Condition characterized by moderate to severe headache and nausea. It is 3 times more common in women than men. The typical migraine headache is unilateral (affecting one half of head), lasting from 4 to 72 hours. Approximately one-third of people who suffer from migraine headache perceive an aura. aura may be transient visual, sensory, language or motor disturbances which means that migraine will soon occur. A migraine headache is a form of vascular headache it is caused by vasodilatation(enlargement of blood vessels) that cause the release of chemicals from the nerve fibres that coil around the large arteries of brain. Enlargement of these blood vessels stretches the nerves that coil around them and cause nerves to release chemicals. These chemicals cause inflammation., pain and further enlargement of the artery. This increasing enlargement of the arteries magnifies the pain.
Migraine commonly activate the sympathetic nervous system in the body. The sympathetic nervous system thought of as apart of nervous system that controls and responses to stress and pain and this activation causes symptoms associated with migraine attacks.
There are different classes of migraine which are given as under…..
1)migraine without Aura/ common migraine
2)migraine with Aura
3)Basilar sporadic migraine
Migraine without Aura/common Aura
It involves migraine headache that are not accompanied by any aura(visual disturbances). Visual disturbances in the form of flashes of white/black lights or formation of zigzag lines, or sometimes temporary blindness of one eye.
Migraine with Aura
It usually involves migraine headache accompanied by an aura. Less commonly an aura can occur without a headache or with a non-migraine headache. Two other varieties are familial hemiplegics migraine and sporadic hemiplegics migraine, in which patient has migraine with aura and with motor weakness. If close relative had same type of condition then it is said to be familial hemiplegics migraine.
Basilar sporadic migraine
In this type of migraine, migraine and aura is usually accompanied by difficulty in speaking, vertigo, ringing in ears.
It involves migraine headache accompanied by visual disturbances or even temporary blindness on one eye.
Causes of migraine
Causes of migraine include triggers, serotonin, neural.
Migraine can be induced by triggers common triggers are stress, hunger, fatigue. Monosodium glutamate is frequently reported as dietary trigger. It also occur around menstruation, other hormonal influences such as menarche, oral contraceptives use, pregnancy, menopause also play an important role.
it is a type of transmitter, or communication chemical, which passes message between nerve cells. It helps to control mood, pain sensations, sexual behaviour, sleep as well as dilation and constriction of blood vessels. Lower level of serotonin in brain lead to constriction and dilation of blood vessels which triggers migraine.
When certain nerve or an area of brain become irritated migraine begins,in response to this body release chemical that cause inflammation and further irritation of nerves occur and results in pain.
Signs of migraine
Migraine typically presents with headache, severity of pain, duration and frequency is variable. Four possible phases of migraine occur
a) prodrome occurs hours or days before headache
b) aura immediately precedes headache
c) pain phase/headache phase
it occurs in 40-60% of patients having migraine. It consists of altered mood, irritability, depression , fatigue, yawning, excessive sleepiness, craving for certain food(chocolate), dizziness, stiff muscles especially neck muscles, hot arms, constipation/diarrhoea, increased/decreased urination.
20-30% sufferers experience migraine with aura. They appear gradually over 5-20 minutes and lasts for 60 minutes but sometime delayed up to several hours and can be missing entirely(silent migraine).
Visual aura consist of flashes of white/black, multicoloured lights(photophobia)or formation of dizzling zig zag lines(scintillating scotoma). Some patients complaints of blurred vision or shimmery or cloudy vision, as they were looking through thick or smoked glasses.
Par aesthesia i.e. feeling of pins and needles experienced in hands and arms as well as in nose mouth area on same side.
During this phase migraine headache is unilateral(one side of head), moderate to start at one side and become generalized. Pain peaks and then subsides and usually lasts 4-72 hours in children. Frequency of attack is variable from few in life time to several a week. Headache accompanied by nausea(90%)and vomiting. Photophobia(intolerant to bright light), phonophobia(intolerant to loud noise) and osmophobia(fear or hypersensitivity to smell), blurred vision, nasal stuffiness. Diarrhoea or sweating may occur. There may be localized oedema of scalp or face, scalp tenderness, prominence of vein or artery in temple, tenderness of neck, disturbance in mood is common. Extremity tend to fell cold and moist. Sometime light headedness and feeling of faintness may occur.
Patient may feel tiredness and have head pain, gastric problems, mood changes and weakness of the body.
Diagnosis of migraine
a) five or more attacks. For migraine with aura,2 attacks are sufficient
b) 4 hors to 3 days in duration
c) It may be unilateral(affecting half the body), moderate or sever pain in intensity, aggravation by or causing avoidance of routine physical activity
d) Presence of nausea or vomiting or sensitivity to both light and sound.
Migraine can be differentiated from other headache—- there is extreme painful headache, unilateral hardly 15 minutes to 3 hours. Onset is rapid.
Treatment of migraine
Beta blockers mainly propanolol, atenolol and metaprolol. calcium channel blockers mainly amlodipine, flunarazine and verapamil. Anti convulsants like sodium valproate. Tricyclic anti depressants are commonly used. In addition to this nefazodone, amitriptyline commonly used for migraine. Low dose aspirin is beneficial for the occurrence of migraine sometime paracetamol alone or in combination with metaclopromide is given. Dihydroergotamine is also useful to some extent.
Physiotherapy treatment of migraine
Physiotherapy uses mobilization and manipulation of joints and muscles in the neck. Therapist will suggest exercises that will help with muscle function and rehabilitation. Physio employ ultrasound or electrotherapy to ease muscle tension. Another effective treatment used to treat pain is hydrotherapy. It involves the use of water to ease pain. Use of hot water bath and cold water bath is done. Placing your feet in hot water and then put an ice pack or cold cloth on head where the pain is more intense. This stimulates circulation and eases tension in the muscles.