Migraine: causes and treatment

Migraine is one of the most common forms of primary headaches, which acts as a separate nosological form, not the symptom of another disease. Migraine affects about 10-15% of people in the population, with women 2-3 times more often than men. Incidence peaks at the age of 35-40 years, but getting a migraine in about 15-25 years.

Migraine also called hemicrania, indicating its clinical features (Hemi – half, kranium, the skull). Migraine pain known since ancient times. The first mention of special headaches and the treatments date back to 3000 BC. Migraine was sick a lot of famous people, among them Freud, Tchaikovsky, Newton, and others.

But today, the disease has not lost its relevance – migraine attack leads to a significant reduction or complete loss of working ability by more than 70% of patients who are forced to abandon their daily duties and to comply with bed rest.

The causes of migraine

To date, no known exact causes of migraines. Most researchers are inclined to the genetic nature of this disorder. Isolated and identified more than 30 genes, mutations in which lead to increase risk of development of migraine in your vehicle, and depending on the type of mutant gene that risk increases from minimal to large.

Also noteworthy trigemino-vascular theory of migraine development, which proposed in 1984. According to this hypothesis, activation of the trigeminal nerve leads to increased release of substances from vazodilatiruushimi abilities. This contributes to vasodilation and activation of afferent innervation of cerebral vessels the trigeminal nerve. This theory explains hemicranial localization of migraine pain.

In addition, many researchers pay special attention to the hormonal causes of migraines due to the fact that women suffer more often than men. From this point of view, the migraine causes an imbalance of sex hormones – decreasing progesterone and increasing estrogen. This theory confirms the link between migraine and onset of menstruation in women.

It is necessary to mention the serotonin theory of migraine development. Before the attack in the blood increase the amount of serotonin. Also, this theory confirms the effectiveness of drugs for migraine from the group of agonists of serotonin receptors (triptan).

But, as a rule, for the occurrence of migraine attack is necessary, in addition to the inclination of the body, the impact of provoking adverse factors or triggers.

Factors that activatea migraine attack:

• acute or chronic stressful situation;
• intellectual or physical overstrain of the body;
• diseases and pathological conditions accompanied by impairment of the physiological balance of sex hormones;
• intake of oral contraceptives;
• sleep disorders – chronic lack of sleep or, conversely, excessive sleep;
• changing weather conditions and climate zone;
• alcohol, especially red wine and champagne;
• eating some foods, especially those rich in tiramina – chocolate, cocoa, hard cheeses, nuts, fish, canned and cured meats, as well as food supplements, preservatives and colorants, sweeteners;
• diseases that affect cerebral blood vessels (hypertension,

  The mechanism of development of headache in migraine

  As you know, migraine is a special type of headache, the mechanism of development of which is unique and not like any other. Because most medications for headaches are ineffective in migraine.

  Migraine attack proceeds in several sequential phases:

  1. The spasm of blood vessels of the brain and the development of short-term

     Classification migraine headaches

     According to the classification of International organization for the study of headache, migraine is divided into several types:

     • migraine without aura, or simple;
     • migraine with aura, or associated;
     • ofthalmoplegical form of migraine;
     • retinal migraine.

     Aura migraine is a complex of focal neurological symptoms that develop shortly before the pain of a migraine or at its height. The nature of the symptoms that comprise the aura, depend on the localization of pathological changes of blood vessels (carotid or vertebral-basilar pool) and include visual, tactile, auditory, gustatory signs.

     The symptoms of migraine

     Migraine without aura

     This is the most common form of migraine and is 75% of the disease. To establish such a diagnosis, it is necessary to find out a few details.

     Criteria of migraine without aura:

     1. A minimum of 5 typical migraine attacks in a patient.
     2. Headache lasts from 4 to 72 hours.
     3. Pain to wear hemicranial, pulsating character, increases with any physical activity, the intensity of pain of medium and high.
     4. The attack is accompanied by nausea, vomiting, increased sensitivity to light, sounds.
     5. No diseases that may cause the same headache (excludes secondary pain).

     Migraine with aura

     Aura may appear for 5-20 minutes before the onset of pain and take place during the firsthours.

     Criteria for migraine with aura:

     1. At least 2 typical migraine attacks in a patient.
     2. One or more aura symptoms, which are reversible and develop a minimum of 4 minutes before the pain and run for the first 60 minutes.
     3. Pain to wear hemicranial, pulsating character, increases with any physical activity, the intensity of pain of medium and high.

     Migraine with classic aura is the most common form in this group. The aura symptoms include visual disturbances different (points, lines, flies, fog, zigzags, lightning, loss of visual field), numbness, feeling of pins and needles in a particular area of the body, speech disturbances, hemiparesis.

     Oftalmologicheskiy migraine

     This is a rare form of migraine in which at the beginning of the attack developing a variety of oculomotor disorders that appear on the height of the headache. Symptoms may include ptosis (drooping eyelid), strabismus, double vision, increased pupil diameter on the side of pain. Usually oftalmologicheskiy attacks of migraine are replaced by migraine with typical aura.

     Retinal migraine

     This is a rare migraine, the aura of which is temporary blindness in one eye or the appearance of cattle (point and visual field defects).
     

     Complicated forms of migraine

     This is a rare cases, but they are a direct threat to patient's life and require urgent medical care.

     Migraine status

     Can manifest in the form of a series of heavy attacks at intervals of not more than 4 hours or one prolonged seizure that lasts more than 72 hours. A headache is impossible to stop the conventional medication that helped the patient. The pain is accompanied by severe vomiting, which can cause severe dehydration. Headache throbbing at first, then becomes diffuse and bursting character. Can occur disturbance of consciousness.

     Migraine stroke

     This complication temporary neurological disorders, which are caused by local cerebral ischemia in the first stage of development of migraine, become persistent. These symptoms persist more than 7 days, and when performing CT or MRI of the brain can be visualized specific education – ischemic cyst. As a rule, all the symptoms disappear during the first month, but the morphological substrate in the brain tissue remains.

     Video transmission about migraine:

     Diagnosis of migraine

     As a rule, the diagnosis of migraine is not difficult, as the clinical picture is quite typical. The important point in establishing the true causes of headache is keeping a diary of headachespatient where indicated when there is pain, the patient connects her, localization and intensity of headache pain on a 10-point scale (for migraine characteristic pain intensity from 5 to 10 points) which pills are taken and in what quantity, the effects of drug treatment.

     But given the fact that there are diseases that can appear similar to a headache, each case of migraine requires detailed examination and exclusion of organic pathology of the brain.

     Diagnostic program:

     • therapeutic and neurological examination of the patient;

     • Drug treatment of migraine

       The migraine treatment is a rather difficult task, because in each case, therapy must be individualized, because what helps one person is not always effective in another.

       The entire therapeutic process in the case of migraine can be divided into 3 stages:

       1. Relief of headache.
       2. Drug prevention of migraine between attacks.
       3. Symptomatic correction of underlying.

       Relief of a migraine attack

       For this purpose, use as specific drugs and nonspecific. The difference between them is that the first allow you to stop a migraine attack, however, they do not have analgesic abilities and affect basic elements of the pathogenesis of migraine. The second group, non-specific, have a direct analgesic effect.

       To nonspecific medications include simple and combination analgesics, and nonsteroidal anti-inflammatory drugs. Narcotic analgesics are used only in the case of migraine status.

       To help get rid of headache can Aspirin (500-1000 mg), Paracetamol (325-500-1000 mg). A great analgesic result show combined analgesics – combination of aspirin and paracetamol with caffeine, minimal doses of codeine (

       Migraine treatment in pregnant and lactating mothers

       As a rule,

       Prevention of migraine attacks

       The main objective in the prevention of migraine is identification of factors that cause headaches.

       General preventive measures:

       • rational regime of rest and work;
       • healthy sleep;
       • regular physical activity;
       • development of stress resistance.
       • avoiding stressful situations and conflicts;
       • regular, balanced and healthy diet;
       • an exception from the products menu provocateurs;
       • to give up alcohol, Smoking;
       • rational use of analgesics;
       • the rejection of the use of oral contraceptives.

       Summing up, we canto say that migraine is a topical issue of modern medicine, as its symptoms are not only reduce the patient's quality of life, but also, at times, are a direct threat to human life.