Simple migraine — the most often found type of migrenozny paroxysms which distinctive feature is lack of aura and any passing neurologic violations. Simple migraine is characterized by the attacks of an intensive headache, a thicket the unilateral, followed nausea, numerous vomiting, zvuko-and a photophobia. Diagnostics is based on clinical criteria. The exception of other cerebral diseases which symptom can be a similar tsefalgiya is obligatory. Treatment idle time of migraine is carried out by agonists of serotoninovy receptors, NPVS, dihydroergotamines, not narcotic and narcotic analgetics, antiemetic, sedative and tranquilizers.
Simple migraine makes up to 80% of all attacks of migraine. Unlike migraine with aura and the associated migraine, it has no the tranzitorny visual, motor or sensitive violations previous or accompanying a headache. The first attacks of simple migraine, as a rule, arise in the period from 17 to 35 years. At advanced age migrenozny attacks lose the duration and intensity. Women have migraine 3-4 times more often than men, attacks at them are often connected with the periods of a menstrual cycle. Simple migraine is observed in suppressing the majority of cases of migraine at children. At the same time the family nature of a disease is often traced. Besides, some authors specify that at 80% of the men having migraine, mothers also suffered from migrenozny paroxysms.
Reasons of simple migraine
It is known what can provoke an attack idle time of migraine a stressful situation, physical overfatigue, a mental overload, a lack of a dream, overcooling, changes in weather, a pungent smell, noise, flickering light, alcohol intake, violation of a diet, the use of separate products (for example, nuts, a citrus, chocolate, soy sauce, cheese, a celery, Coca-Cola and so forth). Simple migraine can be caused in women by hormonal shifts — an ovulation and periods, reception of hormonal contraceptives. Trigger factors of migraine are to some extent individual, over time each patient knows the set of similar triggers from experience.
Simple migraine, as well as other types of migrenozny paroxysms, is associated with such traits of character as ambition and ambition, hypererethism. Patients in the majority strong-willed and strong people, but at the same time they are intolerant of errors of others why they are often irritated and show discontent.
Pathogenetic mechanisms of development of the migrenozny attack still are a subject of studying of clinical biochemistry and neurology. At an attack changes in the maintenance of a number of substances — serotonin, a histamine, catecholamines, prostaglandins, a bradikinin are noted. Today the main role is assigned to serotonin. Researches showed that at the beginning of the migrenozny attack there is a sharp release of serotonin from platelets that is followed by narrowing of cerebral vessels. Then serotonin level considerably decreases. Efficiency concerning migraine of regulators of exchange of serotonin also emphasizes value of this neurotransmitter.
Other researches testify to the trigeminal and vascular mechanism of development of simple migraine. Excitement of neurons of the kernel of a trigeminal nerve which is in a medulla which provokes emission of neurotransmitters is initial. The last irritate trigeminalny receptors and exponentiate an aseptic inflammation of a wall of a carotid. Morbidity of an artery at a palpation is explained by it and puffiness of the fabrics surrounding it.
Symptoms of simple migraine
Simple migraine is characterized by sudden emergence of a tsefalgiya without the previous aura. In certain cases the headache is foretold by the prodromalny phenomena — decrease in mood, drowsiness, working capacity falling, nausea, yawning. As the tsefalgiya often extends only to a half of the head, it carries the name a hemicrany. The hemicrany is more often noted in the right half of the head. In certain cases the tsefalgiya takes the second half of the head and has diffusion character. Pain is followed by nausea, various on intensity, and numerous vomiting. Any movements increase intensity of a tsefalgiya. Hypersensibility to sounds and light irritants, forces patients to be isolated during the migrenozny attack from the world around (to be closed in the room, to curtain off windows, to hide under a blanket, etc.).
Simple migraine can last from 4 hours to 2-3 days. Sometimes the migrenozny attack is followed by the speeded-up urination, diarrhea, dizziness, a nose congestion, vegetative frustration (heartbeat, perspiration, feeling of inflow of heat, a fever, feeling of a lack of air). The termination of a paroxysm in half of cases proceeds with transition of the patient to a condition of a dream. After the postponed migrenozny attack some weakness and weakness can be observed, in some cases, on the contrary, the increased physical and intellectual activity is noted.
Simple migraine at children more often is diffusion or is localized bitemporally and bifrontalno. The attack usually does not last more than 1 days. Intensity of a tsefalgiya at children often is less, than at adults. To the forefront they have a nausea and repeated vomiting. Cases when the migrenozny attack at the child was followed by fever and belly-ache are described and it was mistakenly interpreted as intestinal infection.
Diagnosis of simple migraine
Simple migraine is diagnosed by the neurologist by the following clinical criteria: existence in the anamnesis not less than 5 migrenepodobny paroxysms, duration of each of which is not shorter 4 hours and no more than 3 days; the tsefalgiya is characterized not less than 2 of the listed signs — has average and high intensity, pulsing, unilateral, becomes more intensively at physical activity; is available at least 1 of the following accompanying symptoms — zvuko-and a photophobia, nausea and vomiting.
Important point is differential diagnosis of migraine from serious cerebral diseases, such as an intracerebral tumor, meningitis, arakhnoidit, a brain cyst, encephalitis, aneurism of vessels of a brain, etc. Special vigilance is required at bystry development of the migrenozny attack, not observed earlier excessive intensity of a tsefalgiya or its unusual character, existence of a rigidnost of muscles of a nape, a consciousness loss attack, spasms, restriction of visual fields. For an exception of organic cerebral pathology comprehensive neurologic examination is conducted: an electroencephalography, an ekhoentsefalografiya, REG, UZDG of vessels of the head, survey of the ophthalmologist with a research of an eye bottom and perimetry. According to indications MRT of a brain and MRT of cerebral vessels is appointed.
Treatment of simple migraine
In knocking over of a migrenozny paroxysm standard analgetics are ineffective. As a rule, apply dihydroergotamines (ergotamine, dihydroergotamine) or selective agonists of serotonin — a triptana (, , , , ). At gradual development of a paroxysm happens reception of one of these medicines inside enough. However because of the reduced GIT motility such way of introduction can be inefficient. In such cases use of ergotamine in rectal candles, dihydroergotamine in oil or in/in, a sumatriptana / is recommended to. Use of triptan is accompanied by a frequent recurrence of a tsefalgiya as these medicines have short elimination half-life (only 2 hours). At renewal of a tsefalgiya repeated drug intake, a combination of triptan with nonsteroid anti-inflammatory often is required (an ibuprofen, nimesulidy, diclofenac).
In some cases simple migraine is stopped by endonasal introduction of lidocaine, reception of a naproksen, intramuscular introduction of magnesia. Repeated vomiting is the indication to appointment antiemetic (a metoklopramida, a domperidona, an ondansetrona). At high intensity of a tsefalgiya and lack of improvement from use of the above-stated pharmaceuticals resort to use of narcotic analgetics (a tramadol, trimeperidine, codeine, fentanyl, a nalbufin). However their application is possible not more often than 2 times a week.
Unfortunately, now simple migraine has no effective pharmacotherapy of the mezhpristupny period which would allow to reduce probability of emergence of the migrenozny attack significantly. Neurologists use monoamine oxidase inhibitors, beta , tranquilizers, antikonvulsant, (the predecessor of serotonin), etc. Separate domestic researches showed efficiency of long reception of small doses of aspirin.
As drug treatment is ineffective, much attention should be paid to tenor of life of the patient, an exception from it of the factors provoking the migrenozny attack. This task which to solve on force only to the most sick. Except normalization of a day regimen and food, the serious psychological work directed to reduction of insistence to people around and formation of more benevolent attitude towards people has to enter here. A supporting role consultations of the psychologist, special trainings, psychotherapy can play in it.
Simple migraine in itself is not life-endangering or to health of the patient a disease. However the migrenozny attacks reduce efficiency of patients, making impossible performance of the working duties by them in the period of an attack. Besides, some patients (for example, rescuers, doctors, workers of noisy shops, cooks and so forth) are forced to change the profession as it is accompanied by the triggers provoking migraine. Unfortunately, statistically only in 10% of cases doctors manage to reach the termination of migrenozny paroxysms. On the other hand, numerous cases when patients, by change of the life, tried to obtain recovery are known.