migraine headache

MIGRAINEMohammed Nabil J AlAli

5th Year Medical StudentAt King Faisal University

Group B (210006209)

- DEFINITION- SIGNS AND SYMPTOMS- MANAGMENT

OUTLINES :

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“Migraine is a familial disorder characterized

by recurrent attacks of headache widely

variable in intensity, frequency and duration.

Attacks are commonly unilateral and are

usually associated with anorexia, nausea and

vomiting”

The word derives from the Greek (hemikrania) : pain on one side of the head ( hemi- "half“ , kranion "skull” )

DEFINITION

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According to stage :

Vague symptoms that begin from 12 to 36 hours before the aura and headache

is the complex of neurological symptoms that occurs just before or at the onset of migraine headache

resolution stage , recovery -Deprresion - fatigue For hours to two days

from 4 to 72 hours

SIGNS AND SYMPTOMS

1- Prodrome 2 -Aura

4 -Postdrome

3 -Headache

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Throbbing or pulsatile headache, with moderate to severe pain that intensifies with movement or physical activity

Unilateral and localized pain in the frontotemporal and ocular area, but the pain may be felt anywhere .

Pain builds up over a period of 1-2 hours, progressing posteriorly and becoming diffuse

Headache lasts 4-72 hours

Nausea (80%) and vomiting (50%), including anorexia and food intolerance, and light-headedness

Sensitivity to light and sound

Typical symptoms include the following:

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May precede or accompany the headache phase or may occur in isolation

Usually develops over 5-20 minutes and lasts less than 60 minutes

Most commonly visual (can be sensory, motor, or combination )

Visual symptoms may be positive or negative

Scintillating scotoma is the most common positive visual phenomenon .

DIAGNOSTIC CRITERIA

Migraine with Aura :

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DIAGNOSTIC CRITERIA

Migraine without Aura :

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Non-pharmacological

Pharmacological

- Identification of triggers- Meditation ( Yoga )- Relaxation training- Psychotherapy

Classified as : -Abortive ( acute phase )

- Prophylactic (preventive).

MANAGMENT

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Selective serotonin receptor (5-hydroxytryptamine–1, or 5-HT1) agonists (triptans)

Ergot alkaloids (eg, ergotamine, dihydroergotamine [DHE])

AnalgesicsNSAIDsCombination productsAntiemetics

Pharmacological ( Abortive )

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Pharmacological ( Prophylactic )

Frequency ( greater than 2 per month) Duration of attacks ( longer than 24 hours) Cause major disruptions in the patient's

lifestyle, with significant disability that lasts 3 or more days

Abortive therapy fails or is overused Symptomatic medications are contraindicated

or ineffective Use of abortive medications more than twice

a week Risk of permanent neurologic injury[

Some indications :

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Antiepileptic drugsBeta blockersTricyclic anti-depressantsCalcium channel blockersSelective serotonin reuptake

inhibitors (SSRIs)NSAIDsSerotonin antagonistsBotulinum toxin

Pharmacological ( Prophylactic )

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In December 2013, the FDA approved the Cerena Transcranial Magnetic Stimulator (Cerena TMS), the first device to relieve pain caused by migraine headache with aura for use in patients aged 18 years and older .

Uptodate

Any Question ?

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REFERENCES

Thank you

Prevention is Better