Migraine is a recurrent throbbing headache, which is one of the most common types of headaches. It is often preceded by flashes of light, blurred vision, and numbness in the limbs, and is followed by a throbbing pain on one side of the head for about a few minutes to an hour, which gradually increases until nausea and vomiting occur and the headache is relieved in a quiet, dark environment or after sleep. It may be accompanied by neurological and mental dysfunction before or during the onset of headache. At the same time, it is a progressively worsening disorder that usually develops with increasing frequency. According to studies, migraine sufferers are more likely than usual to have localized brain damage, which can lead to stroke. The more frequent their migraines are, the larger the area of the brain that will be damaged.
The diagnosis is not difficult with a long history of recurrent headaches, with all normal interstitial periods, a normal physical examination and a family history of migraine. Oculomotor palsy can be caused by aneurysms, and arteriovenous malformations can also be associated with migraine, and a cranial CT scan or cerebral angiogram should be performed to clarify the diagnosis. Complex migraine is often caused by organic diseases, and neuroimaging should be performed. Occipital or temporal lobe tumors may also present with visual field defects or other visual symptoms at the beginning, but as the disease progresses, symptoms of increased intracranial pressure may eventually appear. Temporo-occipital headache in the elderly should be excluded from temporal arteritis, where the superficial temporal artery or occipital artery is thickened like a rope and the pulsation is significantly weakened or absent, and arterial biopsy shows characteristic multinucleated giant cell infiltration.
Clinical manifestations According to the international headache classification and diagnostic criteria established by the International Headache Society in 1988, and combined with the clinical practice in China, they are summarized as follows.
(a) Migraine without aura (generalized migraine) is the most common. Episodic moderate to severe throbbing headache with nausea, vomiting or photophobia. The headache is exacerbated by physical activity. The attack begins as a mild to moderate dull ache or discomfort and reaches a severe throbbing or throbbing pain after a few minutes to a few hours. About 2/3 of the headaches are unilateral, but they can also be bilateral, sometimes radiating to the upper neck and shoulders. The headache lasts 4 to 72 hours and is commonly relieved after sleep. There is a clear normal interval between attacks. If 90% of the attacks are closely related to the menstrual cycle, it is called menstrual migraine. The diagnosis can be made only after at least 5 episodes of the above mentioned episodes, excluding various intracranial and extracranial organic diseases.
(b) Migraine with aura (typical migraine) can be divided into two phases: aura and headache.
1. aura phase Visual symptoms are most common, such as photophobia, flashes of light in front of the eyes, sparks, or complex visual hallucinations, followed by visual field defects, dark spots, hemianopia or transient blindness. A small number of patients may develop hemianesthesia, mild hemiparesis, or speech impairment. The aura mostly lasts for 5 to 20 minutes.
2. Headache period Often appears when the aura begins to subside. The pain mostly starts in the supraorbital, postorbital or frontotemporal area on one side and gradually worsens and extends to half of the head, or even the whole head and neck. The headache is pulsating, throbbing or chisel-like, and gradually increases in severity to a constant pain. It is often accompanied by nausea, vomiting, photophobia and phonophobia. Some patients have flushed face, profuse sweating and conjunctival congestion; some patients are pale, depressed and anorexic. One attack can last for 1 to 3 days, usually the headache is obviously relieved after sleeping, but after the attack for several days in a row, tiredness and weakness. In between attacks, everything is normal. The above typical migraine can be divided into several subtypes.
(1) Migraine with typical aura: including ophthalmic migraine, hemiplegic migraine, aphasic migraine, etc. (1) Migraine with typical aura: including ophthalmic migraine, migraine with hemiplegia, migraine with aphasia, etc. The diagnosis can be made only after at least two of these typical attacks have occurred and organic disorders are excluded.
(2) Migraine with prolonged aura (complex migraine): The symptoms are the same as (1). The aura persists during the headache attack and lasts for more than 1 hour but less than 1 week. Neuroimaging does not reveal the presence of intracranial structural lesions.
(3) Basilar migraine (formerly known as basilar artery migraine): Aura symptoms with clear origin in the brainstem or bilateral occipital lobes, such as blindness, visual symptoms in both temporal and nasal visual fields, dysarthria, vertigo, tinnitus, hearing loss, diplopia, ataxia, bilateral sensory abnormalities, bilateral light palsy or mental confusion. Most of them disappear within a few minutes to an hour, followed by a pulsating headache in the occipital region bilaterally. Everything is normal in the interval period.
(4) Migraine aura without headache (migraine isotonic attack): various aura symptoms seen in migraine attacks appear, but there are times when the headache does not follow. When the patient grows older, the headache may disappear completely while still having episodic aura symptoms, but those who completely show aura symptoms without headache are less common. those who have their first attack after 40 years of age need to be examined thoroughly to exclude thromboembolic TIA.
(iii) Oculomotor paralysis type migraine is rare. The age of onset is mostly below 30 years. There is a history of headache attacks fixed on one side, and after an episode of more severe headache (orbital or retro-orbital pain), paralysis of the ipsilateral ocular muscles occurs, most often with ptosis of the upper face. The paralysis lasts for several days or weeks and then recovers. The first few episodes of palsy recover completely, but partial ocular muscle palsy may remain without recovery after multiple episodes. Neuroimaging does not Song body exclude intracranial organic lesions.
(iv) Benign episodic vertigo in childhood (migraine equilibrium attack) with a family history of migraine but no headache in the child himself. It presents with multiple, brief episodes of vertigo, but also episodic balance disorder, anxiety, with nystagmus or vomiting. Neurological and electroencephalographic examinations are normal. Everything is normal in the interval. Some children may turn to migraine in adulthood.
(E) Migraine persistent state Migraine attacks lasting for more than 72 hours (with a remission period of less than 4 hours) are called migraine persistent state.
Causes The causes of migraine are not yet known, according to both Chinese and foreign experts, but may be related to the following factors.
(1) Genetic factors. Since about 60% of patients can ask for a family history and some patients have epileptic patients in their families, experts believe that the disease is genetically related, but there is no consistent form of inheritance.
(2) Endocrine factors, vascular migraine is most often seen in adolescent females, with frequent seizures during menstruation, seizures stopping during pregnancy and recurring after delivery, and gradually decreasing or disappearing after menopause.
(3) Dietary factors, frequent consumption of cheese, chocolate, irritating food or smoking and drinking are all prone to vascular migraine.
(4) Other factors, emotional stress, trauma, worry, anxiety, hunger, insomnia, poor external environment and climate change can also trigger migraine.
Specific explanation.
The etiology is unclear, and about 50% of patients have a family history. The tendency of migraine in female patients to have attacks before menstruation and fewer attacks after pregnancy suggests that the onset may be related to endocrine or water retention. Migraine attacks can be triggered by mental stress, overexertion, sudden climatic changes, bright light stimulation, sun exposure, hypoglycemia, application of vasodilator drugs or reserpine, and consumption of high tyramine food and alcoholic beverages.
Wolff et al. explained the clinical manifestations of migraine by the vascular origin theory. The typical migraine starts with constriction of intracranial arteries, which reduces local cerebral blood flow and causes aura symptoms such as visual changes, sensory abnormalities or mild hemiparesis, followed by dilation of intracranial and external arteries and headache.
Goltman saw intracranial vasodilatation during a migraine attack in a craniotomy patient, but Thie et al. found relatively small caliber of all arteries in a cerebral angiogram during a typical migraine attack, while Olson et al. found relatively small caliber of all arteries in a cerebral angiogram during a typical migraine attack in 11 patients. Lauritzen et al. observed by 133Xe-SPECT that rCBF was not abnormal in 12 cases of common migraine attacks, and in 8 of 11 cases of typical migraine attacks, rCBF was reduced by an average of 17% in the hemisphere corresponding to the side of the aura compared with the corresponding area on the opposite side, which lasted from 4 to 6 hours during the headache. None of the brain areas with increased rCBF were seen. On examination during the interictal period, no abnormalities were found in either type of migraine, and only one case showed a small hypoperfused area in the insula. Olsen et al. applied an intracarotid injection of 133Xe to induce typical migraine and found that the posterior CBF could be reduced by up to 20 ml/(100 g?min) with a 254-probe gamma camera, and that local hypoperfusion could persist until several hours after the disappearance of aura symptoms. Olesen et al. measured rCBF throughout the course of a typical migraine attack and observed that hypoperfusion existed in the occipital region prior to the attack, with a mean decrease in rCBF of 25-30% and a gradual extension forward to the frontal region that lasted for 4-6 hours throughout the headache period. In six cases of generalized migraine and six cases of typical migraine, 30 minutes to 8 hours after the onset of the attack, when the aura had disappeared and the headache was in progress, there was a general increase in 1CBF on both sides, which could be 25% to 35% higher than in the remission period, with the most significant increase in frontal and temporal cortex and thalamus, while the increase in occipital region was not significantly different from the remission period. There was no difference between the two types of migraine. Thie et al. applied transcranial Doppler (TCD) to examine 10 patients with generalized migraine and found that most patients showed abnormally increased flow velocity of the large arteries on both sides or individual skull bases during the remission phase of the headache. three cases showed abnormally increased cerebral blood flow velocity and broad-frequency murmurs during five migraine episodes. . Qin Zhen et al. examined 99mTc-SPECT in 2 cases of generalized migraine and found hypoperfusion in the posterior parietal cortex and temporal lobe, respectively.
Thus, cerebral blood flow may be seen to be either less, more, or first reduced and then increased, cerebral blood flow velocity abnormally increased, and cerebral vessels dilated or of smaller caliber in a significant proportion of patients during migraine attacks. However, there is no constant relationship between these changes and the type of headache, aura or headache onset. Some changes are posterior to the head, while others are anterior to the head. Not all of the abnormal findings reported by the same authors were seen in all of the same patients observed, and some patients also had localized hypoperfusion areas or increased cerebral blood flow velocity during the headache interval. In conclusion, the relationship between migraine and abnormal cerebrovascular function needs to be further elucidated.
A series of biochemical changes occur in the fashion of migraine attacks. During the aura phase, there may be a transient increase in plasma 5-hydroxytryptamine (5-HT) levels; the metabolite of 5-HT, 5-hydroxyindoleacetic acid (5-HIAA), may be significantly increased in the urine during headache attacks. This suggests that plasma 5-HT is quickly degraded and excreted in the urine. 5-HT has a biphasic effect on smooth muscle, with a decrease in plasma 5-HT causing constriction of small arteries and dilation of larger arteries. Constriction of small arteries causes ischemia in brain tissue, producing aura or other symptoms of neurological damage; dilation of large arteries causes headache. Some of the 5-HT leaks into the extracellular fluid surrounding the blood vessels, and together with histamine, bradykinin, vasopressin, and other neuropeptides, it decreases the pain threshold of the vessel wall and causes “sterile inflammation” of the arteries. The combination of vasodilatation and “sterile inflammation” causes the clinical symptoms of migraine. 5-HT is mainly stored in platelets, and when platelet aggregation is increased or 5-HT releasing factors are present, the platelet 5-HT content suddenly decreases and clinical onset occurs. Certain drugs (e.g., reserpine) have a 5-HT releasing and depleting effect and can induce headache attacks in migraine patients; 5-HT blockers (e.g., dimethyl ergometrine, phenothiazine) are used to prevent migraine attacks. The decrease in monoamine oxidase (MAO) activity during headache attacks may be related to the consumption of large amounts of MAO during 5-HT degradation.
Many experiments have confirmed that platelets in migraine patients are more prone to aggregation than in normal subjects. Platelet aggregation releases 5-HT, ADP, histamine, epinephrine, norepinephrine, arachidonic acid (AA), and thromboxane A2 (TXA2), which further contribute to platelet aggregation. This interaction produces large amounts of catecholamines, AA and TXA2, which have a strong vasoconstrictive and cerebral blood flow reducing effect. Prostaglandin E1 can cause headaches in people who have never had migraines. Estrogen increases prostaglandin synthesis, and some women taking high estrogen birth control pills can trigger migraine attacks.
But why do widespread vasoregulatory disorders and many biochemical changes affecting the whole body cause only headache? Why are most headache attacks lateralized? Sometimes they alternate between right and left?
The neurogenic theory suggests that the origin of migraine is in the central nervous system, and that endocrine changes and vasodilatory disorders are a secondary phenomenon, i.e., the vascular findings of migraine are secondary to the “release” of the nerve center. Migraine presents with a variety of complex symptoms as a result of cortical dysfunction, probably due to a decrease in the excitatory threshold of the hypothalamus/mesencephalon, causing headache attacks.
Neurons containing metanephrine 5-HT innervate certain cranial blood vessels, and their cell bodies are located in the blue spot and interstitial nuclei of the brainstem, respectively. Stress, anxiety, fatigue or other factors lead to increased excitation of brainstem neurons and release of transmitters, causing changes in cranial vasomotor activity, cerebral ischemia and “aseptic inflammation” of blood vessels, which stimulate injury receptors of trigeminal nerve endings in blood vessels and produce pain sensation in the brain. In addition, trigeminal nerve endings can release vasoactive substances (vasodilators and pathogenic peptides, substance P) into the large intracranial and extracranial vessels.
The pathogenesis of headache is caused by the stimulation of nociceptive nerve endings, i.e., nociceptive receptors, in intracranial and extracranial tissue structures by physical (e.g., inflammation, injury, or compression of a mass) or chemical (e.g., norepinephrine, 5-hydroxytryptamine, bradykinin, etc.) pathogenic factors, which produce abnormal nerve impulses that are transmitted via nociceptive transmission pathways to the central nervous system and ultimately to the cerebral cortex.
(A) Structural organization of the skull
The human skull is a circular bone cavity composed of many flat bones, called the cranial cavity. The cranial cavity is covered by the scalp, subcutaneous tissue, cap fascia, blood vessels, nerves and periosteum immediately on the surface of the skull from outside to inside, and these structures are collectively called soft tissues; there are meninges, brain tissue, blood vessels and nerves in the cranial cavity. The meninges are divided into dura mater (close to the inner surface of the skull), arachnoid and soft meninges (close to the surface of the brain) from outside to inside, and there is a cavity between the arachnoid and soft meninges called the subarachnoid space, which is filled with cerebrospinal fluid that plays a protective role for the brain. The brain tissue is divided into the cerebellum, cerebellum and brainstem, and the cerebellum is separated from the cerebellum by the cerebellar curtain (canopy). The outer image of the brainstem is a small slender “gourd”, which is connected to the cerebellum and cerebellum through the fissure of the cerebellar curtain and continues downward to connect with the bone marrow, where the nerve fibers and some nerve centers that guide information are concentrated, which is the most important part of the brain tissue, and there are several bone holes of different sizes and shapes at the bottom of the cranial cavity, through which nerves and blood vessels pass to connect the whole body with the brain. (As shown in the figure)
(B) Structures sensitive to pain inside and outside the skull
Various intracranial and extracranial tissues can be divided into two categories: pain-sensitive tissues and insensitive tissues, depending on the number and nature of nociceptive nerve endings they contain. Headache is mainly caused by the stimulation of pain-sensitive tissues (as shown in the figure).
If we take the skull as the boundary line and divide the head into intracranial and extracranial parts, we can call the following structures as pain-sensitive structures.
1. pain-sensitive intracranial structures
(1) The venous sinus and the proximal end of the large vein that drains into the venous sinus.
(2) The dura mater at the base of the skull.
(3) The arteries that innervate the dura mater.
(4) The large arteries that make up the arterial ring at the base of the skull.
(5) The trigeminal, glossopharyngeal and vagus nerves.
(6) Cervical segment 1 to 3 spinal nerves.
2. Pain-sensitive extracranial structures
(1)Scalp, subcutaneous tissue, capillary tendon membrane, and periosteum at the base of the skull.
(2) Extracranial arteries, with the superficial temporal artery, occipital artery and posterior auricular artery being the most sensitive.
(3) Head, face and neck muscles: mainly the bilateral temporalis and posterior cervical muscles.
(4) Extracranial peripheral nerves: such as supraorbital nerve, auriculotemporal nerve, greater occipital nerve, lesser occipital nerve and greater auricular nerve.
(5) Other tissues: the nasal cavity, paranasal sinus mucosa, external ear, middle ear, and dental pulp are rich in nerve endings and are sensitive to
sensitive to painful stimulation.
In contrast, the skull, most of the soft meninges, all of the brain parenchyma, the ventricles, the ventricular canal, and the choroidal filaments do not produce pain.
(3) Innervation and pain sites of intracranial and extracranial structures
The nerve impulses generated by pain-sensitive structures inside and outside the skull must be transmitted to the central nervous system through the corresponding nerve fibers, and finally to the cerebral cortex for analysis and integration in order to produce pain sensation.
1. The pain of various extracranial structures is mainly conducted by the trigeminal nerve and upper cervical nerve, and partly by the glossopharyngeal nerve and vagus nerve.
2. The intracranial innervation consists of the trigeminal nerve, the linguopharyngeal nerve, the vagus nerve, the cervical 1-3 nerve roots and the sympathetic plexus around the cerebral artery.
(1) The tissues in the anterior cranial fossa, middle cranial fossa and the cerebellar curtain are innervated by the trigeminal nerve, so the pain is often expressed in the forehead, orbit and temporal region. The tissues under the cerebellar curtain in the posterior cranial fossa are innervated by the glossopharyngeal nerve, vagus nerve, and 1-3 cervical nerve roots, so the pain is often in the occipital and cervical regions.
(2) The superior dural branch from the 2nd and 3rd cervical nerves enters the skull and distributes to the dura, vertebral artery and posterior dural artery near the foramen magnum. In the initial stage of the pontocerebellar angle auditory neuroma, the pain produced by the stimulation of the tumor projects to the 2nd and 3rd cervical nerve innervation area, which may produce a limited headache in the lower occipital region of the affected side.
(3) Most of the pain sensation at the start of large vessels in the intracranial internal carotid artery, middle cerebral artery, anterior cerebral artery and posterior cerebral artery is felt by the trigeminal nerve, and part of it comes from the sympathetic plexus on the arterial wall. For this reason, pain sensation in the intracranial artery often radiates to the periorbital, prefrontal and temporal areas.
In conclusion, when pain-sensitive structures on the cerebellar vermis are stimulated, the pain is usually felt in the frontal, temporal or parietal regions and is transmitted by the trigeminal nerve; headaches caused by structures in the posterior cranial fossa under the curtain are mainly felt in the occipital, inferior occipital and upper cervical regions and are transmitted by the glossopharyngeal, vagus and upper three pairs of cervical nerves.
The pain sensation in the face, eyes, nasal cavity, paranasal sinuses and oral cavity is conducted by the ophthalmic, maxillary and mandibular branches of the trigeminal nerve respectively; the pain sensation in the soft palate, tonsils, pharynx, posterior tongue and nasopharyngeal canal is conducted by the linguopharyngeal nerve; the pain sensation in the external auditory canal and part of the auricle is conducted by the middle branch of the facial nerve and the vagus nerve.
(D) Causes of headache
The causes of headache are many, and they are mainly physical factors, biochemical factors, endocrine factors and psychogenic factors.
1.Physical factors
(1) Headache is caused by inflammation, injury or pressure of swelling on pain-causing structures inside and outside the skull.
(2) Vessels are pulled, stretched or displaced: Headache caused by the pulling or displacement of the intracranial cerebral basilar artery ring and its main branches, venous sinus and the proximal end of the large cerebral vein that drains to the venous sinus is called traction headache. It is commonly seen in the following 3 conditions.
① intracranial occupying lesions: such as brain tumor, cerebral hematoma, brain abscess, etc.
(ii) Increased intracranial pressure: cerebral edema, hydrocephalus, venous sinus thrombosis, brain tumor or compression blockage by brain cysts affecting cerebrospinal fluid circulation, etc.
(3) Decreased intracranial pressure: commonly seen after lumbar puncture and lumbar anesthesia, due to more cerebrospinal fluid loss and decreased intracranial pressure, causing headache due to dilatation or traction of intracranial venous sinuses and veins.
(3) Vasodilation: Various causes of intracranial and extracranial vasodilation can produce headache. For example, acute intracranial and extracranial infections, hypoglycemia, hypercapnia, plateau hypoxia, gas or alcohol poisoning, seizures, acute intracranial pressure drop caused by lumbar puncture, sudden hypertension, etc., can cause the dilation of intracranial and extracranial blood vessels and produce painful symptoms.
(4) Meningeal stimulation: inflammatory exudate in meningitis, blood stimulation of meninges in subarachnoid hemorrhage, or pulling of meninges in cerebral edema can produce headache.
(5) Contraction of head and neck muscles: When the head and neck muscles are continuously contracted due to inflammation, injury or psychogenic factors, local blood flow is blocked, which can lead to the accumulation of various metabolites and the release of lactic acid, bradykinin and other pain-causing factors to produce headache, called tension headache.
(6) Nerve stimulation or lesion: Headache can be produced by self-inflammation of cranial nerve and cervical nerve or stimulation by tumor and inflammation of surrounding tissues, such as trigeminal neuralgia caused by occipital neuritis, trigeminal neuritis, pontocerebellar horn tumor or cerebral arachnoiditis.
(7) Involvement pain of head: also known as radioactive headache, lesions in the eyes, ears, nose, paranasal sinuses, teeth and neck can not only cause local pain, but also spread or reflect through nerves to the head and face, and the headache is mostly on the side of the lesion.
2.Biochemical factors
In recent years, some biochemical factors related to headache have received increasing attention. For example, 5-hydroxytryptamine (5-HT), catecholamines, bradykinin, prostaglandin E and β-endorphin, substance P, etc. have obvious changes in the blood of patients with headache (especially migraine).
3. Endocrine factors Many clinical cases can prove that the onset and relief of headache are endocrine related. For example, migraines are most common in young women and often start in adolescence. About 60% of female migraine attacks are related to the menstrual cycle; 80% of female patients experience significant relief or even complete disappearance during pregnancy. Tension headaches tend to worsen during menstruation and menopause. Hyperthyroidism also tends to cause headache attacks.
4. Psychogenic factors are headaches caused by mental factors. For example, the mental burden caused by long-term work and life stress, the injury to self-esteem, and the worry and boredom caused by the conflicts and entanglements of family and colleagues can trigger the dysfunction of the vegetative nerves and lead to headache due to vasodilator disorders.
In addition, changes in weather, noise, bright light stimulation and atmospheric pollution can also cause emotional instability and trigger headache in a few people.
Preventive treatment So far there is no special treatment that can make migraine never come back! However, it has been proven that the most effective treatment for migraine is preventive treatment during the interval of migraine, in addition to psychological adjustment and dietary regimen.
1. Reduce 3C foods
Cheese, chocolate, citrous fruit, marinated sardines, chicken liver, tomatoes, milk and lactic acid drinks are rich in tyramine. Tyramine is the main cause of blood vessel spasm, so if you have a history of migraine, then it is best to stay away from these foods.
2. Beware of sausages and hot dogs
Sausages, hot dogs, ham, bacon and other cured and smoked meats, processed meats and other foods containing nitrites, as well as foods containing MSG can cause migraines, so it’s best to eat as little as possible in your daily life.
3. Be wary of sugar substitutes
Research has found that the sugar substitute “Aspartame” (Aspartame) can over-stimulate or interfere with nerve endings, increasing muscle tension and triggering migraines. Low-sugar colas, low-sugar sodas, sugar-free chewing gum, ice cream, multivitamins and many prescription drugs all contain aspartame. So people who are allergic to sugar substitutes can trigger a headache with a small sip of low-sugar soda.
Tip from “Petite”: Pay attention to the food content label on the product packaging. If you find Amino acids, Aspartic acid or Phenylalanine on the label, you should avoid them.
In addition, Dr. Liu Yanping, a nutritionist at the Union Hospital, suggests that to sweeten food or drinks, it is best to use honey instead of white sugar and sugar substitutes.
4. Use painkillers and cold syrup with caution
Painkillers can be a tempting trap. Many people take painkillers privately in an attempt to relieve pain, but overdosing on painkillers not only fails to relieve pain, but can instead cause drug-induced “rebound headaches” that can leave you with chronic migraines. If you take more than 2 or 3 times a week painkillers to relieve pain, please seek medical attention immediately!
5. to some magnesium it!
Magnesium can regulate blood flow, relax muscles. For some people, even just a little magnesium deficiency can trigger a headache. The United States National Headache Foundation recommends that it is best to supplement 500 to 750 mg of magnesium per day.
Tip from The Dainty: Magnesium supplements can have the side effect of diarrhea, so it’s best to take them as prescribed after consulting your doctor. Or eat more magnesium-containing food to supplement on a regular basis, such as: whole grain foods, nuts and seeds (such as sunflower seeds, almonds, cashews, hazelnuts, etc.), cauliflower, tofu, etc.
6. supplement vitamin B2
Studies have found that high doses of oral vitamin B2 can reduce the frequency and duration of migraine attacks, but its dose should not exceed 400 mg a day.
7. Coffee, let you rejoice and let you worry
Caffeine stimulates the nervous system and interferes with sleep, and drinking more is addictive, while quitting coffee can trigger migraines. Therefore, it is best to consume less than 100 mg of coffee in a day (about a cup of strong coffee).
8. Drink less red wine
All alcoholic beverages can trigger headaches, and red wine in particular contains more headache-inducing chemicals. If you really want to drink a couple of glasses, it is best to choose vodka, white wine, such as colorless alcohol.
9. Learn to reduce stress
If you often cause migraines due to work stress, you may want to take a warm bath often, or try some muscle relaxation techniques, such as abdominal breathing techniques: slowly inhale, so that the abdomen fully outside the drum, exhale, feel the abdomen gradually flattened.
10. Regular exercise
Doctors point out: for people with migraine, exercises that focus on breathing training and breath regulation (such as yoga and qigong) can help patients stabilize their autonomic nervous system and reduce symptoms such as anxiety and muscle tightness.
11. Sleep regularly and refuse to lose sleep in the morning and evening
Maintaining a regular routine, going to bed and getting up regularly even on holidays, is especially important for people with migraines. Insufficient sleep or too much sleep can easily cause migraines.
12. Make good use of hot packs and ice packs
When you have a headache, try putting a hot pack on your neck and an ice pack on your forehead. Hot and cold stimulation can help you effectively relieve muscle tension and reduce pain.
13. Do shoulder and neck exercises regularly
Experts have found that pressure on certain parts of the neck and shoulder muscles can exacerbate migraines and even cause chronic migraines in people who have never had them before. So for office workers, if you need to use the computer for a long time, pay attention to the screen and seat height and sitting position, and every 50 minutes of work, it is best to take a 10-minute break, and often around the neck and shoulders.
14. Drink more water during menstruation
Migraines often occur during women’s menstrual periods, so when your period is approaching and between periods, it is best to drink more water than usual to help detoxify your body and effectively reduce the chances of migraines.
15. Be careful with your perfume and many cleaning agents
Strong odors, such as cigarettes and cigars, paint, exhaust fumes, cleaning agents and chemical detergents, printing inks, etc., can trigger migraines. It is best to open windows frequently during the day and try to avoid places with strong irritating odors such as gas stations.
16. Be careful with birth control pills
Some women start having migraine attacks after taking the pill for the first time, which usually lasts for two to four menstrual cycles. Some expert studies have concluded that women suffering from migraines taking the pill can even increase the risk of stroke.
17. Wear your sunglasses
Neurologists warn that strong sunlight and reflective flashes can increase the incidence of migraines by 25-30%. So people with migraines should wear sunglasses when they go out to avoid strong sunlight.
18. Create a quiet environment
Strong light and a noisy environment can trigger migraines. More than 70 percent of migraine patients are super sensitive to loud noises. When decorating, it is best to have workers strengthen the soundproofing of the room, and it is best to choose a slightly thicker style of curtains.
20. Eat fish to prevent headaches
Eating fish at least three times a week and taking some fish oil supplements can effectively reduce the frequency of migraine attacks.
Drug treatment measures The purpose of treatment is to prevent or reduce recurrent headache attacks in addition to relieving acute headache attack symptoms. All kinds of triggering factors should be avoided. Medication, psychotherapy, acupuncture and qigong are effective for some patients.
(a) Treatment of acute attacks Rest in a quiet and light-proof room. Mild cases can take general analgesics and tranquilizers (such as aspirin, ibuprofen, etc.), and most of them can be alleviated. Those with headache accompanied by nausea and vomiting can apply methotrexate.
Ergotamine system is effective in some patients. It is an agonist of 5-HT receptors and also has a direct vasoconstrictor effect. It mainly agonizes 5-HT1A receptors, but also has effects on dopamine and adrenergic receptors, so it has more side effects. Ergotamine caffeine tablets (each tablet contains 100mg of caffeine and 1mg of ergotamine) are commonly used, and 1 or 2 tablets are taken immediately upon the onset of aura or onset of vague pain. To avoid ergot poisoning, do not take more than 4 tablets for a single attack, and do not take more than 8 tablets per week in total. Alternatively, ergotamine tartrate 0.25-0.5mg can be used as subcutaneous or intramuscular injection. Ergot overdose can cause nausea, vomiting, abdominal pain, myalgia and peripheral vascular spasm, ischemia and other side effects. It is prohibited for people with serious cardiovascular, liver and kidney diseases and pregnant women. It is also not indicated for hemiplegic, oculomotor paralysis and basal migraine.
Infinergy (sumatriptan) is a 5-HT1D receptor agonist with highly selective effects on the cerebral vasculature. Adults receive 100 mg orally, headache relief begins after 30 minutes, and optimal efficacy is achieved after 4 hours. Side effects are mild, with transient generalized fever, dry mouth, head pressure and joint pain. Occasionally, there is chest tightness, chest pain or palpitations.
Migraine persistence and severe migraine can be treated with oral or intramuscular chlorpromazine (1mg/kg) or intravenous ACTH 50 units (in 500ml glucose water) or oral prednisone 10mg 3 times a day. Patients with prolonged attacks should pay attention to appropriate rehydration and correction of water and electrolyte disorders.
(ii) Prophylaxis Long-term prophylactic medication should be considered for those who have 2 to 3 headache attacks per month. This type of medication should be taken daily and the effect should be seen at least 2 weeks after the medication is administered. If the effect is sustained for 6 months, the dosage should be gradually reduced to stop.
1. Propranolol is a beta-adrenergic receptor blocking agent. It is effective in about 50% to 70% of patients, and the number of attacks can be reduced by more than half in 1/3 of patients. The general dosage is 10-40mg, 3 times a day. The side effects are small, and gradually increasing the dosage can reduce nausea, ataxia and painful spasms of limbs and other adverse effects.
2. Pizotifen (pizotifen, sandomigran) 5-HT antagonist, also has antihistamine, anticholinergic and anti bradykinin effect. The usual dose is 0.5 mg once daily, slowly increasing to 3 times daily. After 4-6 months of continuous treatment, 80% of patients have improved headache or stopped having attacks. Side effects include drowsiness and fatigue, increased appetite, and fattening with long-term use.
3. methysergide is a 5-HT antagonist, mainly antagonizing 5-HT2 receptors. Need to start taking small doses (0.5 to 1mg/day) and gradually increase to 1 to 2mg within a week, twice a day. It can cause side effects such as nausea, vomiting, dizziness, drowsiness, etc. Long-term use can lead to retroperitoneal tissue and pulmonary-pleural fibrosis. It must be stopped for 1 month after 6 months of continuous administration. Consider trial only in the most recalcitrant patients.
4. Calcium channel blockers Nimodipine (nimodipine) and flunarizine (flunarizine, Cipro) commonly used dose of nimodipine is 20-40mg, 3 times a day. Drug side effects are small, but discomfort such as dizziness, head swelling, nausea, vomiting, insomnia or skin allergy may occur.
5. Sodium valproate 100-400mg, 3 times a day.
6. Amitryptiline (amitryptiline) is a tricyclic antidepressant, which can block the re-uptake of 5-HT. It is mostly used for antidepressant and treatment of chronic pain, and is effective for migraine with tension headache. The common dose is 75-150mg/day.
7. Clonidine can inhibit the vasomotor center and has a hypotensive effect. The effect of preventing migraine is weak, but a small amount of application has no side effects. The common dose is 0.078mg~0.15mg, 2~3 times a day.
Treatment of migraine headache
(A) External headache
1. Wind-cold attack
(1) Treatment: Disperse wind and cold and promote the circulation of meridians.
(2) Formulas: Chuanxiong tea tune san (Taiping Huimin and Pharmaceutical Bureau Formula) plus or minus.
(3)Formulas: Chuanxiong 20g, Jingzhu 20g, Mentha 15g, Qiangwu 10g, Hessian 3g, Angelica dahurica 10g, Fangfeng 10g, Licorice 10g, finely powdered, 15g each time, taken twice daily with clear tea or as a soup, 1 dose daily, divided into 2 doses.
(4) Alternative formula: ① Wu Zhu Yu Tang (Treatise on Typhoid Fever) with addition and subtraction: Indicated in cases where the evil of wind and cold invades the syncope meridian, causing pain in the pinnacle, dry vomiting, vomiting saliva, or even cold extremities, white fur, and stringy pulse. Wu Ju Ju 10g, ginger 18g, Han Xia lOg, Ligusticum 10g, Chuan Xiong 6g, Licorice 10g. decoction in water, 1 dose daily, divided into 2 doses. ②Diversion of wind and pain relief soup (experimental formula): Applicable to the evidence of heat after feeling wind and cold, see head and neck pain and swelling, vicious wind and fear of cold. Fever, severe pain when encountering wind, slight thirst, light red tongue, thin yellow coating, floating pulse or number. Radix et Rhizoma Polygonatum wilfordii 20g, Radix Paeoniae Alba 15g, Radix et Rhizoma Dioscoreae 10g, Fructus Anemarrhenae 10g, Rhizoma Ligustici Chuanxiong 15g, Rhizoma Tianma 10g, Radix Angelicae Sinensis 10g, Radix Angelicae Sinensis 10g.
(5) Add and subtract: add 15g of Pueraria Mirifica if the pain in the neck and back is severe; add lOg of Ligustrum and 6g of Cornus officinalis if the pain in the top of the head is severe; add 10g of Cinnamomum officinale if the fear of cold is severe.
(6) clinical matters: ① this evidence is due to external sensation, the dispersal of qi-consuming products should not be too much, so as not to seriously injure the right qi; ② caution in the use of large pungent and hot products, so as not to injure yin, if necessary, can add discretionary counter-adjuvant products.
2 wind-heat disturbance
(1) Treatment: Disperse wind-heat, clear the head and eyes.
(2) Formula: Ligusticum dahuricae and gypsum soup (“Jinjian of Medicine”) plus or minus.
(3) Formula: Chuanxiong 12g, Angelica dahurica 9g, Gypsum 20g, Chrysanthemum 9g, Ligustrum 12g, Scutellariae 6g, Gardenia 6g, Peppermint 6g, Qiangwu 9g. Decoction in water, 1 dose daily, divided into morning and evening.
(4) Alternative formula: ① Chai Ge Xie Yu Tang (Six Books on Typhoid): For people with cold and wind-cold for a long time, with heat caused by depression, with symptoms of headache, gradual lightening of malignant cold, burning body heat, sore eyes and dry nose, sleeplessness, orbital pain, and floating and slightly flooding pulse. Radix Bupleurum 9g, Radix Puerariae 9g, Radix Scutellariae 9g, Radix Qiangwu 6g, Radix Angelicae 3g, Radix Paeoniae 3g, Radix Platycodon 6g, Radix Glycyrrhiza Uralensis 6g. Decoction with water, 1 dose daily, divided into doses in the morning and evening. Mulberry and Chrysanthemum Drink (Wenzhi Zhanzhi) plus and minus: For people who feel wind-warm evil, with headache, mild cough, body heat, slight thirst, pale tongue, thin yellow fur, and floating pulse. Mulberry Leaf 10g, Chrysanthemum 15g, Almond 6g, Peppermint 10g, Chuanxiong 9g, Radix Platycodon 6g. Decoction with water, 1 dose daily, divided into morning and evening.
(5) Add and subtract: If heat is injuring fluid, add 12g of Zhi Mu and 15g of Dendrobium if the tongue is red and less fluid is seen; if sores are seen in the mouth and tongue, constipation, add Huang Lian Shang Qing Wan, 5g per dose, twice daily.
(6) Clinical matters: (1) bitter cold, dispersing and stasis-transforming products are prone to depletion of qi and injury to yin, so add products that benefit qi and nourish yin according to the condition; (2) the treatment of this disease should use the genus of pungent dispersing and relieving the symptoms with products that clear heat and generate fluid, so that the medicine and evidence will be equivalent and effective.
3 wind-damp external sensation
(1) Treatment: dispel wind and remove dampness, and promote the circulation of the orifices.
(2) Formulas: Qiangwu Shengshu Tang (Treatise on Internal and External Injuries) plus or minus.
(3) Formula: Qiang Wu 9g, Dou Wu 9g, Gao Ben 6g, Fang Feng 6g, Roasted Licorice
Common sense in prevention.
Migraine is a typical manifestation of vascular headache, which is more common in young and middle-aged women and can have a family history of inheritance. There are many factors that can trigger migraine, such as exertion, stress, weather changes, mood swings, eating certain foods, etc. Migraines can be relieved with appropriate treatment, but no treatment can guarantee that the patient will not relapse. After the organic disease has been ruled out by the corresponding examination, migraine patients should completely relax themselves psychologically. Maintain a regular life, keep emotional stability, avoid irritating foods and foods that can trigger headaches, and eliminate the fear of the disease, which can minimize the number of headache attacks. Do not rely on pain relieving tablets.
To prevent migraine attacks, the first step is to eliminate or reduce the triggers of migraine, such as avoiding emotional stress, taking vasodilators and other drugs, drinking red wine and eating food containing cheese, coffee, chocolate, smoked fish, etc.
Dietary precautions for migraine patients.
Do not eat too much coffee, too cold ice cream, and do not drink too much alcohol. Experts have calculated that the ranking of foods that tend to trigger headaches are: chocolate, alcoholic beverages, raw dairy products, lemon juice, cheese, red wine, smoked fish, eggs. It is important to eat in moderation and not to drink alcohol or smoke.
You should also eat more magnesium-rich vegetables and fruits to increase the magnesium content in the brain. Including:peas and other beans and soy products and snow red, winter vegetables, mushrooms, purple cabbage, peaches, cinnamon, walnuts, peanuts, etc.
Try to avoid overexertion and emotions such as worry and anxiety, ensure good sleep, beware that it is caused by lesions of the eyes, ears, nose and sinuses, teeth, neck, etc. Pay attention to personal hygiene to prevent infection, and if you have dental disease, you should first treat dental disease.
Ways to relieve migraine: ice pack cold compress, lie down and rest for a while, massage the head, drink green tea, meditate, wrap a towel around the head.
Predisposing factors I. Habitual predisposing factors
1. High mental and psychological stress, depression or drastic mood changes: The fast-paced social environment, the discontent and pressure of life and work, and the cautious consideration of various affairs and relationships often make people’s brains nervous and depressed, which leads to the occurrence of migraines. Emotional changes are one of the significant triggers of migraine. However, whether mood changes are a precursor to the occurrence of migraine or whether they directly trigger the onset of migraine needs to be further explored. (Published by Wang Jingjing, Acupuncture Hospital)
2. Improper diet: Certain foods can cause changes in the body’s internal environment, thus leading to the occurrence of migraine.
3. Excessive exercise.
4. Irregular sleep: lack of sleep, too much sleep, irregular sleep, etc.
Second, drug triggers
1. Oral vasodilators
2. Contraceptive pills
3. Hormone replacement drugs and other drugs
4. Frequent use of ergotamine, opioids, tretinoin and other single-component painkillers (barbiturates, caffeine, isooctenamines)
Three, climate triggers
Wind, cold, humidity, heat and other climates and drastic weather changes tend to induce migraine headaches.
Humidity and heat tend to cause mood swings, irritability and loss of appetite, resulting in impaired qi and blood flow and triggering migraines.
Wind and cold tend to damage the body’s yang energy and cause blockage of the meridians, which can lead to migraine.
Special tip: migraine patients should avoid cold food and cold
Cold or cold stimulation can cause headache in 10 minutes. In winter, forgetting to wear a hat and exposing the head to cold air; swimming with low water temperature; eating ice cream or cold drinks can cause cold stimulation headache. The mechanism may be related to the vasodilation disorder caused by the dysfunction of the autonomic nervous system. It was found that in the cold environment, the bilateral temporal arteries and their branches spasm and become thin before the headache, and the arterial rage, filling and pulsation are enhanced during the headache period. After eating cold drinks, the cold stimulation of the tongue and oral mucosa by cold drinks reflexively causes spasm of the temporal arteries, and when the spasm reaches its maximum, it turns into passive dilation, and the blood flow impinges on the nociceptive nerve endings on the wall of the dilated arteries, triggering headache. In conclusion, external exposure to cold or eating cold drinks is the condition of cold irritation headache, and the basis of the pathogenesis is related to the physical and neurological dysfunctions of the blood vessels that easily induce sympathetic hyperfunction.
Therefore, care should be taken to stay away from cold environment and eat less or no cold drinks.
IV. Environmental triggers
1.Sudden change of altitude
2.From one time zone to another within a short period of time
3.Stimulation of strong light (such as TV screen, magnesium lamp, strong sunlight and other factors can make people’s eyes tired and cause headache.)
4.The stimulation of noise
5.Pollution of air
6.Sultry room
7.Some strong perfume
8.Long time electromagnetic radiation (Some people who work in front of computers are prone to migraine because of electromagnetic radiation.)
V. Female physiological triggers
1. Before puberty, the prevalence of the disease is similar for both sexes.
2, after puberty, the incidence of female than male significantly increased.
3. Headache attacks are common when women have menstrual periods.
4. After menopause and during pregnancy, headache decreases.
Tip: Menstrual cycle changes have a direct trigger effect on migraine attacks, and this condition may be related to changes in hormone levels. The onset of some female patients is directly related to the menstrual cycle and is called menstrual migraine, a special type of migraine related to the ovarian cycle. Modern medicine believes that the sudden drop in estrogen levels (lower estradiol) during the premenstrual period causes the intracranial and extracranial blood vessels to be sensitive to the consequent changes in biochemical factors (such as 5-hydroxytryptamine and other vasoactive substances), which affects the function of target organs by interfering with the sympathetic nerves, causing changes in the diastolic function of the intracranial and extracranial blood vessels in susceptible patients and resulting in migraine. In Chinese medicine, this disease is called menstrual headache. Clinical treatment is mainly based on regulating qi and blood, so that qi and blood can be harmonized and clear orifices can be nourished, then the pain will stop.