Migraine

By Muzamil
 The two most common types are migraine with
aura and migraine without aura. Less common
   
types include

Abdominal, Basilar, Cyclic, Hemiplegic,

Nocturnal & Ophthalmologic

Types
No specific
single cause

Loss Of MIGRAINE
Appetite Symptoms Causes

Neck Pain

Headache
Diagnoses
Nausea

Medication Treatment
Abdominal Pain

Cardiovascular Bleeding

Antidepressant Ulcers
Complication
Anti-Seizure

Cyproheptadine

Prevention

Prognosis
 Migraine Headache
Migraine is a neurological syndrome characterized by altered bodily perceptions, headaches,
and nausea. Etymologically, the French word migraine & British word meegrain derives from
the Greek hemicrania (half skull) and the Old English megrim (severe headache).

Migraine: Usually, periodic attacks of headaches on one or both sides of the head. These may be
accompanied by nausea, vomiting, increased sensitivity of the eyes to light (photophobia),
increased sensitivity to sound (phonophobia), dizziness, blurred vision, cognitive disturbances,
and other symptoms. Vasodilation in the brain causes inflammation that results in pain but the
exact cause of migraine is unknown.

Explanation
Migraines affect approximately 28 million people in the United States, roughly 75 percent of
them women. The headaches typically begin in adolescence or early adulthood, but onset may be
earlier or later in some cases. There is clustering in families, suggesting a genetic component.

The word 'migraine' to most people and they will immediately think 'headache'. But headache is
just one of a range of symptoms that characterize migraine, which is a neurological condition.
Migraine pain is caused by vasodilation in the cranial blood vessels (expansion of the blood
vessels), while headache pain is caused by vasoconstriction (narrowing of the blood vessels).
During a migraine attack, the temporal artery enlarges. (The temporal artery is an artery that lies
on the outside of the skull just under the skin of the temple.) Enlargement of the temporal artery
stretches the nerves that coil around the artery and cause the nerves to release chemicals. The
chemicals cause inflammation, pain, and further enlargement of the artery. The increasing
enlargement of the artery magnifies the pain.
Migraine is the second most common type of headache syndrome in the United States. Tension
headaches are the most common. Migraines most commonly are found in women, with a 3:1
female-to-male ratio. In childhood, however, migraines are more common in boys than in girls.
More than 80% of patients who develop migraines will have a first attack by age 30. Migraines
continue through the patient's 30s and 40s. Less than half of all migraine sufferers.

Types of Migraine
Migraines are classified according to the symptoms they produce. The two most common types
are migraine with aura and migraine without aura. Less common types include the following:

Types of Migraine

Abdominal Cyclic Nocturnal

Basilar Hemiplegic Ophthalmologic

Migraine With Aura is characterized by a

neurological phenomenon (aura) that is
experienced 10 to 30 minutes before the
headache. Which was previously called classic
migraines. When you're experiencing an aura,
you may:

 Flashing lights

 Zigzag patterns that move in front of your

eyes

 Heat waves that move across your field of

vision
Migraines Without Auras

Most people experience migraines without auras, which were previously called common
migraines. Whether or not you have auras, you may:

 Photophobia

 Nausea

 Vomiting

 Fatigue

 Mood swings.

Abdominal migraine

Abdominal migraine is most common in children with a family history of migraine. Symptoms
include abdominal pain without a gastrointestinal cause (may last up to 72 hours), nausea,
vomiting, and flushing or paleness (pallor). Children who have abdominal migraine often
develop typical migraine as they age.

Basilar Artery Migraine

Basilar artery migraine involves a disturbance of the basilar artery in the brainstem. Symptoms
include severe headache, vertigo, double vision, slurred speech, and poor muscle coordination.
This type occurs primarily in young people.

Cyclic Migraine Syndrome

Patients with cyclic migraine usually experience ten or more attacks per month. These headaches
differ from cluster in that they are long lasting and do not have associated typical cluster
symptoms. Patients do have typical migraine symptoms during these headaches.

Hemiplegic Migraine
This is a very rare form of migraine that is considered to be one of the more severe types of
migraine. The sufferer may develop some temporary motor paralysis and/or sensory disturbances
on one side of the body, immediately followed by the headache. This may be accompanied by
numbness or a pins-and-needles sensation. The neurological symptoms usually leave when the
headache appears.

Nocturnal Migraine
Many patients who have migraine will experience their attacks during the middle of the night or
early morning hours. This headache often awakens the patient from sleep.

Ophthalmoplegic Migraine
Ophthalmoplegic migraine is a rare condition considered to be an unusual form of migraine. The
pain usually surrounds the eyeball and lasts from a few days to a few months, caused by
weakness of the muscles surrounding the eye.

Symptoms of Migraine
A typical migraine attack produces some or all of these signs
and symptoms:

 Moderate to severe pain, which may be confined to one

side of the head or may affect both sides

 Head pain

 Loss of appetite

 Pain that worsens with physical activity

 Pain that interferes with your regular activities

 Nausea with or without vomiting

 Sensitivity to light and sound

When left untreated, a migraine typically lasts from four to 72 hours, but the frequency with
which headaches occur varies from person to person.

Diagnosis
Diagnosis of migraine is based on the history of symptoms, physical examination, and
neurological tests. The tests are performed to rule out other neurological and cerebrovascular
conditions, including the following:

 Bleeding within the skull (intracranial hemorrhage)

 Blood clot within the membrane that covers the brain (cerebral venous sinus thrombosis)
 Cerebral stroke (infarct)
 Dilated blood vessel in the brain (cerebral aneurysm)
  Excess cerebrospinal fluid in the brain (hydrocephalus)
 Inflammation of the membranes of the brain or spinal cord (meningitis)
 Low level of cerebral spinal fluid (CSF)
 Nasal sinus blockage
 Tumor

Lab Test
Computed Tomography (CT scan)

CT scan is performed to rule out an underlying brain

abnormality when migraines are new or when there is
a change in their character or frequency. CT scan
involves injecting contrast dye and then taking a
series of x-rays.

Electroencephalography (EEG)

EEG records electrical signal within the brain using

electrodes placed on the scalp. This test is used to detect
malfunctions in brain activity.

Spinal tap (Lumbar Puncture)

Lumbar puncture is performed to detect infection and determine

levels of white blood cells, glucose, and protein in the
cerebrospinal fluid. This test involves withdrawing a small
amount of fluid and examining it under a microscope.

Magnetic resonance imaging (MRI scan)

MRI scan may be performed for a more complete evaluation.

MRI produces clear images of the brain using electromagnetic
energy. A MRI scan may be recommended if you are getting daily
or almost daily headaches. MRI may also be recommended if a CT
scan does not show definitive results. In addition, a MRI scan is
used to evaluate certain parts of the brain that are not as easily
viewed with CT scans, such as the spine at the level of the neck
and the back portion of the brain.

Magnetic Resonance Angiography (MRA)

MRA produces images of blood vessels in the brain and is used to detect aneurysms and other
vascular abnormalities.

Causes Of Migraine
Migraine is believed to be caused by changes in the neurotransmitters and blood vessels in the
brain but exactly what causes these changes is still a subject for research and debate. However
certain factors have been identified which can trigger attacks in susceptible people:

 Hormonal changes: A fluctuation in estrogen levels may initiate a migraine attack.

Many women complain that their migraine symptoms worsen before or during their
menstrual periods, during pregnancy and menopause, and while taking hormonal
medication.
 Foods: Migraines may be triggered by the consumption of chocolate, alcohol, cheese,
caffeine-rich drinks, monosodium glutamate (MSG) and aspartame.
 Sensations: Bright and flashing lights, sun glare, and unusual smells have also been
known to initiate a migraine.
 Other: Stress, changes in the sleep pattern or the environment, fasting, and physical
exertion are all believed to be migraine triggers for different people.

Other disorders associated with migraine:

There are connections between migraine and other

conditions

Painful conditions like migraine and arthritis could

increase a patient's anxiety about the pain, or panic
attacks may be mistaken for asthma attacks...
Physicians are becoming more aware of the
importance of recognizing and treating
depression...

Major depressive disorder affects 17 percent of the

general population while it affects 47 percent of
migraineurs. We recently learned that people with
bipolar disorder have a significantly higher
prevalence of migraine when compared to the
general population.

In this view, cortical spreading depression, caused by hypersensitive neurons in the cortex,
induces both aura and pain. In patients without aura, a wave of neuronal hyperexcitability
resembling cortical spreading depression might take place in subcortical regions.
 1. Cortical spreading depression is triggered by neurons prone to hyperexcitability.
2. Those neurons release substances that activate trigeminal nerves, which send pain signals
to the trigeminal nucleus in the brain stem.
3. The trigeminal nucleus conveys the signals to the thalamus, which relays them to the
sensory cortex, involved in the sensation of pain.

Risk Factors
 Family history: Migraines are more common in people with a family history of
migraines.
 Sex: Women are three times as likely to have migraines as men are.
 Hormonal changes in women: Migraine may worsen or change during menstruation,
pregnancy or menopause.

Treatments of Migraine
These treatments are used to reduce the frequency of migraine
headache attacks

 Cardiovascular Drug Treatments: Cardiovascular

drugs such as beta blockers are generally used in the
management of high blood pressure and coronary artery
disease. However, these have been shown to be
beneficial in reducing the frequency and severity of
migraines as well.
 Antidepressant Treatments: Certain antidepressants, commonly known as tricyclics,
are useful in preventing all types of headaches, including migraines, by influencing t he
levels of serotonin and other chemicals in the brain.
 Anti-Seizure Drug Treatments: Some anti-epilepsy drugs, such as divalproex sodium
and topiramate, which are used to treat epilepsy and bipolar disease, are known to prevent
migraines.
 Cyproheptadine: This drug may be used in children. It functions by altering serotonin
levels in the brain.

Nutritional Treatments for Migraines

 Food Exclusion Diet: A food exclusion diet can help in identifying and avoiding your
migraine triggers. The most common being chocolate, cheese, red wine, caffeine and
citrus fruits.
  B Vitamins: Vitamin B2 and Vitamin B12 have both shown to be helpful in reducing the
frequency and severity of migraine attacks.
 Fish Oils: People who suffer from recurring or frequent migraines may be benefit from
increasing intake of oily fish or a fish oil supplement.

Complications
Sometimes your efforts to control your pain cause problems. Nonsteroidal anti-inflammatory
drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and aspirin, may cause

 Abdominal pain
 Bleeding
 Ulcers

Especially if taken in large doses or for a long period of time.

Prevention
Understanding the headache triggers can help a person avoid foods and situations that cause
migraines. Keep a headache diary to help identify the source or trigger of the symptoms. Then
modify the environment or habits to avoid future headaches.

Other tips for preventing migraines include:

 Avoid smoking
 Avoid alcohol
 Avoid artificial sweeteners and other known food-related
triggers
 Get regular exercise
 Get plenty of sleep each night
 Massage the back of your neck or ask a
friend or relative to massage your neck
and shoulders.
 Apply gentle pressure to the painful area
using your thumb and forefingers. Push for about 10 seconds and then release.
Prognosis
Migraine headaches in adolescents have a favorable long-term prognosis. Familial disposition for
migraine predicted a poorer outcome, especially in subjects with migraine without aura. Migraine
is a chronic disorder with episodic attacks with a highly variable long-term prognosis. In many,
migraine may have a very benign (complete remission) or relatively benign (partial remission)
prognosis.

A recent population study showed that, over a 1-year period, 84% of the patients with migraine
persisted with this diagnosis (migraine persistence); around 10% had 1-year complete clinical
remission, and 3% had partial remission; the other 3% developed chronic migraine.

References
http://www.mayoclinic.com/

http://www.wikipedia.org/

o http://www.medicinenet.com/migraine_headache/article.htm
o http://www.migraineissues.com/ms/guides/what_is_migraine/main.html
o http://www.health-info-network.com/migraines.html
o http://en.wikipedia.org/wiki/Migraine
o http://www.streetdirectory.com/travel_guide/109760/headaches/what_is_migraine_.h
tml
o http://www.internethealthlibrary.com/Health-problems/Migraine.htm
o http://www.mayoclinic.com/health/migraine-headache/DS00120/DSECTION
o http://www.familyhealthguide.co.uk/migraine-headache/treatment.html
o /www.neurologychannel http:/.com/migraine/diagnosis.shtml
o http://www.sciam.com/article.cfm?id=the-root-of-migraine-pain
o http://headaches.about.com/od/comorbidconditions/a/AnxietyMx.htm