1.
The
term migraine describes periodic
hemicranial throbbing headaches
that are often accompanied by nausea and vomiting . There are four types of
migraine headache . common migraine
is often familial and it is characterized by a usually
unilateral headache , nausea
and vomiting and scalp
tenderness of several hours duration. Classical migraine
has similar symptoms
but is preceded by premonitory neurological phenomena such as visual scotoma or hallucinations . this type of
migraine can sometimes be averted if medication
is taken at the first
premonitory sign . Basilar
migraine includes vertigo dysarthria and
diplopia. Complicated migrane
2.
For
acute attack: PC & Inj Reglan( Metoclopramide
2) Other antiemetic –cyclizine 3)Codeine
Po4 is safe in pregancy 4)For acute attacks short courses of NSAIDs may be
used 5) No ergotamine 7) Prophylaxis is by ecosprin
75 mg OD 8) Propanol 10-=40mg OD
3.
B
– blocker may be used in resistant
cases without contraindications. These work in > 80 % of patients.
4.
If both
aspirin and B blockers are
ineffective in preventing headache and migraine in pregnancy
then tricyclic antidepressants such as
amitriptyline calcium
antagonists or cyprobeptadine may prove
useful and are safe for use in pregnancy.
5.
Greater
occipital nerve injection has been used successfully in pregnancy for chronic migraine.
6.
There
are few data regarding pizotifen
a serotonin antagonist used for
prevention of migraine outside pregnancy , but its use is justified after the
first trimester if first and second
line prophylactic agents are not
effective.
7.
Valproate
and Topiramate useful outside pregnancy
should be avoided. Gabapentin seems safer based on limited data.
8.
Contraception
9.
Women
with classical migraine should not take oestrogen containing
oral contraceptives .
10.
Migraine and headache-
points to remember
11.
Migraine can occur as
a pregnancy related phenomenon
in women without prior history
of migraine.
12.
Those with pre
existing migraine often
improve in pregnancy
13.
Hemiplegic migraine
particularly aura without headache
may mimic TIAs
14.
Ergotamine
should be avoided in pregnancy
15.
Low dose
aspirin , B- blockers,
tricyclic antidepressants and pizotifen may be used for prophylaxis.
Pathogenesis
Tension
headaches are thought to be due to muscle contraction
and are often related to periods of stress.
Migraine is thought
to be a primary neurovascular
disorders with an important inflammatory component
. Pathogenesis involves vasodilating of cerebral blood
vessels possibly related
to platelet aggregation and
serotonin release with stimulation of nociceptors.
Migraine may be precipitated by
-
Certain
dietary factors
-
Premenstruation
-
Oral contraceptive pill
-
Stress
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