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VOL: 99, ISSUE: 34, PAGE NO: 27


Migraine is an episodic headache, typically unilateral, often associated with nausea, vomiting, visual disturbance and dizziness.



- In many patients the headache is bitemporal and generalised and there may be no associated focal, visual or neurological disturbance.



- Migraines are divided into two categories; with or without aura.



- Migraine is the most common neurological condition and affects 8-14 per cent of people in the developed world.



- Women are more affected than men. The condition usually starts after puberty and continues to late middle age. Up to 90 per cent of those affected will have had their first migraine attack by the age of 40. Attacks occur at intervals that vary from a day to months and last for a few hours to days.



- Migraines may be inherited - 70 per cent of patients have other family members with the condition.



- People who have migraines are usually symptom-free between attacks.



- Most people (70 per cent) experience migraine without aura.



- Migraines may be caused by an underlying central nervous system disorder that affects the brain’s vascular system. Stress or some unknown factor triggers the release of peptides, which dilate blood vessels and causes over-excitation of nerves in the trigeminal pathway.



- Research suggests that some migraines may be caused by abnormalities in calcium channels. Two neurotransmitters, serotonin and dopamine, may be involved.



- Stress.



- Intense physical exertion.



- Female hormones.



- Bright or flickering lights.



- High altitude.



- Travel motion.



- Changes in sleep patterns.



- Low blood sugar.



- Alcohol, especially red wine.



- Certain foods such as chocolate, citrus fruits and cheese.



- Anxiety.



- Depression.



- Chemicals such as monosodium glutamate (MSG), caffeine and the amino acid tyramine.



- Triggers are unique to each individual and some patients are not affected by any triggers.



- Migraines progress through five phases, each with its own distinct symptoms (Blau, 1987). Not every person experiences all phases: up to 70 per cent of people do not experience auras.



- Prodrome (subtle symptoms, so may not be noticed) - craving to eat sweet food, mood variations, tiredness, mild photophobia and heightened visual perception.



- Aura - multicoloured visual disturbances, scotoma with flickering, scintillating edge, tingling of face (sometimes one-sided) and numbness of face.



- Migraine headache - throbbing pain that lasts 2-72 hours. Patients may experience other symptoms such as nausea, vomiting, blurred vision, difficulty concentrating, fatigue and photophobia.



- Resolution - sleep, vomiting.



- Postdrome - drained feeling, euphoria, impaired concentration, irritability; cerebral flow observations indicate that anomalies can outlast headache by 24 hours.



- Gastric stasis, whereby the gastric system slows down significantly, or stops temporarily, may occur during a migraine attack.



- A high dose non-steroidal anti-inflammatory drug together with an antiemetic can prevent a migraine attack. The earlier the medication is taken the more effective it will be.



- If these measures are inadequate, then triptans should be used.



- Prophylactic drugs are available, such as beta-blockers, pizotifen, calcium channel blockers and antidepressants. As prophylaxis will not stop all attacks the patient will often require a triptan.



- Advise patients to identify and avoid their own trigger factors.



- Help the patient find the right treatment and diet/lifestyle changes.





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