Migraine

Migraine
Migraine is a chronic neurological disease characterized by regular or episodic pain on one, less often on both sides of the head. Migraine attacks are not associated with injuries, strokes, brain tumors, overexertion or overwork. The intensity of pain and its pulsating nature are the consequences of vascular insufficiency, but are not related to an increase or decrease in blood pressure. Migraines and glaucoma attacks, as well as increased intracranial pressure, do not belong to the causes.

The content of the article:
Etiology and pathogenesis of migraine
Clinical picture
Diagnosis of migraine
Migraine Treatment
Prognosis for migraines
Migraine prevention
Migraine
Migraine is most often observed in women and is transmitted through the female line, but in some cases it is also diagnosed in men. The severity of the disease varies. So one headache attack can occur only a few times a year or several times a week. Most often, the attack is repeated 2-8 times within a month.

Etiology and pathogenesis of migraine
The disease is accompanied by an expansion of the intracranial arteries and a subsequent change in cerebral circulation. The attack is a consequence of a decrease in the level of serotonin, which is responsible for a positive attitude of a person. At the same time, prodromal signs are a consequence of vasoconstriction inside the skull. In other words, there is a narrowing of the lumen of blood vessels and arteries. In about two-thirds of cases, migraine is hereditary.

Two theories of migraine development are known: vascular and neurogenic.

Vascular theory attributes migraine to the consequences of a generalized failure of vasomotor regulation, manifested by the lability of vascular tone. The pain syndrome here is the result of relaxation of smooth muscles in the vascular walls with their periodic stretching, giving the pain pulsation.
According to the neurogenic theory, migraine is provoked by cerebral dysfunction, and vascular changes in this case are secondary.
An important role in the development of migraine is assigned to the trigeminal nerve, which connects the central nervous system, intracranial and extracranial vessels. Neurogenic aseptic inflammation is formed due to the release of nerve fibers from the terminals in the vessel walls of vasoactive neuropeptides, which are the cause of such phenomena as:

Increase in the diameter of vessels;
Increased permeability of vascular walls;
Sweating proteins;
Edema of the walls of blood vessels and the adjacent dura mater of the brain;
Ingress of the contents of granules from mast cells into adjacent tissues;
Platelet pooling.
Clinical picture
Pain can occur due to sudden changes in the weather, taking medications, eating certain foods and alcoholic beverages, emotional stress. A headache attack can occur in women during the premenstrual and menstrual period.

The intensity of sensations can range from moderate to severe, pain is concentrated on one side, less often on both. Sometimes the pain syndrome spreads to the neck, eyes, and lower jaw. Migraine can worsen even from small physical exertion, which often deprives patients of working capacity.

In addition, the list of migraine symptoms includes:

High sensitivity to light, photophobia;
Photophobia;
Dizziness;
Nausea and vomiting;
Deterioration of spatial orientation.
With migraines with aura, blurred vision, impaired speech, hallucinations preceding or accompanying seizures may occur. Any migraine can be accompanied by emotional changes, such as aggressiveness and short temper, or drowsiness and apathy.

Diagnosis of migraine
It is quite difficult to diagnose migraine correctly, therefore, if the patient is suspected of this disease, they are sent for a thorough neurological examination. At its first stage, a patient is interviewed, during which the features of the headache are clarified. The patient should tell how long each attack lasts approximately, what is their nature and intensity, how often they occur, in which area the head hurts, from what age the pain began to bother, whether relatives suffer from migraines.

Based on the patient’s answers, the neurologist makes a conclusion about the necessary tests and additional consultations of other specialists. Often the patient is referred for laboratory tests and X-rays to differentiate migraine from fever, hypotension, hypertension and other diseases.

The most frequently assigned:

psychiatric consultation;
computed tomography;
MRI;
magnetic resonance angiography;
biochemical analysis of urine and blood;
ophthalmologist’s examination;
radiography of sinuses;
lumbar puncture and electroencephalography may be indicated.
After the examination, a neurological examination is performed in order to exclude intracranial pathologies, CNS disorders and neoplasms in the brain.

Differential diagnosis
When diagnosing a disease such as migraine, a number of alarming signs characteristic of organic brain diseases should be taken into account:

Headache attack after sexual activity, strong stretching, coughing;
Pain only on one side of the head for a long time;
Severe nausea, vomiting, high fever, focal neurological symptoms;
The appearance of seizures after 50 years.
In addition to organic diseases, hypertension, vegetative-vascular dystonia and other vascular pathologies, tumors and infectious lesions to which the brain and its membranes may be susceptible should be excluded. It is also necessary to differentiate migraine from cluster headache, episodic headache, which tension can provoke, and chronic paroxysmal hemicrania.

Migraine Treatment
Therapy for migraines is aimed at simultaneously analgesia during seizures and reducing their frequency. The list of painkillers includes paracetamol, aspirin, anti-inflammatory drugs, ergotamine drugs.

Along with these medications, triptans are used — drugs of complex action. At the same time, they anesthetize, narrow the vessels of the brain and affect the receptors that secrete substances that provoke inflammation. As a result, the intensity of pulsation of pain sensations decreases, they completely pass.

Despite the effective effect, the systematic use of migraine medications containing caffeine and codeine is highly undesirable due to the fact that they lead to addiction. The brain has the ability to remember the stimulating effect of these substances, which gives an impetus to new attacks. As a result, in order to get rid of the headache, the patient is forced to take the medicine again.

Prognosis for migraines
In many patients, migraine goes into remission over the years and may even disappear completely. This is especially true for older women, whose estrogen levels decrease after menopause. However, in a number of situations, complications occur.

One of these complications is the risk of heart disease and strokes before the age of 50. Migraine with aura is more dangerous than migraine without aura, especially for women’s health.

It is impossible to ignore such an item as a decrease in the quality of life due to constant emotional stress. Permanent stress negatively affects personal life, labor productivity. People who have migraines are not sociable and are often prone to panic attacks, anxiety and depression.

Migraine prevention
Preventive measures mainly include compliance with the norms of a healthy lifestyle. People with a tendency to this disease should get as much sleep as possible at night, and exercise during the day: attend workouts in the gym or at least walk more often.

It is extremely important to eat regularly and properly, avoiding products that provoke migraines: sodium glutamate, nitrates, sulfites. Alcohol, coffee and chocolate should be excluded. During the period of fasting, dieting or other measures to limit the diet, it is necessary to pay attention to preventive medications.

As for medications, each drug taken needs careful monitoring. Such means include hormonal contraceptives, which must be selected individually by a doctor.

The best solution would be a complete rejection of bad habits, especially smoking.

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