Migraine, a recurrent paroxysmal hemilateral headache, is the most important and common vascular headache, a headache caused by changes in the contractile function of the cranial blood vessels, presenting with pulsating pain or distension in line with the pulse. Migraine patients often have headache attacks during the day, but they can still occur at night. The headache is usually confined to one side of the head, but some patients may have a change in the location of the headache with each attack, sometimes with pain in the occipital area and the top of the head, or with pain in the face and neck. However, the diagnosis of migraine cannot be made only from the location of the headache. When a patient has a headache attack, the pain gradually increases, and the headache peaks in a few minutes to 1 to 2 hours, and may last for several hours or even days, and then the headache gradually decreases or disappears. In a small number of patients, there is a sudden onset of severe headache with no obvious trigger, which peaks within a few seconds and can last for several hours or even days. The pain is often pulsating, some patients present with a non-pulsating dull pain, and a few patients present with a stabbing pain in the head or a percussive sensation. Compression of the artery at the site of the headache or the carotid artery on the diseased side or the eye can reduce the headache, and the pain returns to its original state when no compression is applied. The headache can be aggravated by activity, and the pain can be reduced by bed rest, and can disappear completely by short-term sleep. Vascular headache is divided into two categories: primary vascular headache and secondary headache: primary vascular headache is also called migraine; secondary headache is mostly on both sides. It often develops in adolescence, some patients have family history, and is mostly triggered by exertion, emotional factors and menstruation. Migraine is a kind of vascular headache. Vascular headache is a headache caused by changes in the contraction function of cranial blood vessels, and there are two types of vascular headache: primary vascular headache and secondary vascular headache. Ancestral medicine has long recognized migraine, and believes that its mechanism is mostly a lesion of the three Yang meridians. In Lenglu Medical Talk, it is said that “if the headache belongs to the sun, it goes up from the back of the head to the top of the head, and the pain is even in the neck; if it belongs to the yangming, it goes up to the eye pearl and is in the forehead; if it belongs to the shaoyang, it goes up to the two horns and the pain is in the side of the head.” Migraine may be hereditary. In recent centuries, neurologists have argued that genetic factors play an important role in the pathogenesis of migraine. For example, Gawers writes, “Migraine is clearly inherited, with genetic influences being traced in more than half of the cases, often when other members of the patient’s family (up to the parents) have migraineurs.” The mode of inheritance of migraine cannot be conclusively confirmed at this time. The distribution of family members is different from recessive inheritance, which is autosomal dominant with incomplete epistasis, but it has also been suggested that it is recessive with incomplete epistasis. In conclusion, the heritability of migraine is certain, but the mode of inheritance is inconclusive.
What are the causes of migraine?
Migraines can be caused by abnormalities in the blood vessels, nerves, blood vessels and nerves in the head for various reasons. However, the overall cause of migraine is still not well understood, and there are many pathogenetic mechanisms that explain the cause of migraine, all of which can explain the occurrence of migraine to some extent, but not all. At present, the vascular nerve compression theory is gaining more and more recognition and taking the dominant position.
I. Vascular origin hypothesis. Since Wolff proposed the vascular hypothesis of migraine attacks in 1938, it has ruled the medical community for decades. This theory has not been disproved, although it has not been confirmed by strong experiments. Wolff was the first person to conduct a scientific clinical and experimental study of migraine. He came to the conclusion that headache attacks are preceded by constriction of the intracranial arteries, producing cortical ischemia and aura symptoms such as visual disturbances, followed by dilation of the external carotid artery system, which produces headache attacks that are exacerbated by perivascular vasoactive peptides and irritating sterile inflammation in the tissues.
The bases supporting the vascular origin hypothesis are mainly the following: the nature of clinical migraine pain is pulsatile and throbbing; the diversity of pain sites, where the pain location does not coincide with the anatomical distribution of the trigeminal nerve but with the branches of the external carotid artery in the face and head, suggesting a vascular origin of the pain. Compression of the carotid artery provides temporary relief of migraine attacks. Application of alpha-adrenergic blockers relieved the pain, and the use of vasodilators (e.g., alcohol, nitrites, etc.) worsened their headache symptoms.
Phenomena not explained by the vasogenic hypothesis: common migraine: it is difficult to explain common migraine with Wolff’s typical migraine hypothesis. The latter does not start with focal symptoms in the brain, but occasionally with general sensory symptoms that are not obvious, such as fatigue, yawning and emotional instability. Many studies have reported an increase in cerebral blood flow during a common migraine attack that persists up to 48 hours after the onset of the attack. However, the increase in cerebral blood flow is moderate, and no focal hypoperfusion is seen at the beginning of the attack. Typical migraine: The initial cerebral blood flow (rCBF) measurement technique lent support to Wolff’s classic hypothesis, finding a decrease in rCBF during the aura phase of typical migraine, with essentially the same site as the symptoms. However, with the application of highly spatially discriminatory equipment, repeated measurements in a large number of patients have led to different results. Tomographic measurements of rCBF during a typical migraine attack have shown reduced blood flow in the occipital lobe, which can also involve the more anterior parts of the brain, with blood flow abnormalities limited to the cerebral cortex and normal blood flow to deep brain structures. In addition, the perfusion deficit persists for several hours after the disappearance of the aura symptoms and continues into the seizure phase. Delayed hyperperfusion (reactive congestion) occurs in the late phase. There appears to be no association between hyperperfusion and headache. There is more evidence to reject the cerebral artery spasm hypothesis.
II. Neurogenic hypothesis.
This doctrine was proposed by Liveing more than one hundred years ago, and in recent years many people have supported the neurogenic view in clinical practice and proposed the hypothesis that migraine is a primary neurogenic disorder with secondary vasomotor changes. This doctrine can be supported by three aspects as follows: 1, the migraine attack phase, in which all its symptoms are produced by the brain, such as behavioral changes of pre-symptoms, mood changes, food fetishes, etc. Some patients in the headache phase have throbbing pain and the rest have constant headache. Even throbbing pain is not vascular in origin. Neurological symptoms in the headache phase include shame, acoustic terror, generalized arousal, hypersensitivity to vibration and smell, loss of concentration, insomnia, yawning, and temperature instability, none of which are caused by extracranial vasodilation. The changes of mind and spirit, yawning and fatigue in the recovery period of symptoms are neurogenic.2, The triggering factors of migraine: mental stimulation, hunger, too much or too little sleep, women’s menstruation, stimulation of sensory organs and other factors that induce migraine attacks are all associated with the nervous system.3, The neurogenic theory can be strongly supported by the findings of EEG, cerebral blood flow and brain metabolism.
Third, the vascular nerve compression theory.
Neither of the above two theories can explain why migraine mostly has semi-lateral attacks limited attacks, and targeted drug treatment according to the above theories can only relieve headache attacks basically cannot cure migraine. This problem has been troubling the world medical community. Professor Ren Yanwu, a neurosurgeon in China, proposed the “vascular nerve compression theory” in the late 1980s. He pointed out that the onset of migraine starts with the spasm of the blood vessels in the intracranial segment and then the dilation of the blood vessels in the extracranial segment, and the aura symptoms of headache such as visual flashing black dots are produced during the spasm of the blood vessels in the intracranial segment, while the headache symptoms are produced during the dilation of the blood vessels in the extracranial segment. Then why does the dilation of the extracranial vessels cause headache? The dilation of blood vessels in the extracranial segment should not be confined to the half of the scalp but to the whole head, and why is the pain confined to the half of the head? Prof. Ren Yanwu found that migraine patients have localized compression of nerves by blood vessels in the scalp for various reasons through extensive autopsy. Professor Ren Yanwu believes that this compression does not directly cause headache attacks, but stimulates the nerves in abnormal contact when the concentration of neurotransmitters in the blood vessels and the hemodynamics of the blood vessel walls change, causing headache attacks. Based on this, Ren Yanwu has proposed a new treatment plan of “microscopic nerve decompression for migraine”. In the past 20 years, he has cured thousands of migraine patients at home and abroad, with a cure rate of over 90%. He has been awarded the second prize of Beijing Science and Technology Progress Award, the annual award of American Association for the Advancement of Science, the Fellowship of the Institute of Applied Technology in London, the Lifetime Achievement Award of International Medical Development and dozens of other awards at home and abroad. The “Vascular Nerve Compression Theory” and “Micro-Nerve Decompression for Migraine” are also included in the textbook of neurosurgery. Due to its remarkable clinical results, the vascular nerve compression theory now dominates the pathogenesis of migraine and is increasingly recognized.
Relationship between migraine and other diseases
It has been suggested that mitral valve prolapse (MVP) is extremely closely related to migraine, a phenomenon that is gaining increasing attention. The incidence of migraine is about 28% of the patients with MVP reported by many authors. The mechanism of migraine attacks caused by MVP is still unclear, but it is thought that migraine is caused by platelet aggregation and release of 5-HT during blood flow through the heart valves.
Migraine-induced ischemic stroke has long been a concern. There are reports that migraine can trigger stroke, but the incidence of stroke in migraine patients is still very low in terms of the total number of migraineurs, with 7% of cerebral infarctions in young adults reported to be due to migraine. Migraine patients are more likely to be female and young adults, and therefore, ischemic strokes in migraine patients are more likely to be in young adult women. Migraine-induced stroke can involve both the internal carotid artery system and the vertebrobasilar artery system, but posterior cerebral artery occlusion is the most common. There are three types of migraine stroke: (1) Coexistence of migraine and stroke: the same patient has both migraine and stroke, but the onset of stroke is separated from migraine by a period of time. (2) Stroke with migraine clinical features: In these patients, the brain lesion is not related to the mechanism of migraine, but the clinical presentation has the typical clinical features of migraine. (3) Migraine-induced stroke: The following criteria must be met to diagnose migraine-induced stroke: (1) the patient’s neurological signs must be similar to those of previous migraine attacks; (2) the stroke attack must occur during a typical migraine attack; and (3) other possible factors causing the stroke must be excluded. Migraine-induced hemorrhagic stroke is rare, but has been reported clinically for a long time. Recently, three cases of lobar hemorrhage due to prolonged migraine attacks were reported and confirmed by CT and MRI. Angiography did not show arteriovenous malformations or hemangiomas, and only the corresponding internal and external carotid arteries had extensive spasm. Postoperative pathology in two of these cases demonstrated necrosis of the vessel wall with subacute inflammatory changes. The occurrence of cerebral hemorrhage is estimated to be caused by ischemia of the intracranial vessel walls due to more severe cerebral vasospasm during migraine attacks leading to necrosis and secondary vascular rupture resulting in hemorrhage when perfusion pressure is restored.
The relationship between migraine and hypertensive disease. As early as 1913, it was noted abroad that more migraine patients developed hypertension several years later. Later scholars concluded that migraine patients had five times the chance of developing hypertension than normal people. In China, some scholars found that migraine was diagnosed in patients with intermittent attacks of headache on one or both sides, accompanied by visual aura attacks, nausea and vomiting and positive family history, and 473 patients were diagnosed, 277 of whom developed hypertension or borderline hypertension several years later. The nature of the headache symptoms changed after the onset of hypertension, and was easily accompanied by dizziness, vertigo, tinnitus, insomnia, irritability, impatience, and numbness of the limbs.
What types of migraine are there?
I. Typical migraine. Typical migraine, also known as migraine with aura, accounts for 10% of migraine patients, mostly develops in adolescence, and there are more family history of migraine. The most distinctive feature of typical migraine is that the headache attack is preceded by aura symptoms: (1) Visual aura symptoms: Patients may have flash hallucinations in the bilateral visual field, and the shape of the flash is variable, such as star-shaped or ring-shaped. Some patients have black haze in front of their eyes, commonly monocular black haze, which is mostly transient, or they may see distortion of visual objects, larger or smaller visual objects, or change in shape, etc. (2) Sensory abnormalities: The most common ones are tingling and numbness in the hands and forearms, numbness in both hands, extremities, half of the face and around the mouth and lips, and loss of eccentric sensation, with symptoms lasting mostly for a few seconds to 20 minutes, occasionally for a few hours, and rarely for days to weeks. (3) Other aura symptoms: In addition to the above, migraine patients may also have motor aura, such as monoplegia or hemiplegia, or transient aphasia or psychiatric symptoms.
Second, common migraine. Common migraine, also known as migraine without aura, is the most common type of migraine, and its aura period is not obvious. There may be some non-specific prodromal symptoms including mental disorder, gastrointestinal symptoms and fluid balance changes several hours or days before the onset of headache. The headache may be manifested as unilateral or bilateral frontal and temporal episodic, pulsating pain, which lasts longer than the typical ones, with completely normal intervals.
Third, hemiplegic type migraine. Hemiplegic migraine is rare clinically, and there are two types of migraine: sporadic and familial. Familial hemiplegic migraine is autosomal dominant and may be accompanied by tremor and nystagmus, retinal degeneration, deafness and ataxia. Hemiplegia can be one of the aura symptoms of headache attack, which lasts for 20-30 minutes, and the hemiplegic symptoms return with headache attack. The hemiplegia may also last for hours, days or weeks after the headache has disappeared. The headache usually follows the hemiplegia, and in about 1/3 of patients, the headache is ipsilateral to the hemiplegia and is often accompanied by nausea and vomiting. Dysarthria or aphasia occurs in about 50% of patients with hemiplegia, and sensory centers are involved in about 1/3 of patients, but almost every patient with hemiplegia also has hemianesthesia. Most hemiplegic attacks begin in childhood, and many patients stop having hemiplegic attacks when they are 20 to 30 years old and replace hemiplegic migraine with other types of migraine.
Fourth, hemiplegic migraine. Hemiplegic migraine is rare clinically, and there are two types of migraine: sporadic and familial. Familial hemiplegic migraine is autosomal dominant and may be accompanied by tremor and nystagmus, retinal degeneration, deafness and ataxia. Hemiplegia can be one of the aura symptoms of headache attack, which lasts 20-30 minutes, and hemiplegic symptoms return with headache attack. The hemiplegia may also last for hours, days or weeks after the headache disappears. The headache usually follows the hemiplegia, and in about 1/3 of patients, the headache is ipsilateral to the hemiplegia and is often accompanied by nausea and vomiting. Dysarthria or aphasia occurs in about 50% of patients with hemiplegia, and sensory centers are involved in about 1/3 of patients, but almost every patient with hemiplegia also has hemianesthesia. Most hemiplegic attacks begin in childhood, and many patients stop having hemiplegic attacks when they are 20 to 30 years old and replace hemiplegic migraine with other types of migraine.
V. Oculomotor paralysis type migraine. The oculomotor paralysis type of migraine is rare clinically. Patients have fewer headache attacks with non-pulsating orbital or periorbital pain radiating to the lateral side of the migraine, often accompanied by nausea and vomiting, with symptoms lasting 1 to 4 days, and oculomotor paralysis coexisting with the headache or lasting for a longer period of time even after the headache has subsided, usually lasting a few days, usually within 45 days to 2 months. One side of the ptosis first appears, and within a few hours may present with complete paralysis of the third pair of cranial nerves, sometimes with dilated pupils, and occasionally involving the fourth and sixth pairs and the ophthalmic branch of the trigeminal nerve. Ophthalmic muscle paralysis usually recovers completely, but some extraocular muscle paralysis may persist after several episodes, and occasionally ophthalmic muscle paralysis headache may occur alternately on both sides of the head. The age of onset of this type of disease is similar to that of the common type of migraine, with most patients having their first attack before the age of 12.
Sixth, basilar artery migraine. Basilar artery migraine is a disorder of brainstem nerve function during migraine attacks, often accompanied by total blindness and changes in consciousness. It is most common in adolescent girls, with the majority of patients under 35 years of age, and most attacks are associated with menstruation. Episodes begin with vivid, shapeless visual hallucinations or blinding, involving the entire visual field or even total blindness, accompanied or followed by vertigo, ataxia, dysarthria, tinnitus, and distal or extremity sensory abnormalities. Some of these patients present with progressive impairment of consciousness, and some present with incomprehensible dream-like states, confusional states before the loss of consciousness, which is not too profound and can be awakened by strong stimuli. The neurological symptoms of these episodes are within 2 to 45 days, mostly for 10 to 30 minutes. They are followed by a throbbing headache in the occipital region, often accompanied by vomiting, which can last for several hours or until the patient falls asleep. The majority of patients have only a few dramatic attacks, and before or between these typical attacks the patient presents with a generalized migraine pattern. The basilar migraine attacks cease and are often replaced by the generalized migraine.
VII Psychotic migraine. Migraine with psychiatric symptoms is called delirium migraine. The onset of this type of migraine is usually between 5 and 16 years old, accompanied by acute migraine attacks, but never mental disorder caused by severe headache. Clinical manifestations include excitement, agitation, fidgeting, fear, disorientation, memory impairment, retrograde amnesia, unresponsiveness, and sometimes migraine stiffness, and sometimes autism.
Eight, abdominal pain type migraine. Migraine with abdominal cramps during typical or common migraine attacks is called abdominal pain migraine. Some patients may have no headache but only episodes of abdominal pain, accompanied by nausea, vomiting and vegetative symptoms such as pallor, excessive sweating and calf muscle spasm, etc. The diagnosis is more difficult at this time. The following are required for diagnosis: (1) this disorder can have a variety of strange medical history; (2) accompanied by vegetative symptoms such as pallor, excessive sweating, dizziness, etc.; (3) abdominal tenderness on palpation; (4) mental tension can make the pain worse; (5) repeated episodes of abdominal pain; (6) various laboratory and X-ray tests are negative; (7) no specific findings on proctoscopy.
IX. Periodic migraine. Migraine in this type of patients is mostly periodic, so it is called periodic migraine. In this type of patients, each attack lasts about 25 hours on average, and the duration of the cycle lasts from 2 to 20 weeks (6 weeks on average), and there are 1 to 12 attacks per year (5 attacks/year on average), and in the headache cycle, there are 1 to 7 attacks per week (5 attacks/week on average). In the headache cycle, there is still a fixed, mild, one-sided or bilateral headache in between headaches. The diagnostic criteria for this type should have the following points: (1) the patient should have typical or atypical migraine; (2) the headache is periodic and lasts for more than 2 weeks; (3) in the attack cycle, there are still obvious mild headaches between headaches; (4) the periodic migraine is often confined to the frontal and temporal side, most of them are accompanied by nausea and shyness, and the attacks are continuous, which are easily confused with cluster migraine and should be diagnosed with The diagnosis should be paid attention to. Periodic migraine is currently treated with lithium carbonate as the main western drug. According to foreign scholars, lithium carbonate is more effective in treating this disease, so all periodic migraine should be treated with lithium carbonate for 2 weeks, and if the effect is good, the drug should be applied for at least 1 month, and severe cases should be taken for 1 year.
The relationship between migraine attacks and smoking and alcohol consumption
Migraine attacks have a great relationship with smoking and drinking spilled. The incidence of migraine is significantly higher in patients who smoke and drink alcohol than in the normal population, especially in young people, so how do these two cause migraine attacks? Long-term smoking can cause tissue hypoxia, compensatory erythropoiesis, and increase the red blood cell pressure; in addition, cigarettes contain nicotine, which causes nerve endings and adrenal glands to release epinephrine and norepinephrine, and epinephrine and norepinephrine can cause vasoconstriction, vasospasm, increased resistance, and vascular embolism. Long-term smoking can also increase blood viscosity, slow blood flow, platelet aggregation, release of various inflammatory neurotransmitters, reduce intracranial and extracranial vasodilatory function, and increase blood cortisol, renin, aldosterone and pressor hormone, which increases adrenergic nerve activity and leads to intracranial and extracranial vasodilatory dysfunction. Therefore, in daily life, it is important to pay attention to good habits, not to smoke and not to drink alcohol to reduce migraine attacks.
What are the possible serious consequences of migraine
Migraine persists and requires hospitalization. Vascular migraine attacks last for several hours or even 1 to 2 days, mostly in the morning or during the day, and can occur daily or once every few weeks or years, and those that occur daily are called migraine persistent. Since there are various types of migraine attacks and various complications such as vertigo, vomiting, eye muscle paralysis, limb hemiparesis, severe headache, etc., these symptoms are not relieved for a long time, causing a lot of pain to patients and aggravating the burden of thought. For example, frequent vomiting, obvious dehydration, or aggravation of hemiplegia mistaken for thrombosis, and eye muscle paralysis can be considered as actinic nerve paralysis, etc. Therefore, patients with persistent migraine should be promptly hospitalized. The use of sedatives and antiemetics, rehydration, and hormone administration and other treatments can provide short-term relief.
Recurrent migraine may cause hemiplegia: hemiplegia is called “stroke” or “stroke” in Chinese medicine, and it includes diseases such as cerebral thrombosis and cerebral hemorrhage. There is no causal relationship between migraine and cerebral thrombosis, but cerebral thrombosis may occur occasionally in recurrent migraine. It has been estimated that 15% to 30% of stroke patients may have a history of migraine. In patients taking birth control pills, migraine symptoms can be found to worsen, thus increasing the chance of cerebral thrombosis. Therefore, prevention should be actively pursued to avoid cerebral thrombosis. In addition, hemiplegic migraine occurs during or after an attack, and the hemiplegia may last for a certain period of time after the headache has ended and may even have some sequelae.
Why do migraines favor women? Do migraines occur in children?
Vascular migraine is more common in women, which is related to the physiological characteristics of lesbians, especially young women. Migraine attacks can be triggered by changes in female hormones in the body around menstruation, pregnancy, childbirth and oral contraceptives.
There are two types of female hormones: one is called estrogen, which is used to maintain the development of female secondary sex characteristics and internal genitalia; the other is called progesterone, which is related to the maintenance of pregnancy. Absolute or relative excess amounts of estrogen cause water and sodium retention, leading to cerebral edema, so treatment of migraine with dehydrating agents or diuretics is effective. In premenstrual and postmenopausal lesbians, although the absolute value of estrogen is reduced, it is still relatively increased compared to progesterone. In addition, it is believed that in addition to endocrine factors, environmental and psychological factors also play an important role in migraine.
In addition to women, vascular migraine can also occur in children. Children with migraine or epilepsy have a higher incidence of migraine in their children, mostly in boys, and may have headache on both sides, sometimes blurred vision in one or both eyes, nausea and vomiting. It has been reported that pediatric migraine accounts for 55% of all migraine patients, mostly seen in children aged 7-15 years old, with an average of 7.5 years old, and more males than females, which shows that migraine in children is not uncommon.
Precautions in the life of migraine patients
First, life should be regular, pay attention to the combination of work and rest, should not be overly stressed or fatigued, otherwise it will cause migraine attacks. Physical activities such as jogging, walking, swimming, taijiquan, qigong, etc. should be carried out appropriately. Exercise can enhance the toughness and elasticity of blood vessels and improve the function of vasodilation and contraction.
Second, you should maintain a good mental state of being open-minded and relaxed when things happen, and avoid mental stimulation or tension and depression. Cultivate the interest of raising flowers, goldfish, when the mood is not good, you can look at goldfish, flowers and plants to distract attention. To control anger.
Third, careful to prevent wind and cold, cold weather or sudden climate change, should pay attention to the cold to keep warm, wear a good hat or hood when you go out. Usually do not sleep when the wind or wind and rain. Women should pay particular attention to prevention during menstruation.
It is reported that many foods can induce migraine attack, such as chocolate, alcohol, cow’s milk products, lemon juice, fried fat food, pork, tea, coffee, onion, beer and seafood food, all can cause migraine attack, among which chocolate and alcoholic beverages have the strongest effect and the greatest possibility, followed by cow’s milk products and lemon juice. Therefore, migraine patients should eat light and tasty food that is easy to digest and absorb during the headache attack period, eat more fresh vegetables and fruits, eat more vegetables, especially green vegetables, avoid eating spicy and thick-tasting food, and keep the mood relaxed and the bowels unclogged, which can prevent migraine attacks.
Key points of migraine care
Migraine is the most common disease, which is an episodic neurovascular dysfunction, characterized by recurrent attacks, with a prevalence of more than 10% of the total population and more women than men. Nursing points.
(1) Reasonably arrange the patient’s work and rest, provide appropriate psychological care, care for the patient, and help the patient eliminate the attack factors, such as mental aspects to eliminate tension and anxiety. Avoid suspicious food and so on.
(2) For headache attackers, observe the nature, time, degree of headache and whether it is accompanied by other symptoms or signs. If there is multiorganic headache such as vomiting, reduced vision and limb twitching, the patient should be sent to hospital or contact with the doctor immediately to deal with the cause.
(3) For mild headache, symptomatic treatment can be given and allergic factors can be removed, such as suspicious food is one of the factors of migraine onset, such as eggs, milk and meat; for those with severe headache, frequent vomiting and difficulty in sleeping, symptomatic treatment such as analgesic and sleeping agent can be given and bed rest is needed as appropriate.
(4) Pay attention to the combination of work and rest, avoid overexertion and unstable emotions, eat in moderation, do not drink alcohol and smoke.
(5) Pay attention to personal hygiene to prevent infection, and if you have dental disease, you should first treat dental disease; female patients who have frequent headache attacks and gradually worsen when taking contraceptives can switch to other contraceptive methods.
Migraine must be distinguished from other headaches
There are various causes of headache, which must be diagnosed clearly before treatment. The common ones such as cold, hypertension, sinusitis, visual impairment, etc. can cause headache; other ones such as nervous tension headache, cluster headache, drug headache, post-traumatic headache, neuritis, trigeminal neuralgia, etc. should be distinguished one by one; more importantly, headache caused by various intracranial diseases, such as tumor, cerebrovascular disease, etc. should be diagnosed and treated early. The treatment methods for each kind of headache may be very different, and it is most important not to take painkillers indiscriminately before the diagnosis is clear, as the consequences of delaying the disease are unthinkable. The best choice is to go to the hospital to see a specialist.
Mechanisms of surgical treatment for migraine
Migraine has traditionally been treated with medication by internal medicine, but medication can only relieve or delay the onset of pain but not cure the migraine. Microsurgical dissection reveals that the normal blood vessels and nerves on the scalp are in a companion relationship and do not compress each other; however, in migraine patients, the blood vessels cause abnormal compression or entanglement of the nerves for various reasons; such abnormalities can be congenital vascular malformation entangling the nerves, compression by enlarged lymph nodes, wrapping by scar tissue, etc. This compression does not directly cause pain. This compression does not directly cause pain, but when the blood vessels in the compressed segment are overly diastolic due to various reasons such as mood swings, and when the concentration of neurotransmitters in the blood is abnormally changed due to various reasons such as endocrine changes, the compressed segment produces an abnormal stimulation of the nerve, which causes a headache attack. When this compression is removed by microvascular decompression, the headache is cured.
Efficacy of microvascular decompression for migraine
Microvascular decompression has become the only method that can completely cure migraine. Our team led by Prof. Zuo Huanyuan Zong, Prof. Ren Yanwu and Prof. Chen Guoqiang has performed thousands of migraine headache surgeries, with a complete cure rate of 85% and a significant efficiency of 94%. Of course, the treatment of migraine by microvascular decompression is selective for patients. If a clear diagnosis is made before surgery, a strict preoperative evaluation is made, and the indications for surgery are strictly controlled, it is basically possible to determine which patients are suitable for surgery and have better results, and which patients are not suitable for surgery. Patients who fall within the indications can only achieve satisfactory results by performing microvascular decompression.
Surgical treatment of migraine is very safe
Surgical treatment of migraine is very safe. The incision is only about 3 cm and is mostly made in the hairline, so the incision cannot be seen after surgery because it is covered by hair. The operation usually takes about 45 minutes to an hour, and the patient is basically pain-free during and after the operation.
Migraine is a recurrent paroxysmal hemilateral headache, the most important and common vascular headache, which is a headache caused by changes in the contractile function of the cranial blood vessels and presents a pulsating pain or distension consistent with a pulse. Migraine patients often have headache attacks during the day, but they can still occur at night. The headache is usually confined to one side of the head, but some patients may have a change in the location of the headache with each attack, sometimes with pain in the occipital area and the top of the head, or with pain in the face and neck. However, the diagnosis of migraine cannot be made only from the location of the headache. When a patient has a headache attack, the pain gradually increases, and the headache peaks in a few minutes to 1 to 2 hours, and may last for several hours or even days, and then the headache gradually decreases or disappears. In a small number of patients, there is a sudden onset of severe headache with no obvious trigger, which peaks within a few seconds and can last for several hours or even days. The pain is often pulsating, some patients present with a non-pulsating dull pain, and a few patients present with a stabbing pain in the head or a percussive sensation. Compression of the artery at the site of the headache or the carotid artery on the diseased side or the eye can reduce the headache, and the pain returns to its original state when no compression is applied. The headache can be aggravated by activity, and the pain can be reduced by bed rest, and can disappear completely by short-term sleep. Vascular headache is divided into two categories: primary vascular headache and secondary headache: primary vascular headache is also called migraine; secondary headache is mostly on both sides. It often develops in adolescence, some patients have family history, and is mostly triggered by exertion, emotional factors and menstruation. Migraine is a kind of vascular headache. Vascular headache is a headache caused by changes in the contraction function of cranial blood vessels, and there are two types of vascular headache: primary vascular headache and secondary vascular headache. Ancestral medicine has long recognized migraine, and believes that its mechanism is mostly a lesion of the three Yang meridians. In Lenglu Medical Talk, it is said that “if the headache belongs to the sun, it goes up from the back of the head to the top of the head, and the pain is even in the neck; if it belongs to the yangming, it goes up to the eye pearl and is in the forehead; if it belongs to the shaoyang, it goes up to the two horns and the pain is in the side of the head.” Migraine may be hereditary. In recent centuries, neurologists have argued that genetic factors play an important role in the pathogenesis of migraine. For example, Gawers writes, “Migraine is clearly inherited, with genetic influences being traced in more than half of the cases, often when other members of the patient’s family (up to the parents) have migraineurs.” The mode of inheritance of migraine cannot be conclusively confirmed at this time. The distribution of family members is different from recessive inheritance, which is autosomal dominant with incomplete epistasis, but it has also been suggested that it is recessive with incomplete epistasis. In conclusion, the heritability of migraine is certain, but its mode of inheritance is inconclusive.