Migraine - Medtick
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Migraine

Migraine is understood to be of condition which is an inherited, chronic neurologic disease with recurrent episodic attacks. As with many chronic diseases, prevention is key to migraine management.

Migraine is classified as episodic (up to 14 headache days per month) or chronic (15 or more headache days per month).

(If migraine/headaches are less than 10 days a month, it can be treated over the counter)

  • Chemicals in the brain called Serotonin or 5HT level drops causing blood vessels in brain narrows and then widens (because inflamed, hot, red and swollen) just before an attack.
  • The reasons are unknown but there could be certain triggers that cause it.

Areas of headache and causes:

  • Back of head – Poor posture
  • Temples – Poor eyesight, allergy, hay fever
  • Forehead– sinuses, allergy, hay fever, ill-fitting bra.
  • Side of head-cluster headache
  • Throbbing all over– Painkiller medication overuse.
  • Top of head– Exercise, laughing too hard, too much sleep, too little sleep, sexual excitement.
  • A dull ache in the head and neck that become stronger as sexual excitement increases
  • Sudden, severe, throbbing headache that occurs just before or at the moment of orgasm
Diagnostic criteria for migraine without aura
 Source: International Headache Society
 A  At least five attacks fulfilling criteria B–D
 B  Headache attacks lasting 4–72 hours (untreated or unsuccessfully treated)
 C Headache has at least two of the following characteristics:

1. Unilateral location (one side of head)

2. Pulsating quality (i.e. varying with heartbeat)

3. Moderate or severe pain intensity

4. Aggravation by or causing avoidance of routine physical activity (e.g. walking or climbing stairs)
 D During headache, at least one of the following:

1. Nausea and/or vomiting

2. Photophobia (sensitive to light)
 E Not attributed to another disorder (history and examination do not suggest a secondary headache disorder or, if they do, it is ruled out by appropriate investigations or headache attacks do not occur for the first time in close temporal relation to the other disorder)

Various precipitants of migraine events have been identified:

  • Hormonal changes, such as those accompanying menstruation (common), pregnancy, and ovulation
  • Stress
  • Excessive or insufficient sleep
  • Smoking
  • Exposure to bright or fluorescent lighting
  • Strong odors (eg, perfumes, colognes, petroleum distillates)
  • Head trauma
  • Weather changes
  • Motion sickness
  • Cold stimulus (eg, ice cream headaches)
  • Exposed to air conditioned rooms
  • Lack of exercise
  • Fasting or skipping meals
  • Red wine

Information on dietary triggers is often conflicting. Foods and food additives that have been suggested as potential precipitants of migraine include:

  • Caffeine
  • Artificial sweeteners (eg, aspartame, saccharin)
  • Monosodium glutamate (MSG)
  • Citrus fruits
  • Foods containing tyramine (eg, aged cheese)
  • Meats with nitrites
Magnesium deficiency:
  • Magnesium deficiency has been associated with migraine development.
  • Nuts and seeds such as Brazil nuts, chia seeds, cashews, almonds, walnuts, and hazelnuts are known to contain magnesium.

Medication

  • Medications (eg, vasodilators used in blood pressure and angina, oral contraceptives)

Medscape

When to have a head scan?

Neuroimaging is indicated for any of these characteristics:

  • First or worst severe headache
  • Change in the pattern of previous migraine
  • Abnormal neurologic examination (eg, confusion, stiff neck, papilledema)
  • Onset of migraine after age 50 years
  • New onset of headache in an immunocompromised patient (eg, one with cancer or HIV infection)
  • Headache with fever
  • Migraine and epilepsy
  • New daily, persistent headache
  • Escalation of headache frequency/intensity in the absence of medication overuse headache
  • Posteriorly located headaches (especially in children, but also in adults – severe piercing, throbbing or shock-like pain in the upper neck, back of the head or behind the ears)
  • Resistance to treatment

Medscape

Symptoms

Does one have:

Warning phase:
  • Have a warning phase that a migraine will happen (trigger)?
Aura Phase:

Have an aura 5 minutes – 1 hr before symptoms start (approximately 30% of migraine patients do).

  • Light headedness?
  • Blurred vision/blind spots/flickering lines/zig zags?
  • Tingling/numbness in face and/or fingertips?
  • Slight weakness in one arm/leg?
  • Stuttered speech?
Migraine symptoms:

Migraine symptoms (which can vary from 4-72 hours and repeated occurrence can vary).

  • Severe pulsating and/or throbbing headache?
  • Experienced any nausea and vomiting?
  • Sensitive to light?
  • Affecting one side of head or mainly?
  • Front of head worsens on movement?
  • A cold sensation?
  • Pins and needles?
  • Tired and irritable?
  • Sensitivity to smell/touch?
  • Ringing in the ears?
  • Neck and/or shoulder pain?
  • A sense of feeling detached from your surroundings and/or  Alice in Wonderland syndrome (Todd's syndrome)—a condition in which you feel that your body or your surroundings are out of proportion?
  • Symptoms /condition is ongoing that last upto three months and/or have headaches interfered with your activity on at least one day?
  • Migraine with a similar pattern each time?
  • Symptoms last or symptoms have stopped and feel drained between 4 hours to 72 days?
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