A headache of varying intensity, often accompanied by nausea and sensitivity to light and sound. Migraine headaches are sometimes preceded by warning symptoms. Triggers include hormonal changes, certain food and drink, stress and exercise, writes Dr. Ansu Sen, MD/DM, Neurology, Senior Consultant (Neurologist), Columbia Asia Hospital, Kolkata, Ramakrishna Mission Sewa Prathisthan, Government of West Bengal.
A basic working knowledge of the common primary headaches, and a rational manner of approaching the patient with these conditions, allows a specific diagnosis of chronic migraine to be made quickly and safely, and by making this diagnosis one opens up a substantial number of acute and preventive treatment options. Headache is a common reason for seeking medical help and Headache clinics have been established in many medical centres. Common headache syndromes are migraine, tension type headache,cluster headache.
Migraine is largely familial.It usually occurs on one side. It begins in childhood or early adult life and frequency diminishes as age advances.In a special migraine variant known as Familial Hemiplegic Migraine there are episodes of paralysis of one side of the body that mau outlast the headache.
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Unilateral location and pulsatile throbbing nature of headache is characteristic compared to other headache types.Sensitivity to light, noise and often smells is common.There may be nausea and vomiting.Sometimes there is precipitation of attacks with certain foods like chocolate coffee cheese,foods which are rich in tyramine which acts as a provocative factor.In some persons alcohol particularly red wine or port provoke an attack.
In some migraine there is aura where symptoms are scintillaions, numbness or weakness of limbs or difficulty in speaking. Menstrual migraine occurs in younger women on premenstrual period.
Condering the treatment of migraine the clinician aims at control of individual attack, preventive medicatons and lifestyle modifications For severe attacks tritans (Zolmitritan Rizatriptan)or ergot alkaloids are best given early in the attack.The effective drugs for prevention of sttacs are beta blockers(eg propranolol) Tricyclic antidepressants(Amytriptyline) certain antiepileptics(like valporoate topiramate). The choice of drug depends on other comorbidities such as depression hypertension epilepsy coronary artery disease.
Precipitating factors such as late night sleep, fasting, emotional stress ,certain foods, should be avoided. A headache diary should be maintained. To refrain from analgesic abuse needs to be explained which may may emerge into chronic daily headache. In some refractory cases botulinium toxin A injection produces benificial headache.
Migraine is the most common disabling brain disorder. Chronic migraine, a condition characterized by the experience of migrainous headache on at least 15 days per month, is highly disabling. Patients with chronic migraine present to primary care, are often referred for management to secondary care, and make up a large proportion of patients in specialist headache clinics. Many patients with chronic migraine also have medication overuse, defined as using a compound analgesic, opioid, triptan or ergot derivative on at least 10 days per month. All doctors will encounter patients with chronic headaches.
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