Migraine headache

 

Q. 1.  The definition of migraine ?? What is migraine??  Ans: The term    migraine describes   periodic    hemicranias   throbbing headaches   that are often   accompanied by   nausea and vomiting. 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

 

 

 

Q.2: What are the different types of migraine??  There are four   types of    migraine   headache .

A)               Familial migraine : The common   migraine  is often    familial and   it is characterized    by a usually  unilateral headache  , nausea and  vomiting   and scalp    tenderness   of several hours     duration.

B)             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 . C) Basilar migraine includes  vertigo , dysarthria and diplopia. Complicated migraine includes more severe   transient neurological symptoms and thus may mimic an ischemic event.

C)              Childhood migraine: - Migraine which  begin childhood , adolescence or  young adulthood  but fortunately  tend to   diminish   both  in frequency  of recurrence   as well as   severity   with advancing     years .

 

Q.3 What is the prevalence?? Ans: Investigators have reported that 18 percent   of women   and   6 percent    of men suffer from migraine   headache   at some time. Such     headaches are migraine    headaches    at some time.

Q.4: Any relation with hormonal changes?? Ans: Uncertain. Some headaches are especially     common in young    women and several studies have indicated   an as yet unclear    relationship     between hormone   levels and migraine.

Q.5: A full neurological work up is warranted. Because migraine    is frequently   a diagnosis of   exclusion the initial attack should prompt   a full neurological workup to rule out other more serious pathology .

Q.5 : What the etiology?? The exact pathophysiology   is uncertain   but prodromal neurological symptoms   are believed    to be caused  by cerebral artery  vasoconstriction and  decreased blood flow . Presumably vasodilation follows   and is responsible   for the headache.

Serotonin has been   implicated   in this mechanism . In Q.6: Life risk ?? Ans  Some  cases migraines   are associated   with stroke . Researchers have shown  a   three to six fold   increase in ischemic stroke  in young  women   with migraines although the   absolute risk  is  small from 10 to 20   per 100,000 . Migrainous who   smoked   or used oral contraceptive however   were particularly vulnerable and had  a  10 to 14 fold   increased risk.

Q.7: Drug treatement :--For acute attack: Paraceatmol tablet  & 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-to 40mg OD ,However

B – blocker     may be used   in resistant  cases  without   contraindications.  For acute attack: Paraceatmol tablet  & 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 For acute attack:

 

 

Q 8:  Migraine in pregancy :- Pre  existing migraine often   improve  in pregnancy For acute attack: Paraceatmol tablet  & Inj Reglan( Meto­clopramide  2) Other antiemetic –cyclizine 3) Codeine Po4 all are  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)  B blockers  may be added selectively at the dose of  10-40 mg TDS if no bronchial asthma.

If all these seven agents are ineffective then  in preventing headache and migraine   in pregnancy  then  tricyclic antidepressants   such as  amitriptyline,   calcium antagonists  or cyproheptadine    may prove  useful   and are safe  for use in pregnancy. Greater   occipital Those   with    nerve injection   has been used successfully   in pregnancy for chronic migraine.

  

Q.9: Questions for resistant cases :--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.

Valproate and   Topiramate   useful outside   pregnancy   should be avoided. Gabapentin seems safer    based on limited data.

 

Q.10 Which Contraception will be safe??

Women   with classical    migraine should   not take oestrogen containing oral contraceptives.

Migraine and headache- points  to remember

That these    can occur as   a pregnancy   related phenomenon in women without prior  history     of migraine.

 

Q. 11: Special points :-A) - Hemiplegic   migraine    particularly   aura without headache   may mimic TIAs  

B) Ergotamine should be  avoided   in pregnancy

C) Low  dose   aspirin   , B- blockers, tricyclic  antidepressants   and pizotifen may be used  for prophylaxis.

Pathogenesis