Definition
Migraine (vasoneurotic headache) is the most common and most important type of vascular headache, presenting with pulsating pain or swelling in line with the pulse. The headache can be aggravated by head lowering, heat, exertion, coughing, etc. On examination, the temporal artery is seen to be elevated with increased pulsation, and the headache may be relieved by compression. It often develops in adolescence, and some patients have family history. It is mostly triggered by exertion, emotional factors and menstruation.
Etiology and pathology of migraine
The pathogenesis of migraine is not yet clear.
(1)Vascular origin hypothesis
(2) neurogenic hypothesis.
Symptoms
In typical cases (ophthalmic migraine), the headache attack is preceded by ocular aura, such as flashing glow, black haze, foggy vision, hemianopia, etc. There may also be numbness of face, tongue and limbs, which is related to intracranial vascular spasm. After about 10-20 minutes, it is followed by extracranial vasodilatation and severe throbbing pain or distension on one or both sides, mostly accompanied by pallor, cold limbs, drowsiness, etc. There may be changes in mood and behavior; the headache reaches its peak followed by nausea, vomiting, and lasts for several hours to a day to recover. The frequency of attacks varies.
Those without the above aura are called “common migraine”. They are more common and can last for several days.
Migraine patients often have headache attacks during the day, but can still have attacks at night. The headache attack 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, 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. Activity can make the headache worse, bed rest can reduce the pain, and short-term sleep can make the pain disappear completely.
Diagnosis
Medical history.
Physical signs.
General examination.
Ultrasonography.
Electroencephalogram.
Imaging studies.
Treatment
Treatment of migraine should firstly be relaxed mentally, and secondly, trigger factors should be excluded, such as foods containing fat, alcohol and tyramine should be avoided, pay attention to the combination of work and rest, keep the environment quiet, avoid sunlight and hunger.
In case of mental tension, sedatives (such as Valium) and analgesics (such as painkillers) should be given in time to relieve the headache faster. When vomiting is obvious, gastrofacial or morphine can be given.
Non-steroidal anti-inflammatory analgesics, such as aspirin 600 mg daily or anti-inflammatory pain 75-150 mg daily, can also be given during headache attacks. The drug has anti-prostaglandin effect and can inhibit platelet agglutination, which is more effective when applied early in the headache attack.
Caffeine ergotamine tablet is a special medicine for migraine, 1 to 2 tablets each time. If the attack cannot be relieved, take an additional one after 0.5-1 hour. Do not take more than 6 tablets for a single attack, and do not exceed a total of 12 tablets a day (reduce by half for children); overdose may cause ergot toxicity and is contraindicated in pregnancy and in patients with severe heart, lung, and kidney problems.
Preventive treatment
Since migraine is a recurrent headache, long-term prophylaxis should be given if there are more than 2 to 3 attacks per month.
Cardiotrope 30-120 mg daily.
Calcium ion orange antagonist: nifedipine 30mg daily, cipro 5mg,qn;
benzathine 0.5 mg,tid.
Nimodipine 90 mg daily.
Dimethyl ergometrine, initially 0.5 mg daily, gradually increased to 7 mg per dose four times a day in January.
Hypertension can trigger or aggravate migraine and should be treated concurrently.
Those with depression or anxiety should also be given antidepressant or anxiety medication in time.
Pain management
In addition to the aforementioned treatments, there are some special treatments in the pain department that can be combined for better efficacy.
Head and neck pain spot injections.
Cervical nerve block, occipital greater nerve block, etc.
stellate ganglion blocks.
Patients with combined cervicogenic headache can also undergo image-guided minimally invasive interventional analgesia.