Migraine is recurrent headache associated with visual and gastrointestinal disturbance. The borderline between migraine and tension headaches is vague. Over 12% of any population world-wide report these symptoms.
Mechanisms of migraine
Precise mechanisms of migraine remain unknown. Genetic factors play some part . The headache of migraine, often throbbing, is due to vasodilatation or oedema of blood vessels, with stimulation of nearby nerve endings. Release of vasoactive substances such as nitric oxide has a role . Serum 5 – hydroxytryptamine (5HT) rises with initial symptoms and falls during the headache. Cerebral features, such as tingling limbs, aphasia and weakness, are caused by focal depression of cortical function.
Some patients recognize precipitating factors:
#Week-end migraine (a time of relaxation)
#Chocolate (high in phenylethylamine)
#Cheese (high in tyramine)
#Noise and irritating lights
#With premenstrual symptoms.
Migraine is common around puberty and at the menopause and sometimes increases in severity or frequency with hormonal contraceptives, in pregnancy and with the onset of hypertension. There is no reason to suppose that the development of migraine is suggestive of any serious intracranial lesion. However, since migraine is so common, an intracranial mass and migraine sometimes occur together by coincidence. Migraine sometimes follows a blow to the head - often minor.
Symptoms of Migraine
Migraine attacks vary from intermittent headaches indistinguishable from tension headaches to discrete episodes that mimic thromboembolic cerebral ischaemia.
Distinction between variants is somewhat artificial.
Migraine can be separated into phases:
# initial or, prodromal symptoms
# the main attack (headache, nausea, vomiting)
# sleep and feeling drained afterwards.
Types of Migraine
Migraine with aura (classical migraine)
Prodromal symptoms are usually visual and related to depression of visual cortical function or retinal function. Unilateral patchy scotomata (retina) (Patchy blindness), hemianopic symptoms (cortex), teichopsia (flashes) and fortification spectra (jagged lines resembling battlements) are common. Transient aphasia (Unable to speak) sometimes occurs, with tingling, numbness, vague weakness of one side and nausea. The prodrome persists for a few minutes to about an hour.
Headache then follows. This is occasionally hemicranial (i.e. splitting the head) but often begins locally and becomes generalized. Nausea increases and vomiting follows. The patient is irritable and prefers a darkened room. Superficial temporal arteries are engorged and pulsating. After several hours the migraine settles, sometimes with a diuresis. Deep sleep often ensues.
Migraine without aura (common migraine)
This is the usual variety. Prodromal visual symptoms are vague. There is recurrent headache accompanied by nausea and malaise.
Basilar migraine
Prodromal symptoms include circumoral and tongue tingling, vertigo, diplopia, transient visual disturbance (even blindness), syncope, dysarthria and ataxia. These occur alone or progress to a typical migraine.
Hemiparetic migraine
This rarity is classical migraine with hemiparetic features, i.e. resembling a stroke but with recovery within 24 hours. Exceptionally, cerebral infarction (stroke) occurs.
Ophthalmoplegic migraine
This rarity is a third nerve, or exceptionally a sixth nerve, palsy with a migraine - and difficult to diagnose without investigation to exclude other conditions.
Facioplegic migraine
This is unilateral facial weakness during a migraine.
The diseases, which should be differentiated from migraine
The sudden headache may resemble meningitis or SAH(Sub Arachnoid Haemorrhage). Hemiplegic, visual and hemi sensory symptoms must be distinguished from thromboembolic TIAs(Transient Ischaemic Attacks). In TIAs maximum deficit is present immediately and headache is unusual. Unilateral tingling or numbness may resemble sensory epilepsy (partial seizures). In epilepsy, distinct march (progression) of symptoms is usual.
Treatment of Migraine
#reassurance and relief of anxiety
#avoidance of dietary factors - rarely helpful.
Patients taking hormonal contraceptives may benefit from a brand change, or trying without. Premenstrual migraine may respond to diuretics. Depot oestrogens are sometimes used. Severe hemiplegic symptoms are an indication for stopping hormonal contraceptives.
During an attack. After ruling out any serious cause for a sudden headache, paracetamol or other simple analgesics should be given, with an antiemetic such as metoclopramide if necessary. Repeated use of analgesics leads to further headaches.
Triptans (5-HT, agonists) are also helpful. In some 30% of cases, where there is
recurrent severe migraine, sumatriptan, zolmitriptan, naratriptan and rizatriptan are of value either by prompt self-administered subcutaneous injection, or orally by wafer or inhaler. Triptans should be avoided when there is vascular disease, and not overused.
Prophylaxis of Migraine attack
It is difficult to discern placebo effects of prophylactic drugs. The following are used when attacks are frequent:
#pizotifen (antihistamine and 5-HT antagonist) 0.5 mg at night for several days, increasing to 1.5 mg (common side-effects: weight gain and drowsiness)
#propranolol 10 mg three times daily, increasing to 40-80 mgthree times daily
#amitriptyline: 10 mg(or more) at night.
#Sodium valproate, methysergide, SSRIs, verapamil, topiramate, nifedipine and naproxen are also used.
Showing posts with label headche. Show all posts
Showing posts with label headche. Show all posts
Sunday, March 29, 2009
Tuesday, February 17, 2009
Causes and remedies of headache
Though nervous system is rarely involved in a case of headache, but it is wise to exclude any association with nervous system in long standing and, or undiagnosed headache. If timely diagnosed, headache due to neurological reasons like brain tumor, meningitis, or, hemorrhage can be reverted.
In the following type of headaches seek medical advice promptly when headache is:
*Persistent
*Occurs after head injury, even though minor
*Associated with loss of consciousness or change in consciousness,
*Associated with convulsions, disturbed brain function of memory, orientation, speech, etc.
*Associated with paralysis of any kind,
*Associated with seeing double images; failing vision,
*Associated with fever,
*Associated with vomiting.
Other Common (Non Serious) Causes of Headache:
Tension headache
This is the commonest cause of headache. Factors responsible are stress and strain of modern life, hurrying, racing against time, worries and anxieties, insomnia.
Remedy of Tension Headache:
Tranquilizers help to relieve temporarily but changing the lifestyle should be given utmost importance. Yoga and meditation help immensely to tide over tensions.
Hunger and irregular food intake:
Another important cause of headache is long gap between meals. This tends to lower the blood sugar level and may result in headache.
Remedy
Take food at regular intervals.
Sinusitis
Spaces within the bones around the nasal cavity are called paranasal sinuses; they communicate with the nasal cavity. Inflammation of frontal sinus, located in the forehead is common after common cold. Communication with the nasal cavity is blocked due to inflammation and the air within the sinus is absorbed. A large difference of air pressure inside and outside the sinus results and causes severe headache and vomiting.
Remedy
Steam inhalations help. Sit with your head about two feet above a steaming electric kettle for 10-20 minutes. Blow through the nose as necessary. You will feel relieved as the passages open up.
Eye Strain
If you need glasses but do not wear them, headache may appear after a few hours of work. If you are not wearing proper glasses, especially when you are working on your computer, you can get a headache. It must be understood that the distance of the computer screen from your eyes is more than the reading distance for a book. If you have been prescribed reading glasses, you need a differently-powered glass for computer work.
As distinct from eye strain, beware of acute pain around one eye which could be due to acute glaucoma. This needs urgent diagnosis by an eye specialist. If the tension within the eye is found to be high, urgent operation may be necessary.
Migraine
Typically migraine presents as severe periodical throbbing headache, usually one-sided. Onset is sudden, with throbbing pain which reaches its peak in an hour or so, when nausea and vomiting also start. The attack may last for a few hours or a day or two. In some patients, the attack of headache is preceded by twinkling before the eyes, difficulty of speech, or numbness of lips, face and limbs and even temporary paralysis, but all these symptoms disappear in a few minutes. These symptoms, though recurrent and disturbing to the patient, do not cause permanent disability.
Other important features of migraine are: Frequency of attack is usually once in a few weeks, not daily. The attack may be provoked by alcoholic drinks (red wine in particular), sudden changes in temperatures, exposure to bright sunlight, stress at work, errors of refraction, certain food etc.
Treatment of Migraine
At the first indication of attack, a tablet of Paracetamol or Ergotamine, repeated after half an hour, if necessary. Ergotamine preparations should be taken only under medical supervision, not more than six tablets in a single attack and not to be taken during pregnancy. Sumatriptan Succinate, another preparation works very well, if taken prior to an established attack. Botox injection helps in intractable cases.
Avoid precipitating factors as far as practicable. Get your refraction corrected, reschedule your work to avoid tensions, and avoid any food that is found to consistently precipitate the attack.
Cluster Headaches
This causes a constant non-throbbing headaches on one side of the head.Though not connected with any disease of the eye, the pain is usually located in the region of the orbit of one eye, Cluster headache usually starts within two to three hours of falling asleep and infrequent during waking hours.
The pain is intense, steady and constant with flushing of face, blocked nose and tears from the eye. Pain may last an hour or so and then may leave as suddenly as it came. Pain tends to recur every night for several weeks or even months, hence the name 'cluster'. In between the clusters, there is complete freedom from headache, sometimes for years. Cluster may recur in times of stress, overwork or emotional upheavals. Alcoholic beverages and certain kinds of food may precipitate the headache during the cluster but not during the period of freedom from attacks. This causes no permanent disability.
Treatment of cluster headache
A tablet of Paracetamol for the headache, repeated if necessary. Ergotamine preparations, though reported to be effective, are best avoided because their number can reach dangerously high in a cluster. The anti-depressant drug amitryptaline (Tryptomer), given in a small dose at night, is safe and effective in interrupting a cluster.
High Blood Pressure
Contrary to usual belief, hypertension rarely causes headache. Nervous tension may cause both headache as well as elevation of blood pressure. Do not therefore depend on your feeling of headache to judge the level of your blood pressure but rely on actual readings taken with a mercury BP instrument.
Sudden severe rise of blood pressure, however, can cause severe headache and even cerebral haemorrhage. Then it needs to be urgently but carefully brought down to safer levels with the help of your doctor.
This article is republished at India Study channel
In the following type of headaches seek medical advice promptly when headache is:
*Persistent
*Occurs after head injury, even though minor
*Associated with loss of consciousness or change in consciousness,
*Associated with convulsions, disturbed brain function of memory, orientation, speech, etc.
*Associated with paralysis of any kind,
*Associated with seeing double images; failing vision,
*Associated with fever,
*Associated with vomiting.
Other Common (Non Serious) Causes of Headache:
Tension headache
This is the commonest cause of headache. Factors responsible are stress and strain of modern life, hurrying, racing against time, worries and anxieties, insomnia.
Remedy of Tension Headache:
Tranquilizers help to relieve temporarily but changing the lifestyle should be given utmost importance. Yoga and meditation help immensely to tide over tensions.
Hunger and irregular food intake:
Another important cause of headache is long gap between meals. This tends to lower the blood sugar level and may result in headache.
Remedy
Take food at regular intervals.
Sinusitis
Spaces within the bones around the nasal cavity are called paranasal sinuses; they communicate with the nasal cavity. Inflammation of frontal sinus, located in the forehead is common after common cold. Communication with the nasal cavity is blocked due to inflammation and the air within the sinus is absorbed. A large difference of air pressure inside and outside the sinus results and causes severe headache and vomiting.
Remedy
Steam inhalations help. Sit with your head about two feet above a steaming electric kettle for 10-20 minutes. Blow through the nose as necessary. You will feel relieved as the passages open up.
Eye Strain
If you need glasses but do not wear them, headache may appear after a few hours of work. If you are not wearing proper glasses, especially when you are working on your computer, you can get a headache. It must be understood that the distance of the computer screen from your eyes is more than the reading distance for a book. If you have been prescribed reading glasses, you need a differently-powered glass for computer work.
As distinct from eye strain, beware of acute pain around one eye which could be due to acute glaucoma. This needs urgent diagnosis by an eye specialist. If the tension within the eye is found to be high, urgent operation may be necessary.
Migraine
Typically migraine presents as severe periodical throbbing headache, usually one-sided. Onset is sudden, with throbbing pain which reaches its peak in an hour or so, when nausea and vomiting also start. The attack may last for a few hours or a day or two. In some patients, the attack of headache is preceded by twinkling before the eyes, difficulty of speech, or numbness of lips, face and limbs and even temporary paralysis, but all these symptoms disappear in a few minutes. These symptoms, though recurrent and disturbing to the patient, do not cause permanent disability.
Other important features of migraine are: Frequency of attack is usually once in a few weeks, not daily. The attack may be provoked by alcoholic drinks (red wine in particular), sudden changes in temperatures, exposure to bright sunlight, stress at work, errors of refraction, certain food etc.
Treatment of Migraine
At the first indication of attack, a tablet of Paracetamol or Ergotamine, repeated after half an hour, if necessary. Ergotamine preparations should be taken only under medical supervision, not more than six tablets in a single attack and not to be taken during pregnancy. Sumatriptan Succinate, another preparation works very well, if taken prior to an established attack. Botox injection helps in intractable cases.
Avoid precipitating factors as far as practicable. Get your refraction corrected, reschedule your work to avoid tensions, and avoid any food that is found to consistently precipitate the attack.
Cluster Headaches
This causes a constant non-throbbing headaches on one side of the head.Though not connected with any disease of the eye, the pain is usually located in the region of the orbit of one eye, Cluster headache usually starts within two to three hours of falling asleep and infrequent during waking hours.
The pain is intense, steady and constant with flushing of face, blocked nose and tears from the eye. Pain may last an hour or so and then may leave as suddenly as it came. Pain tends to recur every night for several weeks or even months, hence the name 'cluster'. In between the clusters, there is complete freedom from headache, sometimes for years. Cluster may recur in times of stress, overwork or emotional upheavals. Alcoholic beverages and certain kinds of food may precipitate the headache during the cluster but not during the period of freedom from attacks. This causes no permanent disability.
Treatment of cluster headache
A tablet of Paracetamol for the headache, repeated if necessary. Ergotamine preparations, though reported to be effective, are best avoided because their number can reach dangerously high in a cluster. The anti-depressant drug amitryptaline (Tryptomer), given in a small dose at night, is safe and effective in interrupting a cluster.
High Blood Pressure
Contrary to usual belief, hypertension rarely causes headache. Nervous tension may cause both headache as well as elevation of blood pressure. Do not therefore depend on your feeling of headache to judge the level of your blood pressure but rely on actual readings taken with a mercury BP instrument.
Sudden severe rise of blood pressure, however, can cause severe headache and even cerebral haemorrhage. Then it needs to be urgently but carefully brought down to safer levels with the help of your doctor.
This article is republished at India Study channel
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