OVERVIEW
Complex migraine is a rare type of migraine, which is characterized by recurrent attacks with aura and concomitant symptoms and normal periods between attacks. There is often a family history of the disease, which occurs more often in adolescence and is more common in females than males. Mild limb paralysis or eye muscle paralysis occurs during or after the migraine attack, and the paralysis may still last for a period of time after the pain is relieved, and it is often unilateral paralysis.
Etiology
Genetic, dietary, endocrine and psychiatric factors have a certain relationship with the development of this disease. There are often triggers for the onset of the disease, and there are often multiple triggers, commonly sleep disorders, overwork, diet, etc.. It is currently believed that the complex interaction between multiple susceptibility genes and between susceptibility genes and environmental factors leads to dysfunction in the balance of excitation and inhibition in the central nervous system, and the trigeminal vascular pathway is repeatedly activated and sensitized, resulting in headache attacks and other accompanying symptoms.
Symptoms
The attacks are often throbbing and unilateral, often accompanied by nausea and vomiting, and usually begin in childhood or adolescence, and often stop in adulthood and are replaced by other types of migraine. It is characterized by different degrees of paralysis of ipsilateral or contralateral limbs and weakening of upper and lower limbs, especially upper limbs, at the same time or after the attack, and may last for a period of time after the headache subsides.
Examination
Cranial CT, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) can exclude headache caused by other diseases, and electroencephalogram during headache attack can also assist in the diagnosis, and the hemisphere opposite to hemiplegia can show slow wave.
Diagnosis
The diagnosis of migraine can be made by referring to the diagnostic criteria developed by the International Headache Society (1988).
1. Migraine without aura (common type)
Migraine without aura (generalized migraine) meets 2 to 4 of the following criteria and has at least 5 attacks.
(1) Each attack lasts 4 to 72 hours (untreated or untreated).
(2) Have at least 2 of the following characteristics: (1) unilateral; (2) throbbing; (3) moderate to severe pain (interfering with daily life); (4) aggravated by walking up stairs or other similar daily activities.
(3) At least one of the following during the attack: (1) nausea or vomiting; (2) photophobia and phonophobia.
(4) History and physical examination suggest that there is no evidence of organic or other systemic metabolic diseases, or that they have been ruled out by relevant investigations; or that although there is some organic disease, the first migraine attack is not closely related to that disease.
2. Migraine with aura (classic)
At least 2 attacks with at least 2 of the following.
(1) At least 3 of the following characteristics: (1) 1 or more fully reversible aura symptoms, manifested by focal cortical and/or brainstem dysfunction; (2) at least 1 aura symptom progresses gradually and lasts for more than 4 minutes or 2 or more symptoms occur in succession; (3) the duration of the aura symptom is less than 60 minutes, but with more than 1 aura symptom, the duration is prolonged accordingly; (4) the headache occurs at intervals after the aura symptom, and the headache is not associated with the disease; and (5) the headache is not associated with the disease. Headache occurs after the aura symptoms with an interval of less than 60 minutes (headache may occur simultaneously with the aura symptoms).
(2) History and physical examination suggest that there is no evidence of organic and other systemic metabolic diseases, or they have been ruled out by relevant investigations; or although there is some kind of organic disease, the first attack of migraine is not closely related to that disease.
Differential diagnosis
1. Cluster headache
This disease, also known as histamine headache, is more common in males than females, and most of the patients have no family history of the disease, which is relatively rare clinically. The headache usually occurs once or twice a year, and is more common in spring and fall. The cluster period usually lasts for 3 to 6 weeks, with a longer period of remission.
2. Tension headache
Also known as myoclonic headache, neurotic headache, etc., is one of the most common primary headaches, accounting for about 70% to 80% of headache patients. It manifests as a tight, pressurized, or dull ache in the head, more typically with a girdling sensation. As a transient disorder, tension headache is mostly associated with stress in daily life, but if it persists, it may be one of the characteristic symptoms of anxiety or depression.
3. Non-migrainous vascular headache
Patients with arteriosclerosis may have ischemic pain due to reduced local cerebral blood flow, but it is usually not severe, without nausea and vomiting. Patients with hypertension sometimes have throbbing pain in the frontal and occipital regions, and measurement and control of blood pressure can help diagnosis.
Treatment
The aim of treatment is to terminate the headache attack and relieve the accompanying symptoms as soon as possible, as well as to reduce or avoid adverse effects, prevent recurrence and restore normal life function.