Migraña
Una migraña...
can be described as a neurological disease characterized by recurrent headaches which are either moderate or severe. The disease is often associated with some autonomic nervous system symptoms.
In most cases, the headache will affect one side of the head and the pain will come in a pulsating nature and will last anywhere from 2 to 72 hours.
Migraines are believed to emanate from a combination of genetic and environmental factors. About 66% of migraines run in the family. Hormonal level changes are also thought to be connected to migraines as studies show that during puberty, more boys are affected but in adulthood, 2-3 more women than men are affected.
During pregnancy, the risk of migraine is known to greatly decrease. Though the exact causes and mechanism of migraine are not known, medical experts believe it is a neurovascular disorder.
This theory is based on the abnormal control of the pain neurons located in the brainstem’s trigeminal nucleus and the excitability of the cerebral cortex.
Fases de una migraña
In most cases, Migraines will occur with headaches that are recurrent and connected to autonomic symptoms. 15%-30% of individuals with migraines will experience them with an aura and will also have headaches without an aura.
The duration of the headache, the pain severity and the attack frequency are always varying. Migraines that last for a duration of over 72 hours are referred to as status migrainosus.
A migraine comes in four phases but it is not always that an individual will experience all the four.
Fase de síndrome
Premonitory or prodromal symptoms are experienced by about 60% of people with migraines. This happens with an onset ranging from 2 hours to 2 days before they start experiencing the aura or the pain.
Symptoms in this phase can include mood alteration, fatigue, euphoria or depression, certain food craving, stiff neck muscles, diarrhea or constipation, and sensitivity to noise and odors. This will occur in people with an aura and those without.
Aura
Aurae are transient focal neurological phenomena that happen before the headaches and sometimes during the headache. 30-40% of people who experience aurae will also get a sensory aura.
This is usually a pins and needles feeling that starts from one arm and spreads to the mouth-nose area on the same side as the arm.
Other symptoms include language or speech disturbance, word spinning and sometimes though rarely, a motor problem.
Dolor
Typically, the headache or the pain is throbbing, unilateral and can range from moderate to severe. The headache comes gradually and is mostly escalated by physical activity.
In over 40% of migraine cases, the pain experienced is bilateral and neck pain is a common occurrence. In adults, the pain lasts between 4 and 72 hours and in children, it has been found to occur for a period less than an hour.
The pain frequency varies from a number of cases in a lifetime to several in a week with the most common frequency being once in a month.
Postdrome
The effect of a migraine can be felt a few days after the main pain or the headache is over. This is what is referred to as the migraine postdrome.
Most people who have experienced migraines report experiencing a sore feeling where the pain was and there are reports of impaired thinking during this period.
The symptoms of this phase are fatigue or a ‘hang over’ feeling, cognitive difficulties, mood altering, weakness and gastrointestinal symptoms. The feeling after a pain attack can be refreshing and euphoric, or malaise and depression.
Causas de una migraña
Migraine causes are not known. Though this is the case, they are believed to be a result of a mix of genetic and environmental factors.
Most migraines run in the family and will rarely occur as a result of single gene defects. Initially, it was believed that migraines occur in people with a high intelligence but this has been disapproved.
There are many biological events associated with migraines as are psychological conditions such as bipolar disorder, anxiety and depression.
Fisiopatología
It is believed that migraines are neurovascular disorders. Some medical researchers have placed neuronal mechanisms as playing the greater role while others believe that blood vessels are at the center of migraines and the other group believes that both the neuronal mechanisms and blood vessels are involved.
5-hydroxytryptamine or neurotransmitter serotonin in high levels is believed to be another element involved in the occurrence of migraines.
Diagnóstico
The signs and symptoms of a migraine are what its diagnosis is based on. There is no need for neuroimaging tests when diagnosing migraines but this test might be used in other headache cases that are not migraines.
Studies have shown that a good number of people with migraines have not been diagnosed. If an individual experiences 2 of the following: inability to work or study in a day, nausea, or photophobia it is possible that they have a migraine.
If they experience 4 of the following: pain occurring on one side of the head, pulsating head ache for a duration of between 4 and 72 hours, nausea, and other symptoms that affect their personal life, then the chance of this being a migraine is 92%. For people with less than 4 of the above signs and symptoms, then the probability drops to 17%.
Tratamiento
Prevención
El tratamiento preventivo de la migraña puede incluir suplementos nutricionales, cambios en el estilo de vida, medicamentos y cirugía. Los expertos recomiendan la prevención en personas con cefaleas de más de dos días a la semana, con ataques graves incontrolables o que no toleran la medicación para los ataques agudos.
Medicación
Los medicamentos preventivos para las migrañas sólo se consideran eficaces si disminuyen la gravedad y reducen la frecuencia de los ataques en un 50% o más. Algunos de los medicamentos que se utilizan son propranolol, metoprolol, topiramato, divalproex/valproato sódico y timolol. El frovatriptán ha demostrado su eficacia en la prevención de la migraña menstrual.
Tx360 es otra solución, un dispositivo para el tratamiento de la migraña, que ha ayudado a los afectados en casi el 90% de los casos.
Terapia alternativa
Acupuntura has been found to be equally effective but with less side effects as compared to preventive medication. Stress reduction techniques such as biofeedback, relaxation and cognitive behavior therapy have been found to be effective. Of all the alternative medicines used in dealing with migraines, butterbur has the best evidence for use.
Cirugía
Para las personas que no muestran ninguna mejoría con la medicación se recomienda la cirugía. Se trata de la descompresión de algunos nervios situados alrededor del cuello y la cabeza.
Gestión
El tratamiento de la migraña pasa por tres aspectos: la prevención farmacológica, el control sintomático agudo y la evitación de los desencadenantes. Aunque la medicación es eficaz en las primeras fases del ataque, un uso excesivo puede causar "cefalea por sobreuso de medicación", lo que conduce a una mayor gravedad y a un aumento de la frecuencia. Por eso se recomienda que toda persona con migrañas o cefaleas recurrentes busque atención médica adecuada.
