Migraine Introduction:
The word migraine is derived from the Greek word Hemi crania.
Hemi_half (pain in half head)
A migraine is a typical type of headache which affects one side of the head.
It is characterized by recurrent headaches and it is pulsating in nature.
Migraine can be moderate to severe in its intensity and it may last for a few hours to three days once started.
Migraine headache is always accompanied by some other symptoms such as Nausea, Photophobia, Vomiting and Sensitivity to sound and smell.
One more important symptom which may be associated with migraine is its ‘Aura’
Aura is a short time period sensation
Of visual disturbances.
The patient in this stage can directly feel the onset of a migraine.
In other words, Aura is a sign of the onset of a migraine.
Aura can be experienced by one-third of patients diagnosed with migraine.
Migraine is a neurological disorder.
Its symptom may include.
Headache.
Photo phobia.
Nausea.
Sensitivity to smell and sound.
The onset of migraine is usually around puberty.
Its duration is recurrent and migraine may be chronic in nature.
Some genetic and environmental factors are supposed to be the causating factors of migraine.
Its differential diagnosis includes.
Brain tumours.
Tension headache.
Cluster headache.
Sinusitis.
Subarachnoid haemorrhage.
Idiopathic intracranial hypertension.
Venous thrombosis.
On average, about 15% of the population is suffering from migraine and is ranked 3 as the world’s most prevalent disease.
SIGNS AND SYMPTOMS OF MIGRAINE:
Migraine is a typical type of headache which is divided into four phases.
Though the headache consists of four phases all the patients don’t compulsorily experience all four phases.
A migraine attack which is experienced longer than 3 days is called ‘ status migrainosus ’.
Phases of migraine:
- Predrome phase..(hours or days before headache).
- Aura..( immediate proceeds pain).
- Pain..(headache phase).
- Postdrome..(remained effects end of a migraine attack.)
In addition to these signs, migraine may be associated with anxiety disorders, bipolar disorders and OCD.
PREDROME PHASE:
It includes all the pre-monitory symptoms.
It occurs in about 60% of patients.
Its duration starts from two hours and remains up to two days before the Onset of the next phase I.e. Aura phase.
Symptoms of the Predrome phase:
Alteration of mood.
Depression.
Irritability.
Fatigue.
Euphoria.
Food craving.
Neck stiffness.
Constipation or diarrhoea.
Sensitivity to noise and smell.
The limbic system and hypothalamus are the sites of origin of predromal Symptoms in migraine.
AURA PHASE:
The aura phase is transient and neurological in nature.
It occurs just before the actual headache.
It can occur just before 5 mins and may last up to 60 mins.
Symptoms of the Aura phase:
The blurring of vision.
Hemianopsia (temporary loss of part of a vision).
Tingling sensations in arms, spreading up to the nose.
Speech disturbances.
World spinning.
Auditory hallucinations.
Delusions.
AURA PHASE:
It is the main phase of migraine in which the patient is experiencing unilateral throbbing pain which is moderate to severe in nature.
The pain phase is further intended by physical activity during the attack.
Its average frequency is one attack in a month.
PAIN PHASE:
Symptoms of pain phase:
Nausea.
Vomiting.
Photo phobia.
Sensitivity to sound and smell.
Irritability.
Fatigue.
Light_ headedness.
Confusion.
Blurred vision.
Nasal stuffing.
Increased urination.
Diarrhoea.
Pallor.
Sweating.
Neck stiffness.
(Silent migraine: it is also known as an aura without headache)
POST-DROME PHASE:
It is a phase experienced after the actual pain phase settled down.
It is experienced as a sore feeling in the area where the headache has occurred.
CAUSES OF MIGRAINE:
Migraine is a complex phenomenon which is a result of environmental and genetic factors.
Near about two third of migraine, causes are hereditary.
Some psychological conditions are also responsible for migraines such as anxiety, depression and bipolar disorders.
- Genetic factors:
Migraine with an aura phase is more common to adopt genetically than migraine without an aura phase.
A study has shown that there are four autosomal genes which are responsible for the genetic transmission of migraine progeny to progeny.
Trigger factors:
A migraine attack is most commonly commences by certain triggers.
Triggers for migraine may be of different types such as physiological factors and environmental factors.
Many things like certain foods, fatigue, alcohol and weather can be responsible for a migraine attack.
- Physiological factors :
50% to 80 % of people affected by migraine can experience their Onset due to the following types of physiological factors.
I.e. Hunger.
Stress.
Fatigue.
Post-traumatic stress.
Menstruation.
O.c pills.
Menarche.
Pregnancy.
Perimenopausal state.
Menopause.
In other words, hormonal influence is responsible for the migraine-containing aura.
- DIETARY ASPECTS:
Certain foods can trigger migraine in about 12% to 60% of people.
MSG used in many junk foods is reported as the biggest trigger factor for a migraine attack.
Other food items like alcoholic beverages, chocolate, cheese, and processed meat contain tyramine, which is believed to be a trigger factor for migraine.
ENVIRONMENTAL FACTORS:
The clinical studies for environmental factors causing migraine are not sufficient despite, bad indoor air and light, might trigger migraine, although not proved yet.
PATHOPHYSIOLOGY OF MIGRAINE:
There are some differences between researchers regarding the pathophysiology of migraine.
Some believe it is a neurological disorder while others assume it is a neurovascular disorder in which blood vessels are playing an important role.
DIAGNOSIS OF MIGRAINE
Diagnosis of migraine is quite interesting..
According to I.H.S, migraine diagnosis is made by a rule called (5,4,3,2,1 criteria).
Attacks: 5 no.
Time: 4 hours.
Duration: 3 days.
Symptoms: 2 in no. (From. Unilateral headache, pulsating, pain intensity moderate to severe, triggered by physical activity.)
Symptoms: 1 in no. ( from. Nausea or Vomiting, Photophobia or photo phobia.)
TREATMENT FOR MIGRAINE:
The phrase, prevention is better than cure.
This is the best example of a migraine.
People may avoid migraine attacks by avoiding trigger factors.
As it’s treatment is concerned,
Migraine can be treated by
Non-steroidal anti-inflammatory drugs such AS diclofenac, ibuprofen and aspirin. Along with analgesics, anti-emetic drugs such as sumatriptan can be used in severe migraine attacks