Migraine Headache

Migraine Headache: Introduction,Clinical Features, Trigger factors,Diagnosis,management and Prophylaxis

Introduction:

Migraine is the 2nd most common cause of headache affecting 15% of women and 6 % of men worldwide. It is an episodic headache associated with certain features like sensitivity to light light, sound or movement . Nausea vomiting often accompany the headache.

Triggers for Migraine Headache:

Hormonal Changes:- Changes during menses, pregnancy, menopause, and effect of OCP
Changes in daily schedule:- over sleeping, inadequate sleep, skipping meal and a rest after a hectic schedule.
Weather:- Rapidly rising barometric pressure, rise in pressure, temperature and humidity
Foods:- food rich in tyramin like aged cheese, chocolate,banana, soya sauce and citrus fruits
Environmental triggers like cigarette smoke, perfumes, petrol and fresh paint

Migraine Headache

Pathogenesis of Migraine ( PDF format)

Variants Of Migraine:

  1. Hemiplegic migraine-  weakness which is usually reversible
  2. Basilar Migraine- dizziness,ataxia,tinnitus, vomiting
  3. Retinal Migraine- recurrent attack of unilateral visual disturbances
  4. Complicated Migraine- chronic migraine and status migraines.
  5. Ophthalmoplegic Migraine- Associated with periorbital pain, diplopia sec to cranial neuropathies.

Symptoms:-

  • Nausea
  • Lightheadedness
  • Vomiting
  • Vertigo
  • Seizure
  • Diarrhoea
  • Photophobia
  • Scalp tenderness
  • Visual disturbances
  • Syncope
  • Confusion

Diagnosis:

Diagnosis is Clinical, No investigations are mandatory.

Diagnostic Criteria for Migraine:-

Repeated attacks of Headache lasting 4-72 hours in patient with normal physical examination and no other reasonable cause for headache, and

Atleast 2 of the following features:

  • Unilateral pain
  • Throbbing pain
  • Aggravated by movements
  • Moderate to severe intensity

Plus Atleast 1 of the following features:

  • Nausea/ Vomiting
  • Photophobia or Phonophobia

Management Of Migraine Headache:-

MIDAS ( Migraine Disability Assessment Score) is a well validated tool , on the basis of which Migraine is Graded from I to IV

General Measures Against Migraine:

  1. Identify and Avoid Trigger factors
  2. Regular exercise and healthy diet
  3. Regular sleep pattern, avoid alcohol
  4. Yoga .

Medical Management:

Judicious use of 1 or more drug is the mainstay of treatment:

  • Mild cases- Oral agents
  • Sever cases- Parental therapy
  1. NSAIDS- decrease both severity + Duration. Naproxen, Ibuprofen are good enough
  2. 5 HT1 agonists- Sumatriptan, Naratriptan,
  3. Parental Inj Dihydroergotamine + Sumatriptan is FDA approved therapy
  4. Dopamine Antagonists:- Metoclopramide, Prochlorperazine are used as adjunctive therapy

Other Agents are:

  1. Nasal BUTHORPHANOL
  2. Oral Acetaminophen + Dichloralphenazone+ Isomethaptene
  3. Parental Meperidine ( 50-100 mg )

Prophylaxis therapy In Migraine headache:

According to the British Assocaiation for Study of Headache, Prophylaxis are required when any of:-

  1. Frequent disabling attacks > 2 per month inspite of Acute therapy
  2. Failure of acute Therapy
  3. Hemiplegic migraine, Basilar Migraine
  4. Very high attack frequency( >2/week)
  5. Progressively worsening attack.
  6. Patients Request

Calcium Channel Blocker – FLUNARIZINE  5-10 mg reduces the frequency by 50-75%. Women require lower doses.

NSAIDS- NAPROXEN
Beta Blockers- PROPONALOL
TCA
Botulinum Toxin

Read about http://www.merckmedicus.com/pp/us/hcp/diseasemodules/migraine/pathophysiology_sub.jsp

Simplified: http://www.mayoclinic.com/health/migraine-headache/DS00120

SOURCE: Lecture notes from Harrison, Davidson and ache.org

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About the Author

Administrator
Doctor Medchrome writes for and looks overall management of Medical Online Magazine.

3 Comments on "Migraine Headache"

  1. i have common headaches and up until now i still cannot tell the reason for it. even the doctors i believe cannot tell outright if it is stress headache, migraine, sinus, eye-strain…or whatever else.

    i just try to do whatever i think i should to avoid recurrence. but well, it still comes.

  2. Sleep deprivation is linked to migranes. Treatments that reduce stress are beneficial in preventing migraines, and certain essential oils such as lavender, rosemary and eucalyptus are promoted for relaxation. Snoring is also one of the reason for sleep deprivation. There are many problems that can be the result of having Snoring. Snoring is a very common sleep issue that keeps a lot of people from getting the proper rest they need. A lack of sleep can be problematic, leaving you feel tired and sluggish all day.

  3. Great resource for migrain headache. very informative and many benefits in it.

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