancer or HIV infection
- Headaches worse from attack to attack or attacks are becoming more frequent
- sudden onset of headache (type & quot; thunder & quot;) - a condition that requires immediate treatment to a neurologist
- headaches were accompanied by unusual for the patient's neurological and physical disabilities - for example, migraine without Aura its sudden appearance aura more hours duration (normally within an hour she must pass), the appearance of weakness at movements
- headaches clearly worse when bending, movement - ie, in situations of increased intracranial pressure
- headache accompanied by a gratuitous increase in temperature
With what could be mistaken for the pain of migraine
Differentiate migraine pain must be the following:
Toothache. There is a throbbing pain in the right or left half of the face, and then it is distributed in the temporal and occipital regions. Aura and precursors no.
cervical osteochondrosis. In addition to headaches and dizziness is accompanied by the crunch and pain when moving the head, pain in the neck, chest, shoulders.
Cluster headache. Accompanied by congestion of the ear, severe pain behind the eye, its redness, watery eyes, nasal obstruction, facial flushing and sweating. Marked seasonality of the disease.
Temporal arteritis. Accompanied by headache one half of the head, scalp tenderness of the affected area palpation, skin redness and swelling of the temple, fever, pain in the neck and upper limbs.
- Headaches, which are due to tumors in the brain.
Treatment
Migraine therapy deals with a neurologist.
Therapeutic measures aimed at
- relief of migraine attack,
- reception in the attack-free period of drugs that can reduce the incidence of headache and its intensity,
- preventive actions.
Cupping migraine headache provide the following medicines:
NSAIDs
- ibuprofen,
- paracetamol,
- Diclofenac.
NSAIDs can relieve headaches during migraine attacks weak and average intensity.
receiving dipyrone is not recommended because of the high risk of side effects.
Use of paracetamol in pregnancy (excerpt from the use of the automatic disconnection)
Paracetamol crosses the placental barrier. Until now, there has not been a negative impact on the fetus of paracetamol in humans.
Paracetamol is excreted in breast milk: the content in milk is 0.04-0.23% dose adopted mother.
If necessary, use of paracetamol in pregnancy and lactation (breast-feeding) should carefully weigh the potential benefits of therapy for the mother and the potential risk to the fetus or child.
In experimental studies have found fetotoxic, teratogenic and mutagenic effects of paracetamol.
triptans
The gold standard relief of migraine pain. Eliminate the headache even for severe migraines throughout. Should take or when attack begins, or the aura ending. The most effective are the second-generation drugs - naratriptan and zolmitriptan.
Triptans should be selected taking into account individual susceptibility c. This means that the drug is selected by the search. The drug is considered to be ineffective, with no effect after 2 hours after the onset of the headache.
Important! Preparations triptanovogo series cropped only migraine pain and ineffective for other types of headaches.
Adjuvant therapy
- For the prevention and suppression of vomiting metoclopramide and domperidone, the latter are less pronounced side effects, it can be used by children.
- Some experts recommend the use of diuretics - they increase urination, prevents the appearance of edema and accelerate their disappearance after the attack (furosemide). However, the effectiveness of diuretics in migraine is very individual.
Interictal therapy
Indicated in patients with frequent and prolonged bouts, morbidity and chronic migraine. For the treatment used:
- beta-blockers (propranolol);
- antidepressants - not only to prolong the action of triptans and analgesics, but reduce anxiety and depression (velafeks, Cymbalta);
- anticonvulsants (topiramate, apilepsin).
Power migraine
Dieting will reduce the frequency of attacks of migraine pain and make it easier for them. nutrition principles include:
- Granularity. Food Reception held small meals 4-5 times a day. Eliminate overeating and skipping meals.
- Liquid. Fluid intake should not be restricted.
- Bad habits. Avoid alcohol and tobacco use.
- Limiting animal fats and simple carbohydrates.
In the list of banned products include coffee, cocoa, confectionery, cheese, chocolate, smoked, pickles, citrus fruits, liver, fatty meats / fish, meats, milk, eggs, legumes.
Permitted foods include: lean meats (rabbit, veal) and marine fish, chicken (without skin), vegetable oils, low-fat sour-milk products, bran cereal, dried fruit, walnuts, sesame seeds, flax / pumpkin seeds, herbal drinks, juices, buckwheat, oatmeal.
Cupping at home
If the aura or the attack caught the patient's home, prevent the emergence of a headache or relieve him for help the following techniques:
Reception of weak sweet tea. Effective in the aura, it is useless in the event of a headache.
Creating a comfortable environment. Darken the room (turn off the lights, draw the curtains), remove annoying smell factors, eliminate sources of noise (turn off the TV / phone, close the window and the door to the room), to give up contacts with loved ones. If possible, go to bed.
Massage. Independently perform exercises acupressure (2-4 fingers to press the point on the back of the head and temples from the pain, repeat up to 10 times exhalation) or massage location carotid arteries in the neck (press down for 2-3 seconds from the artery pain, repeat 5-6 time).
Compress. On the frontal region and temporal attach towel with pieces of ice.
complications
The pathology may be complicated by the following states:
Chronic migraine. Frequent complication. The number of attacks per month more than 15. Headache occurs immediately after you wake up, does not disappear during sleep. The patient suffers from insomnia and weakness, increased depression, anxiety.
Migraine status. Refers to serious complications, often develops in patients with essential hypertension. Characterized by a succession of attacks of pain lasting several days or attack that spanned 3 days. Accompanied by severe neurological symptoms, intensive and bursting with pain in the head, repeated vomiting and dehydration. Is fraught with the development of other serious complications.
Migraine stroke. Is a rare but serious complications. Keeps, arching headaches, blurred vision, numbness / tingling in the head. Confirmed on MRI, CT.
Persistent aura. Proceeds as a classic migraine, but the collection of aura symptoms for more than 7 days. It occurs in 1-2% of cases.
Seizure. A quarter of patients with epilepsy suffer from migraine. Migraine attack increases the likelihood of an epileptic seizure in 4 times.
Prevention and prognosis
Compliance with preventive measures will help reduce the frequency of attacks and their intensity:
- the prohibition of alcohol, smoking;
- refusal to take coffee, cola, energy drinks;
- normalization of sleep (at least 8 hours and going to bed before midnight);
- exception dietary factors that provoke an attack;
- moderate exercise, frequent exposure to fresh air;
- regulation of mental stress, prevent stress, nervous stress, rejection of an emergency mental work;
- adherence to the principles of a healthy diet;
In the presence of rare and short-lived attacks, appointment and subject to adequate treatment and prevention of this disease prognosis is favorable.
Therapy for severe migraine lasts from 3 months to a year, with a gradual reduction in the dosage of drugs and their cancellation. Adjustment of treatment specialists conduct every 2-3 months.
Self-medication is fraught with complications and the transition into a chronic disease.
sources:
- Diagnosis and treatment of migraine: the recommendation of Russian experts. - Journal of Neurology and Psychiatry, 1, 2017; Vol. 2.
- Danilov AB Migraine: recommendations for diagnosis and treatment. - Russian Journal of Medicine 2014.
