Migraine is recurrent,paroxysmal,severe,incapacitating,unilateral,throbbing headache,with vomiting and preceded by visual or sensory disturbances.
The pathology of migraine is thought to be due vasoconstriction of branches of internal carotid artery,which causes visual disturbances and sensory-motor symptoms. subsequent throbbing headache is due vasodilatation of the external carotid artery. Migraine is thought to be due to release of certain neuropeptides especially 5-HT histamine and serotonin.
The exact cause of migraine is not known,however few of the predisposing causes are-familial predisposition,psychological disturbances.
precipitating factors-anxiety,fatigue,change in sleep patterns,emotional stress,hormonal imbalance(puberty,menopause,premenstraul tension),fasting or missing meals,bright light,loud noises,aleergic(chemical)-cheese,chocolate,coffee,alcohol,smoking.
Migraine is common in young adults and females are more prone to migraine.
TYPES OF MIGRAINE
- Classical migraine(migraine with aura).
- Common migraine(migraine without aura).
- Systemic migraine(migraine aura without headache).
- Complicated migraine.
- Status migrainous.
- Acephalgic migraine.
- Clinically migraine symptoms start suddenly,and are manifest as prodrome,aura and headache.
- Prodrome(duration of 15-30 minutes)-weakness,lethargy,euphoria or depression,yawning.
- Visual disturbances-blurring of vision,photophobia,hemianopia,lachrymation.
- Sensory disturbances-numbness and tingling in face,extremities,lips,tongue,sernsation of crawling of insects on skin.
- Motor disturbances-weakness,giddiness,dysphagia.
- Headache- onset of headache is morning time after waking,commonly unilateral headache located over frontal,supraorbital,temporal region. character of pain is paroxysmal,sharp,severe,throbbingpulsating,reaches peak within hours.
- Duration of headache is 24-48 hours,bouts of headaceh a\occur at intervals of days,weeks or months.
- Headache worse by light and noise. headache better by rest,dark room,pressure,vomiting. headaceh is associated with irritability,nausea,vomiting,sweating,diarrhea. after attack-profuse urination and sleepiness.
Reassurance to the patient,assess about patients habits,work place personality etc,correct the predisposing causes psychotherapy is psychological disturbance is the cause,avoid all the precipitating factors,improve general health,avoid all the allergy causing food,during attack take rest,remain in dark room.