Prof. Dr. Serbülent Gökhan Beyaz

Migraine Headache

Migraine Headache

Clinical Syndrome
Migraine headache is a periodic unilateral headache that can start in childhood but almost always develops before the age of 30. The attacks are variable, ranging from every few days to every few months. happens frequently. Between 60% and 70% of patients suffering from migraines are women, and many report a family history of migraine headaches. The personality type of migraine patients is meticulous, clean, compulsive repetitively repeating the same movements. defined as a type of disorder. They tend to be obsessed with their daily routines and often have trouble coping with the stresses of daily life. Migraine headaches, changes in sleep patterns or diet or thiamine (vitamin B1) containing foods, monosodium glutamate, nitrates, chocolate or ingestion of citrus fruits.

Signs and Symptoms
Migraine headache, by definition, is a unilateral headache. Although the headache may change sides in each attack, the headache is never bilateral. The pain of a migraine headache is usually around the eyes. It is a throbbing and severe pain. From the onset of migraine pain to its peak The elapsed time is short, ranging from 20 minutes to 1 hour. Unlike tension-type headaches, migraine headaches are usually accompanied by systemic symptoms such as nausea and vomiting, discomfort from light and sound. associated with changes in appetite, mood, and libido. Menstruation is a common trigger of migraine headaches.

Differential Diagnosis
Diagnosis of migraine headache is usually based on a targeted headache history. determined on a clinical basis. Tension headaches are often confused with migraine headaches, and this misdiagnosis can lead to inappropriate treatment plans because these two headache syndromes are quite different. is managed accordingly. Eye, ear, nose and sinus diseases can also mimic migraine headaches. Targeted history and physical examination, along with appropriate testing, allows the clinician to identify underlying diseases of these organ systems. identify and treat appropriately. The following conditions can all mimic migraine and should be considered when treating patients with headaches: glaucoma; temporal arteritis, sinusitis, Chronic subdural hematoma, tumor (see Figure 2-2), intracranial disease including brain abscess, hydrocephalus and pseudotumor cerebri, and inflammatory conditions including sarcoidosis.

When deciding how best to treat a patient suffering from migraine, the clinician should consider the frequency and severity of headaches, their impact on the patient’s lifestyle, focal or long-term neurologic should consider the presence of disorders, the results of previous testing and treatment, and any history. E.g; previous drug abuse or misuse and use of certain treatment modalities such as the presence of other systemic diseases (eg, peripheral vascular or coronary artery disease) that may prevent If the patient’s migraine headaches occur infrequently, it may be necessary to try an abortive treatment. However, if headaches occur more frequently or cause the patient to miss work or be hospitalized, prophylactic treatment is warranted.

Rescue Treatment
The goal of abortive treatment is to reduce the headache. stop as soon as it starts. Abortive drugs are taken through a needle, mouth, or nasal spray. This type of therapy is especially helpful for those with migraine-related nausea or vomiting, and it works immediately. abortive drugs includes triptans that specifically target serotonin. They are very similar in their movement and chemical structure. Triptans are used only for headaches, they do not relieve the pain found among arthritis or premenstrual symptoms. For example: “Almotriptan (Axert), “Eletriptan (Relpax), “Frovatriptan (Frova) “Naratriptan (Amerge, Naramig), “Rizatriptan (Maxalt), “Sumatriptan (Imitrex, Treximet) “Zolmitriptan (Zomig). In patients with migraine headache Drugs that may be considered include isometepten mukat (e.g. midrin), the nonsteroidal anti-inflammatory drug (NSAID) naproxen, ergot alkaloids, triptans containing sumatriptan, and intravenous combined with antiemetic compounds. compounds containing lidocaine. 100% oxygen inhalation can stop migraine headache, and sphenopalatine ganglion block with local anesthetic can be effective. Preparations containing caffeine, barbiturates, ergotamines, triptans and opioids, analgesics tend to cause a phenomenon called rebound headaches, which can ultimately be more difficult to treat than the original migraine. Ergotamines and triptans combined, peripheral vascular disease, It should not be used in patients with coronary artery disease or hypertension. “Acetaminophen-isometheptene-dichloralphenazone (Midrin) “Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray) “Ergotamine tartrate (Cafergot) “Advil Migraine (contains ibuprofen), Excedrin Migraine (contains aspirin, acetaminophen, caffeine) and Motrin Migraine Pain (contains ibuprofen). The following drugs are used for migraine headaches associated with nausea. It is used in addition to the treatment: “Metoclopramide (Reglan) “Prochlorperazine (Compazine) Promethazine (Phenergan). In order for abortive treatment to be effective, it must be present when the headache is first felt or at the first sign. medication should be started. This is quite difficult due to the short interval between the onset and peak of migraine headache, and it is difficult for migraine patients to take parenteral medication, especially because of nausea and vomiting, which limit oral medication intake. or transmucosal.

Prophylactic Treatment
For most patients with migraine headaches, prophylactic treatment is a better option than abortive treatment. The mainstay of prophylactic treatment is blocking are agents. Propranolol and most other drugs in this class can control or reduce the frequency and intensity of migraine headaches and help prevent auras. 80 mg daily of the long-acting formulation dose is a reasonable starting point for most patients with migraine. Propranolol should not be used in patients with asthma or other reactive airway diseases. Valproic acid, calcium channel blockers (eg, Verapamil), Clonidine, tricyclic antidepressants and NSAIDs have also been used in the prophylaxis of migraine headache. Each of these drugs has advantages and disadvantages, and the clinician can best meet the patient’s needs. should come up with a treatment plan. This form of treatment is used if the migraine is frequent, more than once a week, or if the migraine symptoms are severe. The goal is to reduce the severity and frequency of migraine attacks. Migraine Preventive medicine can be taken every day. Preventive treatment drugs are: “High blood pressure drugs, beta-blockers (propranolol [Inderal], timolol), calcium channel blockers (verapamil [Covera]) “Tricyclic Antidepressants; amitriptyline (Elavil), nortriptyline (Pamelor) “Anticonvulsant drugs; gabapentin (Neurontin), topiramate (Topamax), valproic acid (Depakote). Complications and Pitfalls
In most patients, migraine headaches are painful. however, it is a non-life-threatening disease. However, patients suffering from prolonged migraine with aura or migraine with complex aura are at risk for the development of permanent neurological deficits. Such patients are best treated by headache specialists who know these unique risks and are better equipped to deal with them. Prolonged nausea and vomiting, sometimes associated with severe migraine headaches, May cause dehydration requiring hospitalization and treatment with intravenous fluids.

Clinical Pearls
The most common reason a patient does not respond to conventional treatment for migraine headaches is because the patient is actually tension-type headache, analgesic rebound headache, or a combination of headache syndromes. Caffeine or barbiturates, which may cause analgesic rebound headache, He should ensure that he is not taking significant doses of over-the-counter headache preparations containing other vasoactive drugs such as ergots or triptans. The patient’s headache will not improve until these drugs are withdrawn.