Migraine

Migraine: What is it, Causes, Symptoms and Treatment

Migraine is a neurological disorder that manifests itself in a severe headache. It is an extremely disabling disease and can be accompanied by vomiting, intolerance to light and sound, etc.

According to the WHO, migraine is the 8th most disabling disease of humanity in capacity days for years lived.

What is a migraine?

The migraine is a neurological disorder that manifests itself in a severe or severe headache, which makes it an extremely disabling disease for people who suffer.

It affects the front or the entire skull area and comes in the form of crisis or attacks. It may be accompanied by other symptoms.

These crises can appear in the following way:

Episodic

When the pain appears up to 9 days a month, we will talk about a rare episodic crisis;
or very frequent episodic if there is pain between 10 and 14 a month.

Chronicle

When there are 15 or more crisis days per month.

TYPES OF MIGRAINE

Migraine without Aura

It causes very strong pain, so it interferes with normal activity, and its main symptoms are:

• Pain on one side of the head, although in some cases it can spread throughout the head.
• In some cases, it is throbbing pain (heartbeat felt).
• Less frequently, pain can occur in the neck or jaw.
• The pain appears spontaneously and usually lasts more than 4 hours and less than 3 days. In children and adolescents, the attacks can last less than 4 hours.
• Physical activity and head movement make pain worse.
• It can cause intolerance to light (photophobia), sounds (phonophobia) and odors (osmophobia). Also, nausea and vomiting.

Migraine without aura is the most common form of migraine

Migraine with Aura

It is distinguished from migraine without aura by the appearance of other symptoms (aura), which can affect different senses: sight, touch and / or language. These symptoms are often pre-pain and, less frequently, may appear during or after pain.

Types of aura:

Visual aura

• Luminous flashes appear in the center of the field of view, shifting zig-zag to one side.
• It is the most frequent.

Sensory aura

• It usually begins with tingling at the tips of the fingers of one hand, rising to the shoulder, and finally manifesting at the corner of the mouth and tongue.
• It is the second most frequent.

Aura of language

• It causes difficulty in understanding the language and / or in articulating words.
• It usually appears together with visual or sensory symptoms.
• It is rare.

Other less frequent types of aura

• Retinal aura: equal to the visual aura, but with only one eye involvement.
• Brain stem aura: Characterized by visual, sensory, or language symptoms.
• Motor aura: causes temporary partial or total paralysis of one side of the body and an alteration of consciousness, which can last for 24 hours. It can occur alongside other types of aura.

Migraine with aura affects between 15 and 30% of people with migraines

Menstrual Migraine

It is related to the sharp drop in estrogen levels, which usually occurs just before menstruation.
It usually starts with the first period, but can improve or disappear during pregnancy or menopause. However, hormonal treatments (birth control pill / hormone substitutes) can make it worse.

There are two types of menstrual migraines:

• Pure menstrual migraine: migraine attacks that occur during day 1 of bleeding ± 2 days.
• Related Migraine: Pure menstrual migraine that can coexist with migraine episodes at other times in the cycle.

MIGRAINE SYMPTOMS

The pain…

• Sharp, deep, and throbbing, like they’re hitting the head. It only affects half of the head. In some cases, it can appear on the front or in the entire cranial area
• Gradual, since it starts slightly and increases as the hours go by
• Light, noise, and movement often make pain worse
• The same pain, can last from hours to 2 or 3 days

It can also provoke you…

• Tearing
• Hypersensitivity to odors
• Nasal congestion and / or discharge
• Nausea or vomiting
• Light intolerance (photophobia)
• Phobia of loud noises (phonophobia)

CAUSES OF MIGRAINE

The origin of migraine is a combination of environmental and genetic factors. Some families are especially prone to it and genetics influences the type of migraine that affected people suffer.

Common Genetic Variants

Scientific studies have identified different genetic variants very important in the multiplication of migraines in the same family. For example, three Mendelian genes associated with hemiplegic migraine (a severe form of migraine) and, most importantly, polygenic inheritance, involving the intervention of a group of specific genes with different versions (alleles), which interact with each other to provoke the manifestation of this disease.

In addition to genetic factors, these factors can also lead to a crisis:

• Psychological: stress, anxiety and depression.
• Bad sleep habits: sleep a lot or little.
• Dehydration: it is important to drink enough water to stay hydrated, since dehydration can trigger migraine episodes.
• Hormonal: menstruation or ovulation.
• Diet:
  • For Bad dietary habits such as excess alcohol or caffeine, foods with nitrites, aspartame and monosodium glutamate.
  • Skipping meals, feeling hungry, having low blood sugar levels, etc.
• Pharmacological: nitroglycerin, estrogens, pain relievers…
• Sudden changes in physical activity.
• Headache or cervical pain, of another origin.
• Changes in the environment : seasonal or weather changes, changes in atmospheric pressure…
• Sensory stimuli:
  • Visual stress from sunlight, prolonged exposure to the computer screen, or other strong or flashing lights.
  • Strong odors, such as perfume, incense, cleaning products, tobacco smoke, or pollution.
  • Loud and / or constant noises.

DIAGNOSIS OF MIGRAINE

There is no specific test to diagnose this pathology. To confirm if you have a migraine,
your neurologist in Delhi will analyze your medical history (anamnesis):

1. Area and type of pain
2. Presence of other symptoms such as nausea or vomiting, light discomfort, sounds, odors, etc.
3. Onset, frequency and duration of pain
4. Family history of migraine

Additionally,…

• To rule out other diseases, you can have a general physical exam and a neurological exam.
• For the diagnosis of migraine with a visual or retinal aura, an ophthalmological evaluation may be necessary to rule out possible eye diseases.
• For the diagnosis of menstrual migraine, it is recommended to complete a pain recording calendar for 3 consecutive menstrual cycles. You should write down the start and end days of the period and the days with pain in that period.
• Additional diagnostic tests may be necessary, depending on your medical history.

MIGRAINE TREATMENT IN DELHI

The migraine is a chronic disease that will accompany life at different times. Although it does not carry a risk of death, in some cases it can cause disability.

There is no curative treatment, but it is a manageable disease. Your neurologist in Delhi will indicate the most appropriate way to control the disease and improve your quality of life.

The success of migraine treatment in Delhi is measured by reducing the frequency or severity of pain. There are two types of treatments:

In episodes of acute pain, your doctor will prescribe analgesic treatment to stop the symptoms, with medications such as…

• Analgesics. Its effect is very limited in adults, they are only recommended in children and adolescents.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), to treat mild or moderate migraine attacks.
• Triptans. Mainly used to treat moderate and severe migraine, and for those patients who have a mild crisis and do not tolerate or respond to NSAIDs.
• Antiemetics. They are mainly used to control nausea and vomiting due to migraine.

To prevent its occurrence and reduce the intensity of the pain will recommend starting at preventive treatment tried. It is indicated when migraine attacks are very frequent and intense, and when analgesic treatment has no effect:

• Beta blockers. Indicated for migraine with aura, caused by hypertension and pregnancy.
• Calcium antagonists. To prevent migraine with or without aura and for people who reject beta-blockers.
• Antidepressants. When there is depression and / or anxiety.
• Antihypertensive. To treat migraine due to high blood pressure and when the patient does not tolerate beta-blockers.
• Neuromodulators. They are used when migraine is related to overweight and epilepsy. Also, to treat migraine without and with aura, and chronic migraine.
• Botulinum Toxin A. As a preventive method for chronic migraine cases.
• Human monoclonal antibodies. New group of drugs that are administered monthly as a subcutaneous injection for migraine cases in adults with at least 4 migraine days per month.

In addition to these migraine treatments in Delhi, new drugs are being investigated with encouraging results for some patients. Complementary therapies may also be helpful.