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Migraines

Definition of migraine (Migraine) the source of the word from the Greek language of the word (Hemicrania) means, literal translation: half of the skull. The name derives from a characteristic of a migraine headache, as migraines usually affect one-half of the head. It is a chronic disease that manifests itself infrequent cases of headache, accompanied by physical and psychological phenomena, as well. It is a common disease in about 12% of people.

headache attack

In the first stage of an attack, about a third of people develop pre-existing symptoms that last from hours to days before the attack occurs. These symptoms include mood changes, fatigue, difficulty concentrating, hunger, or a stiff neck. 

In patients with migraines, attacks occur at a frequency of about once a month, but some patients have several attacks per week, and some attacks last more than 3 days without a break (status migrainosus).

Types of migraine

Migraine attacks can be classified into two types:

• Migraine without aura, the most common type, up to 66% of migraine attacks are with aura (formerly called classic migraine ). The International Headache Society has defined migraine headaches according to the following indicators:

1. The patient has had five distinct, typical episodes in his life.
2. Migraines last from 4 hours to 72 hours.
3. Characteristics of pain include at least two of the following: (a) pain is localized to one side only (unilateral); (b) the pain appears as a pulse; (c) the pain is moderate to severe; (D) The pain is exacerbated by physical exertion.
4. During the attack, the patient has at least one of the following symptoms: (a) nausea, vomiting, or both; (b) Sensitivity to light or noise.
5. The seizures are not attributed to another problem.

• Migraine with aura is a migraine in which, at least two episodes are accompanied by an aura characteristic of the following disorders:

1.  Numbness (lack of sensation) or slurred speech, which quickly disappear completely
2. Disorder on one side, or both sides, of the field of vision, which appears in the form of flashes, flashes, lines, spots, or lack of vision, accompanied by sensory disturbances on one side of the body, or without
3. At least one of the following phenomena: One (or more) symptoms appearing and lasting over 5 minutes, lasting more than 5 minutes but less than 60 minutes.
4. A typical migraine develops during an aura or within 60 minutes of its onset.

spread of disease

Migraines are very common among the population of Western countries and 18% of women and 6% of men have experienced at least one migraine headache. 60% - 70% of migraine sufferers are women. Before puberty, the prevalence of migraine is about 4%, and then its prevalence increases, at a later stage, especially among girls until the age of 40 years. After the age of 40, and with age, the incidence of migraine headaches begins to decrease. The highest prevalence rate among women is between the ages of 25 and 55 years. Migraine does not endanger the lives of patients, but it causes significant damage to the quality of life and its normal course, causing loss of working days and material losses.

Migraine symptoms

• Among the symptoms of migraine, the aura appears in a quarter of the patients: transient localized brain damage manifested by disturbance of vision (the most common), disturbance of sensation, decreased body strength, on the right or left side, disturbance of balance, or disturbance of speech. The aura usually appears before the onset of the headache, but it may also sometimes appear during or after the headache, and it lasts less than an hour. Because of the similarity, it is sometimes thought of as a stroke, but it is not caused by a blockage in a blood vessel, nor even by a disruption in blood flow to a specific part of the brain. The next stage is the headache.
• The pain usually begins on one side of the head, but sometimes moves to the other side, too, then gradually increases in intensity within hours, throbbing and affecting a person's functional performance.
• The headache is usually accompanied by nausea, and sometimes vomiting. 
• Excessive sensitivity to stimuli, such as light, noise, and smell, and the patient prefers to lie in the dark and quiet until the seizure ends.
• The attack may be accompanied by a feeling of tiredness, thirst, excessive urination, paleness, sweating, hunger or lack of appetite, nasal congestion, feeling cold or hot.
• A decrease in the ability to concentrate, a feeling of depression, anxiety, and nervousness can occur.

The last stage of a migraine attack is the “absorption” stage, as the patient remains exhausted, nervous, or restless, has little ability to focus, with noticeable sensitivity in the scalp. While some patients may feel depressed and restless, others feel refreshed and euphoric after the episode is over.

Migraine causes and risk factors

 Causes of  migraine headaches include:

1- family influence

A disease with great familial influence. About 70% of migraine sufferers have a first-degree relative who suffers from it, and first-degree relatives of a migraine sufferer are 1.5-2 times more likely to have migraines than other people. If the migraine is with aura, the rate rises to four times. So far, mutations (mutation/mutation) have been discovered in several genes that cause specific and rare forms of migraine, such as familial hemiplegic migraine. Studies show that, in most cases, migraines are not caused by a defect in a single gene, but rather are linked to several factors, whether genetic or environmental.

2- Catalysts

The most common catalysts for a seizure are:

• stress and fatigue

• sleeping too much

• Fasting and irregular eating in skipping some meals

• Taking some vasoactive substances

• Caffeine and alcoholic beverages

• menstruation

• Barometric pressure

• Changes in geographic elevation

• Some medications can speed up the occurrence of a seizure, such as nitrates, estrogen hormones, Indomed, or Reserpine.

The true cause of migraines is still unknown and not completely clear, but it is known today that there are processes that affect it and are related to its appearance. A system called the "trigeminovascular system" works in the brain, designed to protect the brain from harmful agents. When an external factor (lack of sleep, a certain food) stimulates the trigeminal nerve(nerve trigeminal) in the skull, this nerve secretes pain mediators (Substance P and CGRP) into the blood vessels in the lining of the brain, causing the secretion of other inflammatory mediators from mast cells, which in turn attract inflammatory cells (neutrophils) Polymorphonuclear neutrophil) to that region. These latter cells also secrete chemicals that cause changes in the diameter of blood vessels and increase the permeability of blood vessel walls, thus creating neurogenic inflammation. In this case, the penetration of pain mediators and the expansion of blood vessels will also be causes of pain. The aura occurs as a result of the spread of depression Spreading cortical depression, the process of changing the polarization of neurons in the cerebral cortex, spreads slowly at a rate of 3 to 5 mm per second on the surface of the brain, accompanied by changes in blood flow to these areas.

Migraine Diagnosis

Physical neurological examination, other tests, such as blood tests, examination of brain imaging computed tomography (Computed Tomography - CT), brain imaging MRI (Magnetic resonance imaging - MRI), or examination of the scheme electroencephalogram (EEG - Electroencephalogram) shows a situation intact, usually, In most cases, no tests are needed at all. The disease can be diagnosed based on the patient's description - (history of the disease - anamnesis) and based on a normal, sound neurological examination.

Migraine treatment علاج

Migraine treatment consists   of several types of therapy:

Behavioral therapy to prevent seizures:

• regular sleep
• regular diets
• moderate physical activity
• Avoid some foods that contain caffeine, tyramine, monosodium glutamate, or nitrates.

Migraine prevention treatment:

This treatment is usually prescribed to people who suffer from more than 4 migraine attacks in one month that lasts 12 hours or more. The main goals of inhibitor therapy:

• Reducing the frequency, severity, and duration of seizures.
• Increased response to treatment during acute attacks.
• Improving patient performance and reducing disability
• Reducing the development of the disease and its transformation from an acute attack to chronic disease.

Medicines to prevent migraine attacks:

Categories of drugs that are effective in scientific research as preventing migraine attacks:

• Beta-blockers such as metoprolol (Metoprolol, propranolol, timolol)
• Tricyclic antidepressants Calla Mitrabtelin (Amitriptyline) and venlafaxine (venlafaxine)
• Anticonvulsants (anticonvulsants) Calfalbrooat (valproate) and topiramate (topiramate)

Treatment to relieve symptoms during an attack:

Many medications have been scientifically proven to treat acute migraine attacks, and we can divide them as follows:

Ordinary pain medications such as analgesics, such as: 

• paracetamol 
• Non-steroidal anti-inflammatory drug - NSAIDs such as aspirin, ibuprofen, naproxen and diclofenac.
• Opioid analgesics, despite the difference in opinions among doctors about the best use of them to treat migraines

Medicines to treat migraine headaches:

• Triptans, which are medicines developed specifically for the treatment of migraines, are agonists of a neurotransmitter called serotonin (5-HT1B/1D). Drugs in this class include eletriptan, naratriptan, rizatriptan, sumatriptan (which is the most commonly used drug today and is known to start relieving pain within a short time of taking it), and zolmitriptan. These drugs have a good effect and high efficacy at the time of the seizure.
• Drugs anti-emetic (ANTIEMETICS): The role of these drugs is supportive and assistant to treat headaches relieve pain and prevent cases of vomiting associated with headaches in migraine attacks. Drugs in this category include metoclopramide, chlorpromazine, prochlorperazine, droperidol, and diphenhydramine.
• Ergo drug class: These drugs also bind to the serotonin (5-HT1B/1D) receptor. Types of drugs in this class are ergotamine and dihydroergotamine.
• Dexamethasone (Dexamethasone): This drug has proven effective in relieving a recurrence of a bout of migraine (setback) if the drug was given during an acute attack.
• Magnetic alarm via craniotomy (Transcranial Magnetic Stimulation).

New research is now underway on new drugs that act on other receptors for the neurotransmitter serotonin that show potential efficacy for migraine sufferers.