The Migrenozny status — hard proceeding paroxysm of migraine or a continuous series of the migrenozny attacks lasting over 3 days. It is characterized by the expressed intensity of a pain syndrome, recurrence of vomiting, weakness, giperesteziy, adinamiy. It is diagnosed on the basis of clinical criteria after an exception of an organic disease of a brain with use of Ekho-EG, EEG, REG, cerebral KT/MPT, the analysis of a likvor. Demands performing the urgent therapy including glucocorticosteroids, ergot pharmaceuticals, antiemetic, psychotropic drugs, blockade methods.
Migraine — widespread pathology, is noted at 12-15% of the population. Arises on the second decade of life, reaches the maximum expressiveness by 35-45 years. Then migrenozny paroxysms decline, stop to 60-year age. Women get sick 2-3 times more often than men. The Migrenozny status is a migraine complication, constitutes potential danger in the development plan for a migrenozny stroke therefore demands urgent treatment in the conditions of a hospital. It is observed rather seldom. Statistical data on its exact prevalence are absent. Pathology meets mainly in practice of emergency doctors, neurologists.
Reasons of the migrenozny status
According to modern ideas of migraine, the caused dysfunction of separate neyrotransmitterny systems, inadequate adjustment of a tone of cerebral vessels is the cornerstone of a disease hereditarily. The status develops against the background of not stopped migraine paroxysm. Are the main reasons:
- Lack of adequate therapy in the period of an attack. Some patients do not see a doctor, preferring to stop independently headache attacks analgetics. Overdue reception of medicine can provoke the migrenozny status (2 hours later from the beginning of a paroxysm).
- Insufficient effect of pharmaceuticals. In most cases development of the status is connected with inefficiency of the applied earlier antimigrenozny medicines. The reasons of sudden resistance to standard therapy are not established.
The Migrenozny attack proceeds in several pathogenetic stages. In the beginning the vazokonstriktorny mechanism which is replaced by a vazodilatation of brain vessels is started. The pulsing tsefalgiya (headache) results. The vascular atoniya leads to perisosudisty hypostasis, dumping of blood into venous system that causes transformation of a pain syndrome in the pressing tsefalgiya type. With time or under the influence of antimigrenozny medicines the described processes get the return development, the vascular tone is restored, the attack comes to an end. If vascular changes have the expressed character, do not take place for a long time (more than 72 hours), then the paroxysm develops into the migrenozny status. In the conditions of long vascular dysfunction ischemia of tissues of brain develops, developing of a stroke is possible.
Symptoms of the migrenozny status
The basis of a clinical picture is made by the intensive diffusion aching tsefalgiya. The periods of more severe pain (the tsefalgichesky attacks) alternating temporary reduction of pain are allocated. The headache remains over three days, does not disappear after a dream, reception of analgeziruyushchy and antimigrenozny medicines. The expressed general weakness, an adinamiya, pallor is characteristic. The heavy tsefalgiya is followed by repeated vomiting owing to which patients cannot eat food, medicines. The organism loses liquid and electrolytes, dehydration develops.
Condition of the patient heavy. Hypersensibility to light (photophobia), to sounds (giperakuziya), to smells is noted. Spasms, a meningealny syndrome, all-brain symptomatology, consciousness changes, passing visual frustration (decrease in visual acuity, a zatumanivaniye, blinking) are possible.
The status at migraine is dangerous by development of an ischemic stroke. The Migrenozny stroke makes 13,7% of ischemic cerebral defeats of young age. Proceeds it is hidden, as a lacunary heart attack. It is possible to suspect its development at emergence of a clinical picture "pulsing" (appearing, vanishing) focal neurologic symptoms (a gemianopsiya, a gipesteziya, paresis of a facial nerve). At the patients having migraine with aura, the symptomatology repeats manifestations of aura.
According to criteria of the International society of a headache, the diagnosis "the migrenozny status" is competent at compliance to the following criteria:
- The clinic of an attack of a tsefalgiya corresponds to the previous migrenozny attacks, differs in bigger duration.
- The headache is characterized by considerable intensity, lasting over 72 watch.
- Tsefalgiya is not a consequence of other diseases.
For the purpose of a confirmation/denial of the third criterion the additional inspection of the patient including is necessary:
- Survey of the neurologist. Does not reveal focal neurologic deficiency. Existence of focal symptomatology demonstrates development of a migrenozny stroke, other organic pathology of a brain.
- Ekhoentsefalografiya is carried out for an exception of volume process in a brain. Does not find pathological changes.
- Electroencephalography. The diffusion dizritmiya of nonspecific character is defined, epileptogenny activity is absent.
- The rheoencephalography can diagnose an asymmetric krovenapolneniye of cerebral vessels, decrease in a tone of a carotid.
- Oftalmoskopiya. It is carried out by the ophthalmologist. In the period of the status narrowing of arteries and expansion of veins of a retina is defined.
- Research of tserebrospinalny liquid. Does not reveal changes. Gives the chance to exclude inflammatory defeat of TsNS, hemorrhage.
- KT, brain MRT. Help to be convinced of lack of organic defeat of TsNS: intracerebral hematoma, abscess of a brain, cerebral cyst, tumoral process. At long-term existence of migraine visualize the atrophy centers, expansion of ventricles, increase in subarakhnoidalny space. Existence of the site of ischemia of brain fabrics allows to diagnose a migrenozny stroke.
- MRT of cerebral vessels is made for an exception of aneurism, an arteriovenozny malformation of a brain.
It is necessary to differentiate the migrenozny status from meningitis, an encephalomeningitis, subarakhnoidalny hemorrhage. The intensive tsefalgiya at inflammatory diseases is followed by fever, an obshcheintoksikatsionny syndrome, changes of clinical blood test (increase in SOE, ), cerebrospinal fluid. The sharp headache with the accruing disorder of consciousness, presence of blood at a likvor is typical for subarakhnoidalny hemorrhage.
Treatment of the migrenozny status
Urgent hospitalization in office of neurology is shown. The status is stopped by a combination of several techniques provided below:
- Introduction of glucocorticosteroids. It is carried out intravenously struyno with use of dexamethasone, Prednisolonum. Corticosteroids have the expressed anti-inflammatory, antiedematous effect.
- Use of medicines of an ergot (ergotamine). Intravenous drop administration is made. Pharmaceuticals of this group eliminate dilatation of cerebral vessels, block a neurogenetic inflammation, render dopaminergic effect.
- Introduction of psychotropic pharmaceuticals. It is necessary for normalization of the mental sphere of the patient. According to clinical manifestations appoint antidepressants, neuroleptics, tranquilizers.
- Knocking over of vomiting. It is reached by means of the antivomitives (metoklopramid) blocking an emetic reflex.
- Periostalny blockade. Are carried out in trigger points of the arch of a skull, nape, temporal area, cervical vertebras. Normalize venous outflow, restore local microcirculation, lower excitability of local vegetative knots, have antiedematous, anti-inflammatory, soothing effect.
- Intra bone blockade. Are carried out at insufficient effect of periostalny. Introduction is carried out in malar bones, awned shoots of vertebras of cervical department. The effect is based on switching off of intra bone receptors from the mechanism of formation of angiospastichesky and painful components of an attack. Thanks to the developed venous network the injected drugs easily spread in surrounding fabrics that provides bystry medical effect.
Forecast and prevention
In due time carried out urgent therapy allows to stop the migrenozny status. Lack of treatment, incorrect therapy bring to the long current of the status exhausting the patient, to development of a stroke, dehydration. The best way of prevention is the adequate treatment of migraine including performing mezhpristupny therapy. The patients having migraine are always recommended to have at themselves the medicines stopping a paroxysm, to apply them at the first signs of the approaching attack.