Migraine is the primary incidental form of a headache which is shown intensive, pristupoobrazny headaches (is more often unilateral) with a combination of neurologic, vegetative and gastrointestinal manifestations. It is for the first time shown usually aged from 12 up to 22 years. On frequency takes the second place after tension headache. Often the attack of migraine arises after some aura and comes to an end with feeling of the general weakness and weakness. During diagnosis of migraine it is necessary to exclude organic pathology of a brain and to deal with the possible reasons of emergence of migraine. Treatment consists of means for knocking over of the arisen attack and prevention of emergence of a new episode of migraine.
Migraine — primary incidental form of a headache which is shown intensive, pristupoobrazny headaches (is more often unilateral) with a combination of neurologic, vegetative and gastrointestinal manifestations. It is for the first time shown usually aged from 12 up to 22 years. On frequency takes the second place after tension headache.
Etiology and pathogenesis
Earlier migraine was considered as vascular pathology as during an attack of migraine there is an expansion of vessels of a firm brain cover in which innervation trigeminovaskulyarny fibers participate. However pain during an attack of migraine is secondary, they result from allocation from the terminations of trigeminovaskulyarny fibers of painful neuropeptids-vazodilatatorov, the most important of which — And yes peptide. Thus, the attack of migraine arises because of activation of trigeminovaskulyarny system. Such activation happens at patients to a gipersensitization of trigeminovaskulyarny fibers and hypererethism of a cerebral cortex. As "provokers" of an attack of migraine an emotional stress (the attack of migraine arises after a stressful situation at once), periods, the physical tension, hunger, and also some products containing and (a citrus, chocolate, champagne, red wine) most often act.
The pressing, pulsing headaches taking a half of the head with localization in a forehead/temple/a eye are characteristic of migraine. In certain cases migrenozny pain arises in occipital area with the subsequent transition to one half of the head. From time to time localization of a headache can change from one half of the head on another. Moreover, constants (or periodic) unilateral headaches are not characteristic of migraine, and are considered as the absolute indication to inspection for an exception of organic damage of a brain!
It is in certain cases observed prodry (migraine attack harbingers), shown weakness, decrease in concentration of attention, and postdry (a state right after a migraine attack) in the form of the general weakness, pallor and yawning. The attack of migraine is followed, as a rule, by nausea, photo and phonophobia, deterioration in appetite. The headache amplifies at rise on a ladder and walking. At children's age the attack of migraine is followed by drowsiness, and after a dream pain, as a rule, passes. Migraine is closely connected with female genitals therefore in 35% of cases the attack of migraine is provoked by periods, and so-called menstrual migraine (the attack of migraine arises within two days which passed from the beginning of periods) — in 8-10%. Reception of hormonal contraceptives and replacement hormonal therapy aggravates the course of migraine in 70-80% of cases.
Distinguish several clinical kinds of migraine:
- vegetative or panic migraine — an attack is followed by vegetative symptoms (a fever, the strengthened heartbeat, dacryagogue, feeling of suffocation, a face edema);
- migraine with aura - before an attack tranzitorny, visual, speech, sensitive, motive violations appear; its version - bazilyarny migraine;
- associative migraine - a paroxysm of a headache is followed by passing neurologic deficiency; its versions are afatichesky, cerebellar, gemiplegichesky and oftalmoplegichesky migraine.
- dream migraine — an attack arises during sleep or in the morning, during awakening;
- katemenialny (menstrual) migraine — the kind of migraine connected with a menstrual cycle. It is proved that the attack of such migraine is caused by decrease in level of estrogen in a late lyuteinovy phase of a normal menstrual cycle;
- chronic migraine — attacks arise more often than 15 days/month within three months and longer. The quantity of attacks increases up to emergence of daily headaches every year. Intensity of a headache at chronic migraine with each attack increases.
As well as at other primary tsefalgiya, a basis of diagnosis of migraine are complaints of the patient and data of the anamnesis. In most cases need for carrying out additional methods of a research (EEG, a rheoencephalography, brain MRT) does not arise. Manifestation of neurologic symptoms is noted only at 2-3% of patients. At the same time tension and morbidity of one or several perikranialny muscles is in most cases noted that becomes a constant source of discomfort and even neck pain and occipital area.
Migraine needs to be differentiated from incidental pain of tension for which, unlike migraine, less intensive headaches of the pressing (squeezing) character are typical bilateral, independent of physical activity.
Treatment of migraine
Therapy of migraine it is possible to divide into two stages: knocking over of the developed attack and further preventive treatment with the purpose to prevent new attacks of migraine.
Knocking over of an attack. Appointment of these or those medicines as the neurologist for knocking over of a migrenozny attack depends on its intensity. Attacks of weak or moderate intensity lasting less than two days stop by means of the simple or combined analgetics: ibuprofen (0,2 — 0,4 g), paracetamol (0,5 g), acetilsalicylic acid (0,5 — 1 g); and also kodeinsoderzhashchy medicines (combination of codeine, paracetamol, metamizol of sodium and phenobarbital). At the heavy course of migraine (high intensity of a headache, duration of attacks more than two days) medicines of specific therapy — a triptana apply (agonists of serotoninovy receptors like 5HT); for example, , , , and also other forms of triptan (candles, solution for subcutaneous injections, nasal spray).
Prevention of migraine
For the prevention of synchronization of a disease and improvement of quality of life preventive treatment of migraine which purpose are is carried out: reduction of duration, frequency and weight of attacks; reduction of influence of migraine by everyday life of the patient.
The migraines making preventive treatment choose individually for each patient, considering the pathogenetic mechanisms of a disease provoking factors and emotional and personal violations. The greatest distribution was gained beta (, propranolol), by antidepressants (, to tsitalopra), blockers of calcic channels (), and also NPVS (, acetilsalicylic acid). In modern medicine even more often apply non-drug methods (a progressive muscular relaxation, psychotherapy, acupuncture) to prevention of migraine.