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Dictionary The Nervous System

Headaches

Synonyms :  

Clinical features, Diagnosis, Management, Prognosis,

Migraine

It is characterised by episodic headache, which is typically unilateral (not always on the same side) but may become generalised.

The cause is unknown and the pathophysiology is not fully understood. It appears that dilation and over-distension of the intracranial arteries may play some role. However several triggers are recognised: oral contraceptives, hormone replacement therapy, periods (the importance of oestrogens), stress, anxiety, depression, fatigue, insomnia, dieting and fasting; tension headache and migraine often co-exist. It also appears that weather changes, strong odours, bright lights, smoke, glare from snow and water, flickering lights (as in night clubs or video spots), loud noises, and excessive sun exposure can precipitate attacks. Caffeine, alcohol (red wine), chocolate, cheeses and artificial sweeteners have long been suspected to precipitate migraine headaches in some patients.

The role of oestrogens explains why migraine is much more common in women than men (the ratio is 3:1). Genetic factors have been implicated since more than 50% of patients have a family history of migraine.

 

Clinical features:  < BACK TO TOP >

  • Migraine attacks occur at intervals which vary from a few days to several months, and last for 2 to 72 hours.
  • In 10-20% of patients headache is preceded by an aura in form of transient, reversible symptoms such as zig-zag lines, flashing coloured lights, or defects in the visual field (scotomas).
  • The pain is severe and throbbing and may be associated with nausea and/or vomiting, sensitivity to light (photophobia), sensitivity to sound (phonophobia), pallor, and prostration, which may force the patient to lie down in a quiet, darkened room.

Diagnosis:  < BACK TO TOP >

  • It is established on clinical grounds alone; typical presentation, history of episodic headache, family history.
  • No diagnostic tests are available, except to exclude intracranial pathology as a cause of pain. 

Management  < BACK TO TOP >

  • It depends on the frequency of attacks and may be prophylactic, abortive and analgesic.
  • In patients with more than one migraine episode per week, long term prophylaxis is warranted; the drugs considered are b-blockers propranolol [Inderal, Cardinol, Deralin] or metoprolol [Betaloc, Lopresor], tricyclic antidepressant amitriptyline [Trypanol, Tryptine, Endep], anti-epileptic valproate [Epilim, Valpro], calcium channel blockers verapamil [Isoptin, Cordilox, Veracaps] or diltiazem [Cardizem, Dilzem] and serotonin antagonist methysergide [Deseril]. ?Abortive drugs are used for acute treatment; ergot alkaloid such as ergotamine [Ergodryl, Cafergot, Migral] and dihydroergotamine [Dihydergot injection], serotonin agonists such as sumatriptan [Imigran], zolmitriptan [Zomig], naratriptan [Naramig], dopamine antagonists such as metoclopramide [Maxolon, Pramin] can suppress nausea and vomiting. ?Analgesics should be used as less as possible since in some patients they cause rebound headache; the choices are paracetamol with codeine [Panadeine Forte, Dymadon Co and Forte, Panamax Co, Codalgin], naproxen [Naprosyn, Naprogesic], ibuprofen [Nurofen Actiprofen], indomethacin [Indocid], dextropropoxyphene [Doloxene, Digesic, Paradex], pentazocine [Fortral] and tramadol [Tramal].-

Prognosis  < BACK TO TOP >

  • - - 

Nutrition  < BACK TO TOP >

Nutrition that alleviate or prevent migraine :-
C

Herbs  < BACK TO TOP >

Herbs that alleviate or prevent migraine :-

Camellia sinensis (Green tea)
Mentha piperita (Peppermint)

(source : -)
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