Migraine with aura
Migraine with aura — pristupoobrazny primary tsefalgiya before which emergence visual violations, frustration of the sensitive sphere or the speech are observed. It differs from simple migraine in the bright points arising in 10-60 min. prior to a headache and disappearing before its emergence, lightnings, dark or light stains in eyes, distortion of visual perception, delay or indistinctness of the speech, a pricking or a sleep of extremities, acoustical or olfactory hallucinations, paresis. Diagnosis of migraine with aura is based on neurologic and ophthalmologic inspections, brain EEG, MRT and KT. Treatment includes prevention and knocking over of attacks.
Migraine with aura
Migraine with aura is one of forms of primary tsefalgiya (headache), i.e. it arises absolutely independently, but not as one of symptoms of any disease. According to experts in the field of clinical neurology, migraine occurs at 18% of women and 6% of men. About a quarter of cases of migraine makes migraine with aura. The aura represents the temporary visual, sensitive, speech violations arising in 10-60 min. prior to an attack of a migrenozny tsefalgiya, changes of taste, sense of smell or acoustical perception. As a rule, the migrenozny aura lasts no more than 60 min. Sometimes it does not lead to developing of a headache.
Among classical cases of migraine with aura migraine attacks with the so-called extended aura can be observed. Tell about the extended aura when at least one its symptom proceeds more than 60 min. but at the same time given neurologic inspection and methods of neurovisualization do not reveal any pathology. If the migrenozny aura lasts more than 7 days, then with a high probability it is possible to assume development of such complication as a migrenozny heart attack which existence is confirmed by means of neurovisualization methods.
The causes of migraine with aura
On modern representations, hypererethism of cerebral pain receptors is the cornerstone of migraine. Emergence of aura is caused by change of biochemical and bioelectric activity of neurons of a certain site of a brain. So, assume that the most often found aura of visual character arises owing to hyper excitement of neurons of the site of bark of an occipital share which is responsible for "processing" of visual information.
Migraine with aura is a polietiologichny disease. Among the reasons of its emergence first of all call stressful situations and a mental overstrain. As stress level in this or that situation is individual for different people and depends on their subjective reaction, it is possible to claim that developing of migraine with aura is substantially caused by the repeated incorrect relation of the person to the developing circumstances. It is indicative that people who manage to keep the benevolent relation in various life situations have migraine much less often, the those, the it is heavy to keep from discontent, irascibility and irritability.
Are capable to provoke migraine with aura: sleep debt, change of weather, too bright light, blinking of the monitor, noise, pungent smell, excessive sexual activity and so forth. At women act as trigger factors: the begun periods, reception of oral contraceptives or hormonal therapy of a climax. Migraine with aura can be observed at patients with depressive neurosis, a syndrome of chronic fatigue, ipokhondrichesky neurosis, an insomniya and other sleep disorders.
Emergence of an attack of migraine with aura at the use of certain products is noted. Most often such "provokers" are tiraminsoderzhashchy food: bananas, cheese, nuts, citrus, fish caviar, and also red wine. However reaction of patients to various products is very individual. In this regard neurologists assume that regular emergence of an attack after the use of a certain product is connected not with a product, and with the fact that once its consumption coincided with emergence of an attack of migraine and the brain "recorded" it.
Clinic of migraine with aura
Character of an attack of a tsefalgiya at migraine with aura differs in nothing from usual migraine. The pulsing or pressing headache usually takes only a half of the head, is followed by nausea, the slight dizziness raised by perception of sounds and light irritants. Migraine with aura, as well as simple migraine, can have prodry in the form of change of mood, drowsiness or hypererethism, the speeded-up yawning, the general weakness and so forth. The main difference is existence of aura. At the same time it is not necessary to confuse the last to the prodromalny symptoms appearing in several hours (sometimes in 1-2 days) to a migrenozny attack.
Usually the disease is characterized by emergence and increase of a tsefalgiya within the first hour after disappearance of the phenomena of migrenozny aura. In certain cases symptoms of aura appear in the period of a headache again, and sometimes remain even after its termination. The attack of a tsefalgiya can proceed from 4 hours to several days. After it the patient feels some weakness and weakness. In other cases he falls asleep and wakes up completely healthy that occurs at children more often.
Types of migrenozny aura
Most often at patients the aura of visual character is noted. In classical option, it begins with emergence of an uneven and flickering spot which can have white, iridescent or golden coloring. This spot or scotoma settles down in both eyes gomolateralno, i.e. or in both right, or in both left half of fields of vision. Gradually extending, the spot can fill completely with itself a half of a field of vision in each eye. Then there is a restoration of sight and there is a typical attack of a tsefalgiya.
At children's age migraine with aura of visual character is often expressed as "Alice's syndrome" when the sizes are visually distorted, a form and contours of objects, visual hallucinations develop. Such phenomena as black spots and the sparkling points before eyes, sight turbidity, "fog" and "lightning flashes" in eyes also belong to visual (oftalmichesky) aura. The retinalny aura which is expressed in emergence of the central scotoma with the subsequent passing blindness is in rare instances observed.
Migraine with aura can be characterized by the tranzitorny sensitive violations preceding a headache. Most typically for sensitive aura emergence of a pricking and/or sleep (gipesteziya) in finger-tips of one hand with distribution of this phenomenon on all hand, a half of the head and a neck, and in certain cases and on all half of a body. Such phenomena as a ring in ears, emergence of unusual sounds or smells can act as aura.
At some patients the aura in the form of temporary violations of the speech is observed: aphasias, the slowed-down pronunciation of the phrase, a muffled conversation, difficult selection of words. Less often the aura in the form of the motive violations caused by passing muscular weakness in a hand and a leg of one half of a body meets.
Diagnosis of migraine with aura
Consultation of the patients having migraine attacks with aura is carried out by the neurologist. Its main diagnostic task is the exception organic (an intracerebral tumor, a cyst, encephalitis) and vascular (TIA, distsirkulyatorny encephalopathy, an ischemic stroke) the pathologies of a brain capable to cause symptoms, similar to migrenozny aura. Neurologic examination, brain MPT or KT is for this purpose conducted; consultation of the ophthalmologist with definition of fields of vision and an oftalmoskopiya is appointed.
Important point at diagnosis of migraine with aura is carrying out an electroencephalography (EEG) allowing to obtain data on functional activity and specific features of a bioelectric rhythm of a brain of the patient. Results of EEG are used further at the choice of medicines for medicamentous therapy.
Treatment of migraine with aura
Medicamentous therapy has 2 directions: knocking over of an attack and prevention of its emergence further. It is selected individually taking into account severity of attacks and data of EEG.
NPVP (, an ibuprofen, diclofenac) or the combined analgetics are usually applied to knocking over of an attack. At attacks with high intensity of a tsefalgiya appoint medicines from group of triptan: , , , . If such attacks are followed by repeated vomiting, then in addition apply antivomitives (), or . Therapy of a migrenozny attack of subjects is more effective, than the stopping medicine was accepted earlier. The patients having migraine with aura can prevent completely emergence of an attack if accept such medicine at the first symptoms of aura.
The treatment directed to the prevention of attacks is usually shown at their emergence of 2 and more times a month. These are the long, sometimes occupying several months, therapy. Antidepressants (, , ), antikonvulsant (valproata, ) or psychotropic drugs can make its basis. As a rule, preventive treatment of migraine with aura is carried out by one carefully picked up medicine. The combined therapy is applied only in difficult cases.
Searches of more effective ways of treatment of migraine continue now. In Europe there take place researches on application of the antagonist of CGRP receptors preventing the expansion of cerebral vessels arising during a migrenozny attack. The American scientists I investigate possibilities of application of the transkranialny magnetic stimulation (TMS) for interruption of attacks. The aerosol from migraine which efficiency and speed are comparable to intravenous administration passes clinical tests.
Non-drug aspects of treatment of migraine with aura
Therapy of migraine is not only drug intake. Not less importance is related the patient to the disease and those efforts which he makes to cope with it. In fact the patient needs to reconstruct the way of life. It is necessary to avoid the use of tea, coffee, Coca, lemonade, etc. as they overload nervous system. It is useful to drink herbal teas, compotes, uzvara and just water. If the migrenozny attack arises in response to the use of a certain product, it is better to exclude it from a diet.
Along with introduction of a feasible daily routine, full-fledged dream and healthy nutrition, the patient should understand what situations, what his actions and the relations I provoke the next attack of migraine with aura or without it. It is whenever possible necessary to avoid trigger situations, and to change the attitude towards them even better. The patients who are not trying to understand the reasons of the disease and possible non-drug ways of prevention of the next attack risk to receive long-term treatment by the increased doses of medicines without desirable effect.