| ID | 106 |
|---|---|
| Name | MIGRAINE |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | Management: General management- 1. Precipitating factors should be identified and removed or avoided. 2. Oral contraceptives (if any) should be stopped in female, if the attacks are frequent. 3. Reassurance & relief of anxiety 4. During acute attacks, keep the patient in a quiet, drakened room until the symptoms subside. Drug treatment- 1. Treatment of acute attacks- a. Simple analgesia with soluble aspirin 600-900mg, or paracetamol Igm stat and 2-3 times daily, b. Antiemetic, such as metochlopramide 10mg, or prochlorperazine 5-10mg stat and 3 times daily. 2. Treatment of recurrent severe attacks- a. Sumatriptan (a 5-HT agonist, potent vasoconstrictor of the extracranial arteries)- by s.c injection, 6mg as soon as possible after onset; if migraine recurs, second dose may be given after not less than 1 hour; max. 2 injections (12mg) in 24 hours; if patient does not respond, second dose should not be given in the same attack. By mouth, 50mg as soon as possible after onset; may be repeated if migraine recurs; max. 300mg in 24 hours; if no response, dose should not be repeated in the same attack.21 Or, b. Ergotamine tartrate 0.5-lmg sublingually or rectally stat and repeat if necessary. It should be taken as soon as visual/sensory symptoms develop. Or, Ergotamine tartrate 0.25mg i.m stat. Or, Ergotamine tartrate 360mgm by inhalation also helpful. 3. Prevention of migraine- When migraine attacks occur so frequently, that daily work and social life is disrupted, preventive measures should be taken. Useful agents aife-a. Pizotifen 0.5mg at night for several days, may be increased upto l.5mg at night. Or, b. Propranolol 10mg 3 times daily, increasing upto 40-80mg 3 times daily. Or, c. Amitriptyline 10-50mg at night. d. Topiramate 25 to 50mg twice daily for months or as required, e. Methysergide (a 5-HT antagonist) 2-6mg per day for month |
| Introduction | Migraine is characterised by episodic headaches which are typically unilateral and are often associated with visual disturbance and vomiting. Common in female rather than in male; (male-female ratio 1:2). |
| History | |
| Etiology | Etiology: The condition is believed to be due to a disturbance in the carotid or vertebro-basilar vascular tree (an initial phase of vasoconstriction causes symptoms and is followed by vasodilatation). Precipitating factors are- anxiety, overwork, emotional upsets, menopause, hypertension, cerebral tumour, premenstrual tension, fasting state, contraceptive pills, chocolate, cheese, alcohol etc. |
| Clinical Features | Clinical features: Age: Young adults, usually starts after puberty and continue until late middle life. Sex: Common in females. Temperament: Obsessional. Family history: Is positive. Attacks occur at an interval which vary from few days to several months and last for hours to days. The symptoms are divided into- 1. Premonitory symptoms: some patients compla-int of zig-zag lines, flashing colured light or defects in the’visual field but others complaint of dysphagia, hemiparesis or hemi-anaesthesias in association with headache. 2. Headache: the headache is usually localised to the frontal region and spread to affect the whole of one side of the head but may become generalized. Pain is severe and throbbing, may be associated with vomiting, photophobia, pallor and prostration. |
| Preventions | |
| Treatment | |
| Complications | |
| Prognosis | |
| Types | Types of migraine: 1. Classical migraine (migraine with aura)- migraine having a triad of paroxysmal headache, vomiting and focal neurological events, (usually visual) are designated as classical migraine. In this, prodromal symptoms are usually visual & consist of field defects, visual hallucinations, such as stars, sparks, unformed light flashes, geometric patterns or zigzags of light. Other focal disturbances may be numbness, tingling, clumsiness, weakness, aphasia etc. 2. Common migraine- paroxysmal headache, with or without vomiting & photophobia only, but no neurological focal events. 3. Hemiplegic migraine- prolonged headache followed by hemiparesis. 4. Basilar- migraine- occipital headache preceded by vertigo, diplopia, dysarthria with or without visual and sensory symptoms. 5. Cluster headache (migrations neuralgia)- affects mostly male- bouts of severe pain around one eye with associated epiphora & nasal congestion. |
| Classification | |
| Observation | |
| Pathology |
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