Migraine has been accepted as a neurological disorder. Neurogenic inflammation associated with vasodilatation: A decrease in the excitement threshold of the brain results in headache. During the migraine attacks, autonomic, vascular and gastrointestinal symptoms may occur.
The onset of migraine is frequently identified between the ages of 5-25 years. The prevalence of migraine ranges from 15% to 20% in women and from 5 to10% in men.
Migraine should not be accepted as a simple headache, because it also affects negatively the quality of life, performance at work and social relationships.
PHASES OF THE MIGRAINE ATTACKS
Migraine is not just a headache, but also it is a symptom complex related to brain dysfunction..
Prodromal Phase of Migraine:
Largely psychological, neurological, autonomic symptoms occur in this phase. Major symptoms include depression, hypersensitivity, dullness, slowing of thought, stuttering, trouble in finding the correct words. Prodromal symptoms such as photophobia, phonophobia, hypersomnia, fatigue, unwillingness, polyuria may also be observed.
Frequently, aura symptoms may be in the form of numbness, prickle, vertigo, visual disturbances. The presence of the numbness of arms and legs and visual disturbances, necessitates imaging examinations (cranial MRI, EEG) of the patients.
It is observed at the onset of pain, pain and the termination of pain. At the onset of pain, one sided sense of heaviness in the head is observed and this is the best time for treatment. Pain phase may last from hours to days, pain may be unilateral or generalized. In this phase nausea, vomiting, photophobia, phonofobia may occur. Patient desires to be alone in a dark room. When the patient falls asleep, the last phase is entered. Later, the state of fatigue and exhaustion resolves gradually.
FACTORS FACILITATING THE OCCURRENCE OF MIGRAIN ATTACKS
Factors such as stress, hunger, sleep disorder, menstruation, some food, alcoholic drinks, smells, changes in weather, fatigue may be included.
The Development of the Migraine Attack: It has been suggested that migraine has a neurological origin, the excitement threshold of the brain decreases while the attack occurs and some structures in the brainstem initiate the attack. This paroximal state has been thought to be a familial disorder. Brain imaging performed with special techniques, revealed an increase of the blood circulation in some parts of the brain.
Migraine treatment consists of knowing the triggers of migraine and avoiding them as well as to start the treatment that restrain the attacks. In the treatment of migraine attacks, anti-emetic, analgesic and anti-inflammatory medication is started. Triptans are the last drugs being effective in each phase of pain. Beta blockers, antidepressants, anticonvulsants are used as a preventive medication for migraine attacks. Besides, the effectiveness of the application of acupuncture, yoga, massage treatments is controversial.
.ZEKAİ TUNCAY, M.D