June is the month for Migraine and headache awareness .
It is a common cause of headache and neurologic cause of disability.
What is migraine?
It is an episodic or recurrent headache often one sided with characteristic features (attributed to autonomic nervous system) ,like sensitivity to sound, light, movement, and with nausea and vomiting.
Precipitating and aggravating factors could be bright light, glare, sounds, hunger, stress, food containing tyramine like aged cheese, smoked fish, cured meat, MSG ,physical exertion, atmospheric pressure and temperature changes. Hormonal fluctuations in females during menstruation, lack or excessive sleep, alcohol intake.
Mechanism
it's a brain disorder where there is a constant activation of trigeminovascular system causing release of neuropeptide like calcitonin gene related peptide , substance P from peripheral trigeminal nerve endings causing headache (dysfunction of monoaminergic sensory control system located in brainstem and hypothalamus.)
Pulsating headache due to peripheral sensitisation.
Familial mainly in females.
Familial genes identified ( FHM familial hemiplegic migraine).There is involvement of ion channels with alteration in membrane excitability .Mutations involving Ca channels,Na k ATP ase ,sodium channels.
Types of Migraine
Migraine without aura, with aura
typical aura with and without headache
Migraine with brain stem aura
Hemiplegic migraine…familial hemiplegic migraine type 1,2,3
Retinal migraine
Chronic migraine
complications of migraine status migrainous
Coming to the Symptoms
One sided pulsatile or throbbing headache lasting for 2 hrs to 3 days.
Nausea, vomiting, photophobia, phonophobia ,in classic migraine with aura ,light headedness, scalp tenderness, visual disturbances like flickers or flashes, vertigo, numbness, altered consciousness, diarrhoea ,syncope ( fainting attack), seizure,confusion.
Common migraine usually has throbbing headache, nausea with out aura.
Patient may come to ENT for headache, giddiness,vertigo, some of the patients will have one-sided nasal congestion, nasal discharge, eye watering, eye redness .
Treatment
Assessment of the extent of disability ( migraine assessment disability score MIDAS)
Migraine due to its tendency to headache it can be controlled by lifestyle adjustment, medication, avoidance of trigger factors.
Healthy lifestyle , with a heathy diet, regular exercise, regular sleep patterns, avoid excess alcohol, caffeine, stress.
Reduce stress by yoga, meditation.
Medical management
Mild to moderate symptoms simple analgesics like NSAID .
Moderate to severe needs other medications
Preventive measures
Life style alterations, nutritional supplements, medications.
Prophylactic medication for those having headache for more than 2 days a week,those with severe attacks,who cannot tolerate medications used to treat acute attacks.
To summarise migraine is a brain disorder and it's included under disability .Need to have a thorough history and examination as certain symptoms can mimic Sinusitis ,not to be confused and should not start antibiotics , straight away.
