Migraine is a common cause of headaches.

Migraine is a common cause of headaches.

Often the main problem with which the patient goes to the pharmacy is headache. What do we mean by this term? By definition, D. Harrison (1993), any pain and discomfort localized in the head area are considered a headache. In some manuals the headache is limited to the area located up from the eyebrows and to the occiput. Many patients can not clearly localize the pain, describing it as a feeling of heaviness, “nalitosti”, “someone else’s head.” According to experts, more than 90% of people experience a headache in their lifetime. Among the neurologist who applied for consultation, more than 30% indicated her as the reason for the request. Headache is the leading symptom in pathologies such as vascular diseases of the central nervous system, brain lesions, inflammatory diseases of the central nervous system, diseases of the eye, upper respiratory tract, autonomic dysfunction syndrome, depression, kidney disease, endocrine pathology. In clinical practice, isolated and independent pathological forms of headache (migraine, tension headache, cluster headache), when it occurs, regardless of any disease, and is a completely independent pathological condition.

Migraine: main symptoms and features of the course of the disease
Migraine affects an average of 19% of the world’s population. It is the most common and severe form of primary headache. WHO attributes migraine to 2 diseases in women aged 15–44 years, most often contributing to disability (WHO, 2001). Women suffer 1.5 times more often than men. Migraine – a pathology that has a hereditary nature and is transmitted through the maternal line. Headaches are associated with irritation of the trigeminal nerve on one side (therefore, the pain is one-sided). The endings of the trigeminal nerve, which are located in the vessels of the head, secrete neuropeptides, which, interacting with the receptors of blood vessels (branches of the external and internal carotid arteries), cause their dramatic expansion and increased permeability of the vascular wall. Periodic stretching of the vascular wall to the beat of the heartbeat leads to activation of pain receptors and gives the headache a pulsating character. Exercise contributes to increased pain, which can be explained including an increase in the frequency and strength of heart contractions during exercise, which increases the stretching of the walls of the cerebral arteries.

Thus, migraine headache has clear characteristics:

  • one-way localization;
  • high intensity of pain (it is so strong that a person loses the ability to work);
  • pulsating nature of pain;
  • deterioration during exercise (while walking);
  • the pain is accompanied by light and sound fear (a bright light and a loud sound irritate the patient, it is easier for him to lie in a dark and quiet room).

The duration of a migraine attack in the absence of treatment is 4–72 hours, that is, the attack does not last more than 3 days. If a person complains of constant pain for weeks and months, which, however, does not prevent him from working, it is most likely a tension headache, not a migraine.

In clinical practice, there are 2 types of migraine – with or without aura. Aura is a complex of disorders that precede the development of an attack of a headache, and sometimes can be observed simultaneously with it.

Aura includes the following manifestations:

  • visual symptoms (flickering light, points, lines, “fog” before the eyes);
  • symptoms of the sense organs (tingling, numbness);
  • speech disorders.

Observed visual and sensitivity disorders are always from the same side. Each of the symptoms of the aura can last up to 60 minutes. After the end of the aura, all these symptoms disappear.

In the development of a migraine attack, several stages are distinguished: prodromal, aura (for migraine with aura), pain, postdromic.

Prodromal (initial) stage. Begins 48 hours before the headache phase. Lasts from several hours to 2 days. At this stage, characterized by increased fatigue, mood changes, increased sensitivity to noise, irritability, decreased concentration, appetite. This stage may pass unnoticed by the patient, since the subsequent symptoms of the aura and especially the manifestation of pain have a very rapid clinical manifestation.

Aura (characteristic of migraine with aura). Developed immediately before a headache. Lasts 5–60 minutes It is manifested by visual symptoms (flickering light, points, lines, “fog” before eyes) and from the sense organs (tingling, numbness on one side of the body).

The pain occurs after prodroma and aura (if there was one) and lasts an average of 8-24 hours. One-sided, debilitating headache sharply reduced, which is accompanied by increased sensitivity to noise, light and smell, nausea, vomiting. The symptoms are aggravated by physical exertion, so the patient is looking for solitude and peace in a dark and quiet room.

Milton Montgomery