What to do if one is suffering from Migraine?
Migraine is a paroxysmal headache disorder characterized by varying degrees of recurrent vascular-quality headache, photophobia, sleep disruption and depression.
Pathophysiology
Although the mechanism of migraine remains not completely understood, various theories have been put forward: vascular theory, depolarization theory, serotonin theory and neural theory.
Variants of Migraine
According to the ICHD(International classification of headache disorders), second edition(ICHD-2), there are the following subclasses of migraine(some of which include further subdivisions):
- Migraine without aura or common migraine.
- Migraine with aura.
- Childhood periodic syndromes.
- Retinal migraine.
- Complications of migraine.
- Probable migraine.
Clinical Features
There are 4 phases of migraine attack:
- The Prodrome phase is the one that occurs hours or days before the headache.
- Aura phase, which immediately precedes the headache.
- Pain phase, also known as the headache phase.
- Postdrome phase.
Diagnosis
To diagnose migraine without aura, according to the IHS, can be made according to the following criteria: five or more attacks,4-72 hours with nausea/vomiting, photophobia/phonophobia; and two or more of these symptoms: unilateral, moderate/severe pain intensity, pulsating, worsened by physical activity.
Management
Conventional treatment mainly focuses on three areas: Trigger avoidance, abortive therapy and prophylactic pharmacological drugs.
- Trigger avoidance: Avoid alcohol, birth control pills, caffeine, anxiety, smoking or exposure to smoke, hunger and loud noises.
- Abortive therapy: Analgesics/nonsteroidal anti-inflammatory drugs(NSAIDs): High dose aspirin 900 mg/6h or paracetamol 1g/6h p.o. with metoclopramide. Serotonin agonists: Sumatriptan
- Prophylactic therapy: propranolol, atenolol, metoprolol, flunarizine, sodium valproate, topiramate, and tricyclics are commonly used drugs.