Migraine: Symptoms and Treatment
Migraine is a fairly common neurological disease, accompanied by severe paroxysmal headache. Migraine, the symptoms of which are actually pain, concentrated from one half of the head mainly in the eyes, temples and forehead, in nausea, and in some cases, in vomiting, occurs without binding to tumor brain formations, to stroke and severe head injuries, although And may indicate the urgency of the development of certain pathologies.
Headache with migraine is rarely localized in both halves of the head, while, as we have already pointed out, its appearance is not associated with any concomitant conditions that could explain it. The nature of such pain is not associated with a traditional headache that occurs against the background of tension, but with blood vessels. With migraine headache has nothing to do with blood pressure (with its increase or decrease), as it is not associated with increased intracranial pressure or with a glaucoma attack, which defines it in combination with the above descriptions as a special kind of manifestation of headache.
The predisposition against the background of heredity is the main factor provoking the risk of migraine, although in general the reason acting as a justifying factor has not been determined for the present because of the complexity of the mechanism of development of this condition.
Among the provoking factors, there are also physical and emotional overloads, alcohol consumption (in particular, champagne, red wine, beer), eating and sleeping disorders, excessive exposure to noise and sunlight (overheating), smoking, climate change and The whole meteorological conditions, changes in the hormonal background in the female body (including and against the background of hormonal contraceptive use), as well as changes associated with the menstrual cycle. It is noteworthy that foodstuffs rich in tyramine (such as cocoa and chocolate, cheese, coffee and nuts, citrus fruits and smoked products) lead to disturbances in the central nervous system related to serotonin processes, which in turn allows them to be considered as factors , Which are directly related to the development of migraine.
When considering at a deeper level, the situation with the development of migraine against the background of the listed factors looks as follows. In particular, they lead to the development of angiospasm in the carotid or in the vertebrobasilar system, which, in turn, provokes characteristic symptoms in the form of photopsy, loss of visual fields, numbness of one of the extremities. All this can be reduced to the definition of a specific stage, on which this symptomatology indicates, the stage is prodromal. Gradually, the next stage begins, accompanied by a pronounced dilatation, which encompasses arterioles and arteries, veins and venules, in particular this process is expressed in the region of the branches of the carotid outer artery (the membrane middle, occipital and temporal).
Next, there is a sharp increase in the amplitude of the walls of the vessels that have undergone expansion, as a result of which receptors in the vessel walls become irritated, which, accordingly, leads to localized and severe headache. Subsequently, due to increased permeability, the walls of the vessels begin to swell. As a rule, at this stage of the process, muscle contracture of the neck and scalp region is formed, as a result of which the influx to the brain of the blood is greatly increased. After this, there are quite complex changes at the level of biochemical processes, in which histamine and serotonin are actively released from platelets, which causes capillaries to become more permeable, which in turn narrows along with a narrowing of the tone of the arteries. All this leads to the third stage of the migraine course.
In the future, patients against the background of the listed processes may face such a symptomatology, which indicates that hypothalamus is involved in them. This symptomatology appears in the form of chills and low blood pressure, low-grade fever and rapid urination.
When the attack ends with the onset of sleep, the headache when the patient awakens disappears, but instead of it there may be general weakness in combination with malaise.
The fourth stage of migraine manifests itself in the form of a postmigrenous symptom, as well as in the form of disorders of the allergic type and angiodystonia.
Returning, again, to the causes of migraine, it is important to note that the leading role in its development is assigned to the activation process in the nucleus of the trigeminal nerve. In this version, migraine is an actual condition for people with high social activity, as well as for people who are excessively ambitious and anxious.
Predominantly, the disease is observed at a young age, with its onset at the age of 20, and the peak at the age of 25 to 35 years. Modern statistical data indicate that migraine is diagnosed in 20% of cases among women and about 6% among men. It is not excluded and migraine in children — the symptoms of this condition are noted in the order of 4% of cases.
When considering heredity in favor of the subsequent appearance of migraine in a child, its presence in both parents increases this risk to 90%; If there is migraine only in the mother — the risk of development reaches 70%; The presence of only the father determines the risk of developing a migraine in the range of up to 20%.
The main manifestation of the disease, as we have already explained, is a paroxysmal headache, most often focused on one side of the head of the frontotemporal area. Often the pain is pulsating and intense, in some cases accompanied by nausea (and sometimes vomiting), photophobia and phoneticism are not excluded. In particular, painful sensations increase with excessive loads of various types (mental loads, emotional or physical loads).
The attack of the disease can occur at any time, and it often happens that the migraine appears during sleep (at night), closer to the morning or on waking. Predominantly, the pain is one-sided, but later it is dispersed to both sides of the head. As for nausea (with some vomiting added in some cases), it appears mainly towards the completion of the pain phase, although the variant of its appearance along with the attack itself is not excluded.
The period of the attack leads, as a rule, to the patients’ desire for privacy, with the dimming of the room from excess sunlight and the adoption of a reclining position. According to the frequency of seizures, they may appear in a variant of several episodes throughout life, and in the version with the appearance of several times a week. Most patients experience up to two seizures per month. In general, the attack can last from an hour to three days, although mainly its duration is noted within 8-12 hours.
Migraine in pregnancy mostly weakens in manifestations, although the opposite effect is not excluded, in which attacks in manifestations, on the contrary, are amplified or even appear for the first time at this time. The nature of migraine, as we have already noted, is more hereditary, and, in the main, heredity comes from the maternal line. Intervisciplinary period does not determine neurological examination of the focal type of neurological disorders.
Consider some of the main types of migraines in more detail regarding their manifestations and the characteristics of the clinical picture.
Migraine without aura: symptoms
This type of migraine is also defined as a simple migraine. This type is the most common, it is about 2/3 of the total number of the disease under consideration. It is noteworthy that women face migraine attacks more often before their menstruation occurs or during it. It also happens that attacks of this type of migraine are noted only on specific days of the cycle.
In the diagnosis of migraine without an aura are guided by a number of criteria, which include, in particular:
- the appearance of seizures at least five times
- the total duration of each of these seizures is on the order of 4 to 72 hours if there is no adequate therapy for them;
- the relevance of the actual headache to at least two of the following characteristics:
- the pulsating nature of manifestation
- localization from one side
- the average degree of intensity of manifestations or their severe degree, on the basis of which patients lose the opportunity to conduct their usual activities
- marked increase in manifestations in the presence of physical activity or walking
- the appearance in a complex with a headache of nausea (possibly — with vomiting)
Ophthalmoplegic migraine: symptoms
This kind of migraine is quite rare with the prevalent symptomatic of the defeat of eyeballs with one-sided paralysis. It is characterized by the development of a number of oculomotor disorders, which can be transient in their manifestations. They can arise at the peak of pain at a headache or at its very beginning, being concluded in the following conditions: strabismus, dilated pupil on the side of localization of painful manifestations, doubling, lowering of the upper eyelid on the side of pain manifestations, etc.
The majority of patients face the development of the disease when it alternates with seizures, in which a typical aura appears. Visual pathologies in this state with the appearance of the aura are reversible, that is, they disappear after a while.
Hemiplegic migraine: symptoms
Hemiplegic migraine is a relatively rare variety of the disease we are considering, its feature is the appearance of temporary and repeated weakness on one side of the body. The very term «hemiplegia» defines itself a muscle paralysis that affects one side of the body.
Hemiplegic migraine is predominantly noted in those patients whose parents also had a tendency to develop such seizures. Until the diagnosis is established in this variant of the disease, they are not based solely on actual attacks of muscle weakness, but it is sufficient to use computer tomography data for this.
Eyelid Migraine: Symptoms
Ocular migraine, which is also defined as ciliated scotoma or migraine with aura, is a disease whose symptoms are reduced to periodic disappearance within a particular visual field of the image. Ophthalmic migraine is noted in patients quite often, and although the name for the main term determining it indicates pain, in fact the disease in this form is not accompanied by it. Meanwhile, the variant of the combined course, that is, the combination of ophthalmic migraine with migraine, that occurs due to a violation in the brain of the circulation, is not excluded.
Defining the features of ocular migraine, it should be noted that it implies a neurological process, appearing in the form of a response to certain changes occurring in the body. In particular, such changes include changes in the hormonal background, changes related to the characteristics of the chemical composition of the consumed products, changes induced by the drugs used by the patient, etc.
As a result, there may be a headache, and it can last for several hours, or several days. Because of the impaired circulation in the brain-responsible areas of the brain (they are concentrated in the region of the occipital lobe), the eye migraine can subsequently develop.
Eyelid migraine, the symptoms of which, according to its name, consist in visual pathologies, can manifest itself in different ways. Mostly, an ophthalmic migraine appears from the scotoma (or the so-called «visual spot») of small sizes, centered in the center of the patient’s field of vision, in addition it can appear as zigzag lightning or scintillation within the blind spot. The stain, in turn, can increase in size, moving along the field of view. The duration of this phenomenon can be on the order of several minutes, but it mostly disappears after about an order of half an hour.
This type of migraine accounts for about a third of cases of the disease as a whole. It is noteworthy that in some cases, the symptoms typical for visual migraine are accompanied by the appearance of one-sided paresthesias (that is, sensations in which numbness occurs in a certain area of the body), speech disorders are also less often diagnosed. Numbness in particular can affect both half of the body and half of the face, the tongue, there is much less marked weakness in the limbs in a complex with speech disorders.
An important feature is that the appearance of neurological disorders, for example, on the right side (i.e., disorders in the form of the listed symptoms), indicates that the localization of the actual headache itself is concentrated from the opposite side, that is, to the left. If the localization is centered on the left side, then the pain, respectively, is felt on the right.
Only about 15% of cases localization of neurological disorders and headache is the same. After the completion of the aura, which in itself is the definition of a listed set of neurological symptoms that occur prior to migraine with accompanying pain or symptoms immediately at the beginning of a migraine, pain of a pulsating nature appears, centered within the frontal-temporal-ophthalmic region. Growth of such pain occurs within a half an hour and a half hours, which can be accompanied by nausea, and in some situations, and vomiting. The vegetative form of this condition is accompanied by the onset of fear and panic, shaking appears, breathing becomes more frequent. It is remarkable that any symptoms characteristic of migraine with the appearance of an aura are reversible, which was also previously noted by us.
It also happens that migraine leads to complications, one of them is a migraine status. It implies a series of fairly severe migraine attacks, which follow one another in a complex with multiple vomiting. The appearance of seizures occurs in intervals of about 4 hours. This condition requires in-patient treatment.
Migraine: symptoms in children
Headache in children is not uncommon, moreover, vigilant parents do not rule out the need for treatment for this reason to the doctor, which, however, does not always make it possible to find out the cause of this condition. Meanwhile, painful attacks, accompanied by a general malaise, in many cases mean nothing more than a migraine.
This disease is not accompanied by any specific objective data, because the temperature and pressure with it correspond in general to normal parameters, the analyzes also do not indicate the relevance for the small patient of any deviations. Actually, the examination of children in this case does not determine any specific changes concerning the work of individual systems and organs. Whatever the case, statistics on children indicate that up to 14 years, about 40% of them experienced a migraine, moreover, about 2/3 of them and at all inherited it from their parents.
The reason for the headache in children with migraines is that this condition is accompanied by an increased production of adrenaline (which, in fact, is also relevant for adults). This hormone, in turn, produces a narrowing of the brain vessels for a certain time (which, as we noted earlier, can be from several hours to several days), and the vessels in this case cease to react to the therapy acting in the form of certain medications, which in a significant way Complicates the matter. In particular, due to the narrowed lumen of blood vessels, the process of blood flow to the brain is significantly disturbed along with the delivery of the required nutrients to it.
Against the backdrop of such fasting, severe headaches appear. We also note that as a factor provoking such an attack with adrenaline, the nervous overstrain is determined, which, you will agree, is quite a frequent condition for children. It is noteworthy that the tension can be actual both for recreation (computer games, TV, etc.), and for enhanced learning with stress on the background of responsibility, with this training related. It should also be noted that migraine can lead to certain foods, as well as the already noted predisposition, inherited from the parents.
And if the hereditary predisposition is more or less clear, then the food products in this context require some attention, if a migraine appears against their background. This can be concluded in the elementary intolerance of certain foods, which in turn determines the need for a change in the diet, as well as in the appointment of an appropriate diet, aimed at preventing migraine on the basis of the nutritional impact factor. Let us outline the main symptoms accompanying migraines in children:
- headache (predominantly one-sided),
- nausea, in some cases — vomiting;
- hypersensitivity to light
- speech disorders
- Reduces the apparent field of view.
Cervical Migraine: Symptoms
When considering migraines, you can not miss this look. He has a number of names: this, in fact, and «cervical migraine,» and «sympathetic cervical syndrome (posterior),» and «vertebral artery syndrome.» Any of the above options can be used to diagnose a particular condition, but in any of its variants, in fact, it is about the same state.
Cervical migraine implies a state under which the inflow of blood to the brain is broken through the basin of one or two vertebral arteries at the same time. Let us dwell in more detail on the essence of this process.
Blood supply to the brain, as you probably know, is provided by two swimming pools. The first of these, the carotid basin, contains the carotid arteries. At their expense (or more precisely, at the expense of the main branches in the form of internal carotid arteries), up to 85% of the total influx to the brain of the blood is provided, as well as responsibility for various types of blood circulation disorders (primarily stroke ). It is the carotid arteries in particular paid attention during the examinations, and in particular it is given to their atherosclerotic lesions in combination with actual complications.
As for the second basin, it is a vertebrobasilar pool, to which the vertebral arteries (left and right side) belong. They provide blood supply to the posterior parts of the brain along with about 15-30% of the total blood supply to it. Defeat of this type, of course, with a lesion in stroke does not compare, but disability with it is not excluded.
When the arteries are affected, the following conditions are noted:
- severe headaches;
- visual and auditory disorders;
- coordination disorders;
- loss of consciousness.
As for the reasons that can provoke such a defeat, they can be divided into two groups:
- non-embryogenic lesions (i.e., lesions whose occurrence is not related to the spine) — lesions caused, as a rule, by atherosclerosis or anomalies of the congenital type, associated with the peculiarities of the arteries and their size;
- vertebrogenic lesions (respectively, lesions that occur against the backdrop of a pathology that is relevant to the spine) — here, in particular, it is a case of a spinal disease that acts as a predisposing factor. The traumatic character of this lesion is not excluded, which may be due to the general anamnesis of the adolescent age of the patient and the traumas that accompany this period, however, the changes of the most pronounced scale are noted to a greater extent in adults, which is correlated with the development of osteochondrosis.
The listed reasons initially irritate the sympathetic plexus in the vertebral arteries, leading to a spasm in the future, followed by compression of the arteries along the course of the bone channel or at the exit of the artery from it, which, in turn, leads to the development of circulatory disorders. The latter have a short-term character of manifestation and arise when the head tilts or its turns, as well as when the person changes the position of the body.
Pausing on the symptoms that are relevant for the state we are considering, we distinguish that the main one, as noted by us earlier, is a headache. It is constant in its manifestation and in some cases — increasing in the form of pronounced seizures. In some cases, this pain is burning or pulsating, it focuses on the occiput. The possibility of spreading the pain to other areas of the head is also not excluded (irrigation is often noted, that is, spread to the bridge of the nose and to the eye socket, etc.). Increased pain occurs with neck movements. Quite often, this symptomatology is also accompanied by soreness, noted in the scalp, which occurs even with a slight touch to it or during combing.
The head tilts and its turns are accompanied by a characteristic crunch, possibly burning. Also, some patients are confronted with a generally typical for migraine of any type of states in the form of nausea with possible vomiting, ringing in the ears, noise in them (often in combination with synchronous heartbeat). Lifting up the head is accompanied by dizziness, which occurs as a result of leaving the artery to the narrow part of the hole. In the version of the actual for a patient atherosclerosis in this case, dizziness appears as a result of tilting the head forward.
Specific, it is possible to say, symptomatology is the appearance of visual disturbances (in the form of the appearance of «flies» before the eyes, a decrease in the overall visual acuity, double vision and veils before the eyes, etc.). May decrease hearing. In some cases, the possibility of swallowing in combination with the appearance of a foreign object in the throat is also possible.
It is noteworthy that squeezing the vertebral artery often leads to paroxysmal conditions that arise as a result of turning the head. Thus, the turn of the head may be accompanied by the fall of the patient (it falls «as if it is knocked down»), and there is no loss of consciousness in this case, it can stand up independently. It is also possible, and such an option, in which a sharp head movement leads to a sudden fall, but already accompanied by a loss of consciousness. Man can come to himself in a period of 5 to 20 minutes, can stand up alone, but for a long time after that he experiences weakness. In addition to the above, vegetative disorders are possible, which may consist of feelings of hunger, chills, fever.
In a situation with a recurring headache, it is necessary to visit a doctor without fail. Diagnosis is made on the basis of clinical indicators based on the patient’s questioning and general examination. It is important to take into account that paroxysms of a migraine-relevant condition (that is, systematically recurring seizures) can act as the first symptom indicative of a brain tumor or vascular malformation (in particular this implies the possible relevance for the patient of developmental anomalies resulting in pronounced Changes in the functions of the vessels and in their structure).
Given the possible seriousness of the patient’s condition, a detailed examination is required, in which the organic process will be eliminated. In particular, you will need to visit an ophthalmologist to check the fundus, visual acuity and its field. It will also require electroencephalography, CT and MRI procedures.
Treatment of migraine
Treatment of this disease can be medicamentous and non-medicamentous. In the first case, the following preparations are meant:
- anti-inflammatory (non-steroid) drugs — in particular, such may include ibuprofen, paracetamol, etc.
- dihydroergotamine nasal sprays
- Selective agonists that stimulate the production of serotonin.
As for the second, non-pharmacological treatment option, it first of all consists of the need to provide the patient with peace and quiet, as well as a certain darkness of the room in which the patient is located, which is provided on the basis of an increased reaction to the impact of bright Lighting. Massage can be applied to the collar zone and head, as well as a massage of the ears. Certain results can be achieved through the use of acupuncture, as well as cold or warm bandages used for the head.
As a rule, patients are guided in circumstances, knowing what exactly can lead to migraine, respectively, this requires them to independently exclude such circumstances and provoking factors in them. In addition, water procedures (therapeutic baths) and exercise therapy are available, aimed at maintaining the general tone and the corresponding effect on the cervical spine. An additional measure in the treatment of migraine is a diet with the exclusion of products that provoke her attacks (within the framework of the general description of the disease we have considered this point above). If possible, stress should be avoided — they also play an important role in the context of considering the causes of migraine.
By the way, an important way to affect migraine as part of its treatment (elimination) is sleep. So, if a patient can fall asleep in a migraine state, then as a rule, if he wakes up, if he does not completely disappear the headache, then a significant improvement in the overall condition and intensity of pain. This method is relevant for light and infrequent migraine appearances.
If there is a symptomatology peculiar to migraine, you need to turn to a neurologist, and also need an ophthalmologist’s advice.