MIGRAINE

Migraine - a disease, which are the dominant manifestation of recurrent attacks of intense headache. In the pathogenesis of migraine important genetic predisposition plays a role. For a long time, migraine was associated with changes in vascular tone: narrowing of intracranial arteries and the expansion of the arteries of the dura mater. It is now established that these changes are secondary and may not be directly related to the symptoms of the disease. The leading role in the genesis of pain plays the activation of neurons of the nucleus of the trigeminal nerve, and which resulted in their endings in the wall of blood vessels stand out biologically active substances that cause focal neurogenic inflammation and swelling of the blood vessels and the adjacent portion of the dura mater. And the initiation of the attack and the genesis of the aura an important role is played by the activation of serotonergic neurons in raphe nuclei. Migraines are more common in women aged 25 - 55 years.

Clinically distinguish two main forms: migraine without aura (simple migraine) and migraine with aura (classic migraine). More than half of patients with migraine attack preceded by prodromal phenomena, starting a few hours or days before the onset of the headache (depressed mood or euphoria, irritability or lethargy, drowsiness, sometimes light and phonophobia, thirst, frequent urination, nausea , constipation, diarrhea) . Typically, the headache unilateral (hence the name - migraine, derived from the term "hemicrania"), but not less than 40% of cases it is bilateral. The pain is usually very intense, has a pulsating character, localized in the fronto-temporal region, enhanced by physical activity. The attack often starts in the morning. Pain gradually increases (within 30 min - 2 h) and then stabilized and then slowly passes. The total duration of the attack is on average about one day (with a range from 4 to 72 hours). Almost always, the headache is accompanied by other symptoms: anorexia, nausea, sometimes vomiting. During the attack there is increased sensitivity to light, sounds, so patients tend to find a dark quiet room. Many patients sleep contribute to the cessation of attacks or vomiting . After an attack often feel fatigue, irritability, depression, some, on the contrary, noted an unusual freshness and euphoric.

Aura - the hallmark of a classic migraine, which is about 20% of migraine. It is characterized by the focal neurological symptoms that precede or accompany the headache. The aura usually develops within 5 - 20 min, 10-30 continues (maximum 60) minutes. Headache usually occurs within 60 minutes after the end of the aura. There are typical aura (visual, sensory, motor or aphasic). Most often it celebrated visual aura, manifested light flashes, moving twinkling dots and luminous zigzags, sometimes resembling the outline of the bastions of the fortress, which remains in place scotoma - a blind spot. Visual phenomena often begin in the central area and gradually spread outwards. As an aura can act paresthesia and numbness in the hand, perioral area, and half of the language, hemiparesis, aphasia .

Provoking factor are menstruation, stress (or rather, its resolution), fatigue, sleep disturbances, changes in weather, long exposure to the sun, noise, exposure to perfumes. In some patients, the provoking factor is the ingestion of certain foods: chocolate, nuts, cream, yogurt, chicken liver, avocado, citrus, bananas, canned (especially pickled) products, pork, tea, coffee, sausages, alcohol (especially red wine) , pizza, cheese.

If focal symptoms persist after the headache, talk about complicated migraine. Currently Two distinct states: migraine with aura elongated extending from 1 hour to 1 week, migrainous infarction, and in which focal symptoms persist for more than 1 week. In middle and old age migraine attacks can occur only aura without headache (migraine equivalents).

The diagnosis is based solely on the data history that reveals the characteristics of headache and associated symptoms, prodromal symptoms, positive family history, pain relief after sleep, worsening due to menstruation, typical triggers. Repeatability attacks - the hallmark of a migraine, so after the first attacks should be careful - migrenepodobnaya pain can be a manifestation of a tumor of the brain, sinusitis or glaucoma.

Treatment. In a fit of the patient should be placed in a quiet darkened room, make a warm or cold compress, compressing several head. Part of helping patients simple analgesics: 2 aspirin or paracetamol, taken at the first sign of attack. Additionally used antiemetics, improving the absorption of analgesics - metoclopramide (Reglan) of 5-10 mg orally, domperidone (Motilium) of 5-10 mg orally, pipolfen 25-50 mg meterazin 5 - 10 mg. Vomiting these preparations administered rectally (a suppository) or parenterally.

With the ineffectiveness of simple analgesics resorted to nonsteroidal anti-inflammatory drugs (NSAIDs) or a combination product containing caffeine and barbiturates. Caffeine enhances the action of analgesics, improving their absorption, but with frequent attacks, when the daily dose of caffeine at least several times a week, more than 300 - 500 mg (3 - 4 cups of coffee), it can worsen, causing withdrawal or rebound headaches. Adding codeine and barbiturates (sedalgin drugs pentalgin, solpadein) improves efficiency, but also increases the side effects and creates the potential for abuse. Migraine various NSAIDs are effective, but usually administered ibuprofen (200 mg), naproxen (250 mg), ketoprofen (75 mg), ketorolac (10 mg) (typically take 2 tablets with repeated reception of the same dose after 1 h). NSAIDs can be administered parenterally and aspirin (aspizol) 1000 mg intravenously, diclofenac (Voltaren) and 75 mg of ketorolac (Toradol) and 30 - 60 mg intramuscularly. When these drugs are ineffective, ergotamine tartrate is used, usually in combination with caffeine, improving its absorption (kofetamin preparations kofergot et al.). Usually beginning with 2 tablets (1 mg 1 tablet 100 mg ergotamine and caffeine), if necessary, the same dose was repeated after 1 h. When using a rectal suppository need smaller doses, as is more complete absorption. Start with 1/4 candles (1 candle - ergotamine 2 mg and 100 mg of caffeine), after failure of 1 hour introduced spark 1/2. The maximum daily dose of ergotamine - 4 mg (it can be applied 1-2 times per week). Since ergotamine provokes nausea and vomiting, before the reception is often necessary to introduce an antiemetic (metoclopramide, chlorpromazine or pipolfen). Ergotamine also causes abdominal pain, paresthesia in the distal extremities, cramps. The drug is contraindicated in pregnancy, uncontrolled hypertension, stenotic lesion of the coronary, cerebral and peripheral vascular disease, sepsis, liver and kidney diseases. Effectively relieves migraine attacks and dihydroergotamine which is administered parenterally (0.25-0.5 mg). The drug is available in the form of an aerosol for nasal administration (digidroergot). High efficiency has sumatriptan (Imigran), which is administered subcutaneously at a dose of 6 mg (drug comes in the form autoinektora) or 100 mg orally. Partial effect of the drug can be re-entered after 1 h. The drug is contraindicated in patients with coronary heart disease, bazimirnoy and hemiplegic migraine, uncontrolled hypertension. After the introduction of possible pain at the injection site, paresthesia in the distal extremities, flushing, chest discomfort. Opioids tramadol (Tramal) may also be used for cupping, butorphanol (stadol) promedol 10-20 mg intramuscularly optionally combined with antiemetics. When the status migraine, drug addition to the above, necessarily, parenteral administration of liquid (especially when persistent vomiting), corticosteroids (dexamethasone 8.12 mg intravenously or intramuscularly, if necessary again after 3 hours).

Prophylactic treatment consists primarily in removing precipitating factors, including dietary. Equally important are the regular meals, getting enough sleep, reducing caffeine and alcohol consumption, exercise stress. The patient should be taught various relaxation techniques. Pharmacological treatment is indicated for frequent or severe attacks. The most common use of beta-blockers, calcium antagonists, NSAIDs (naproxen), antidepressants (amitriptyline). With the ineffectiveness of first-line drugs used antiserotoninovym agents (methysergide, cyproheptadine (Peritol), sodium valproate). In some cases, effective papaverine, no-spa or in high doses.