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Migraine its presentation and management
- 1. DR. MOHIT MATHUR Reader (Dept. of Medicine) NHMC&H
- 2. What is Migraine? Repeated attacks of headache Moderately or severely painful Frequent or infrequent Last a few hours to a couple of days Often only one side of the head hurts Often experience loss of appetite, nausea, and vomiting World Federation of Neurology
- 3. What You Might Experience During an Attack Nausea Vomiting Diarrhea Sweating Cold hands Sensitivity to light Sensitivity to sound Scalp tenderness Pale color Pulsating temple Pressure pain
- 4. Migraine headaches are often triggered by specific things
- 5. Triggers: Changes in Daily Cycles
- 6. Triggers: Environment or Diet
- 8. DEACTIVATORS OF MIGRAINE 1. Sleep 2.Exhiliration 3. Pregnancy 4.Sumatriptan
- 9. 1.2% 18.4% 47.2% 33.2% Mild Moderately severe Severe Extremely severe National Headache Foundation. American Migraine Study II: Migraine in the United States: Burden of Illness and Patterns of Treatment
- 10. 52%39% 9% Need bed rest Can work with some difficulty Can work as normal National Headache Foundation. American Migraine Study II: Migraine in the United States: Burden of Illness and Patterns of Treatment
- 11. In the past 3 months... 9 million 14 million 21 million 18 million 16 million Missed family or leisure activity Functioned less than half as well at household chores Were unable to do chores/household work Functioned less than half as well at work/school Missed Work or School Migraine Takes Time Out From Your Life
- 12. Unnecessary Suffering More than half of people with migraine suffer for at least a year before they are diagnosed with migraine 38% suffer for 3 or more years National Headache Foundation. American Migraine Study II: Migraine in the United States: Burden of Illness and Patterns of Treatment
- 13. Migraine Major Forms: Migraine without aura (common) 70% Migraine with aura (classical) 25% Migraine variants and complicated migraine 5% Hemiplegic Migraine Basilar type migraine Ophthalmoplegic Migraine Retinal Migraine
- 14. Migraine without aura No focal neurological disturbance precedes the episodes of headache. Headache is of pulsating quality, unilateral location and aggravated by walking stairs or similar routine activity. Concomitant nausea, vomiting, photophobia and phonophobia. Each episode last for 4 to 72 hrs.
- 15. Migraine with aura (classic migraine) Headache is associated with premonitory sensory, motor, or visual symptoms. Most common premonitory symptoms are visual: Scotomas in central portion of visual field Hallucinations Fortification spectrum (paracentral scotoma which expands into a “C” shape with luminous angles at the enlarging outer border)
- 19. 1 Migraine originates deep within the brain 2 Electrical impulses spread to other regions of the brain. 3 Changes in nerve cell activity and blood flow may result in visual disturbance, numbness or tingling, and dizziness. 4 Chemicals in the brain cause blood vessel dilation and inflammation of the surrounding tissue 5 The inflammation irritates the trigeminal nerve, resulting in severe or throbbing pain
- 20. Chronic Daily Headache About 4% of Americans have this condition 20% to 40% of primary care headache patients are affected Defined as 15 or more headache days each month
- 21. Chronic Daily Headache Some contributing factors: Frequency and duration of migraine attacks Overuse or misuse of certain medicines Other diseases (for example, depression or anxiety) Life style or life events
- 22. Some Medications May Cause Migraine to Become Chronic May cause chronic headaches: Opiates Combination analgesics Caffeine Barbiturate-containing medications Ergotamine tartrate, isometheptene Triptans Others Not clearly associated with chronic headaches: Acetaminophen Aspirin Dihydroergotamine Others
- 24. Self Treatment Efforts: What You Can Do For Your Migraines Rest Biofeedback Ice/heat Massage Exercise Avoid triggers Seek treatment early Keep a headache diary Take medications as directed by your doctor Many options are available for migraine relief – ask your doctor what’s right for you
- 25. Protective Factors Regular sleep Regular meals Regular exercise Biofeedback Healthy lifestyle
- 26. The National Headache Foundation For more information on headache causes and treatments visit the National Headache Foundation (NHF) Web site at: www.headaches.org
- 27. Acknowledgement: My sincere thanks to my friend Dr. Parduman Singh [MD, MRCP (I, UK), ABPN (USA), FLEX (USA), ABQEEG (USA), FAAN (USA),FAADEP (USA) CLINICAL PROFESSOR OF NEUROLOGY (OHIO UNIVERSITY COLLEGE OF MEDICINE, ATHENS, OHIO (USA)]
Notas del editor
- Respondents were asked to self-report the severity of their headaches on this 4-item scale. Eighty percent of these symptom-defined sufferers reported severe or extremely severe headaches.
- In this question respondents were asked, “How are you usually affected by your severe headaches?” There were 4 response choices : Able to work/function normally Working ability or activity impaired to some degree Working ability or activity severely impaired Bed rest required The severe impairment and bed rest codes were combined for this analysis. In 1999, over half of migraine sufferers reported that they were severely disabled or required bed rest and 92% had some disability. The distribution of impairment scores look similar, but there was a statistically significant (p<.05) shift toward higher levels of impairment between 1989 and 1999. This finding is surprising given the therapeutic advances over the last decade and may reflect greater awareness of migraine symptoms and sensitivity to disease impact. Based on national projections of this data, there are 14 million migraine sufferers who are severely disabled by their headaches.
- This slide summarizes findings for the 5 items from the disability questionnaire that was included in the 1999 survey instrument. This instrument captures 3 impact domains for a 3 month time period: work/school household chores or work family/leisure activity Reported here are the proportions of migraine sufferers who have lost at least 1 day in the last 3 months for the “missed work/school” or “unable to do” questions. For the reduced productivity questions, the proportions represent those where productivity is reduced by 50% or more for at least 1 day in the last 3 months. Work/school: 31% reported missing school or work in the last 3 months and 51% report a 50%+ decease in work related productivity. Household chores or work: 75% report being unable to do household chores or work and 66% report a 50%+ decrease in household work related productivity. Family/leisure: And 59% report missing family of leisure activity due to their headaches.
- The number of years between headache onset and diagnosis is derived by subtracting the self-reported age of initial diagnosis from the current age of each diagnosed sufferer. On average it took 4 years for these diagnosed sufferers to be diagnosed by a physician. The median time to diagnosis was 1.5 years; 5.3 million sufferers (38%) required 3+ years to be correctly diagnosed with migraine and 3.6 million of those (26%) required 6+ years to be diagnosed. This underscores the importance of careful screening for potential migraine cases and/or referral to neurology or headache specialists when appropriate. At the same time, patients must learn make their symptoms known to their provider.
- Migraine is more than just head pain. Migraine is a process that can start long before head pain begins. The process of headache is generally believed to come in phases: preheadache (prodrome and aura), headache, and postheadache. The migraine process can begin at any phase, and not all phases present themselves (either in every migraine or at all). The process of migraine can also stop at any phase: in some cases sufferers have an aura; however, the headache never develops. The variability inherent in the migraine process and symptoms makes multiple migraine treatment options extremely important.