Migraine - SpeedyLook encyclopedia

Physiopathology

The causes of the disease are incompletely elucidated, but of the vascular anomalies seem to be at the origin of the Douleur S: Vasodilatation (increase in the gauge of the vessels) and increase in the vascular permeability. The Symptôme S of will have migraineuse were connected to a reduction blood flow cerebral in certain territories. In addition, the fact that many Médicament S antimigraineux interacts with the system serotoninergic directs towards an important role of some Neuromédiateur S: Serotonin and Noradrenalin.

The 20 last years studies could show that the vasodilatation of the cerebral blood-vessels was not the cause, but the consequence of the migraine. Its origin would be rather has to seek side of a deterioration of the peripheral Nervous system. The migraine would be the result of a Inflammation neurogenic (i.e. caused by an activity of the nervous system) of the blood-vessels of the Dure-mère, whose still unspecified origin with precision could be an attack of the sympathetic nervous system. However this system has a moderating effect on the fibers C noxious of the blood-vessels, while the parasympathetic system cholinergic is stimulative of these fibers C. Under these conditions, any stimulations of the noxious fibers C (as for example an activation of cholinergic fibers) will not be more blocked by a defective moderating system and will involve a neurogenic ignition at the origin of the migraineuse pain.

Diagnosis

The migraineuse crisis generally starts with the alarm clock, sometimes preceded by signs heralding that the patients know often well, enabling them to anticipate the crisis (a very early treatment makes it possible to shorten and attenuate the crisis considerably). The pains are gradually increasing in a few hours before reaching a plate. It is generally localized with a half of the cranium, alternatively on the left and on the right of a crisis with another (but the pain is fixed within the same crisis). The tiredness (Asthénie) induced by the migraine and intolerance with the external stimuli often oblige the patient to remain lengthened in the black, time that the crisis yields (24 hours on average). The end of the crisis is fast, with a discrete note of legal tender Euphorie.

Diagnoses criteria

The International Headache Society proposes the following criteria to pose the diagnosis of migraine:

the crises last between 4 a.m. and 72 hours.
the pain presents at least two of the following characteristics: taking the half of cranium, invalidating, pulsatile and worsened by the physical effort.
the migraine is accompanied by at least two of the following signs: photophobia (intolerance with the light), phonophobie (intolerance with the noise), nausea S, Vomiting S.
Occurred of at least 5 crises answering these criteria.
And absolute normality of all the other examinations, primarily neurological examination.

Will have migraineuse

Sometimes the migraines can, among certain patients, to be accompanied by sensory phenomena gathered under the name of “will have”. One then speaks about accompanied migraines (approximately 20% of the cases). These will have precede the crisis and in general last less than one hour. The migraineuse pain makes him continuation, sometimes after a time of a few minutes. Will have most frequent are will have them ophthalmic: the field of vision fills of phenomena with type of scintillating points (phosphenes), flies seeming to cross the field of vision (myodésopsies) or of luminous broken lines, being able to form complex compositions (these phenomena would be an explanation to certain religious extatic visions: the drawings or descriptions brought back by those and those having lived these felt phenomena as mystical are sometimes surprisingly close to one will have migraineuse). Visual can also consist of a homonymous Hémianopsie side will have (loss of the same half of the field of vision of each eye), a Cécité monocular transient, etc Will have sensory can often appear by disorders of the Sensibilité to types of paraesthesias (swarmings, tingling) of a hémicorps, of topography chéiro-oral (stops and hand). Others will have are rarer, and can pose problems diagnoses: transitory Hémiplégie, Diplopia by paralysis oculomotrice, mental health disorders, Hallucination S auditive, speech difficulty. In all the cases, the signs must regress quickly and without after-effect . The neurological examination is always normal in the migraine (apart from extremely rare complications, to see further).

Role of the cerebral scanner

A migraine does not require any complementary investigation provided that the crisis answers the usual criteria of typical migraine, and that the clinical examination and neurological is normal. The cerebral scanner will be practiced in the following cases:

Migraine always affecting the same half of the cranium
Will have of unusual duration (more than one hour)
Will have brutal beginning (will have it settles in a few minutes: one speaks about “walk about will have”)
Will have very atypical (diplopia, anomalies brought back to the cerebral Tronc, mental health disorders, auditive/gustatory hallucinations)
First crisis migraineuse before 10 years or after 40 years
major and recent Modification of symptomatology.

The scanner seeks a arteriovenous Malformation intracranial, a transitory ischemic Accident, a cerebral infarction.

Evolution, complications

the state of migraineux evil is a migraine whose Symptôme S are prolonged well beyond 72 hours, generally because of a Céphalée of tension added again or abuse medicamentous: the Antalgic S, and in particular the Ergotamine and the tartrate of ergotamine involve, when their consumption is chronic and very excessive, of the paradoxical cephalgias whose treatment is long and difficult.

the Infarctus migraineux is an extremely rare complication, which should not be evoked that within a very precise framework:

Survenue of a ischemic Cerebral vascular accident at a suffering individual of migraine with will have

the vascular accident occurs in the cerebral territory corresponding to the territory responsible for will have usual

All the assessment etiologic is negative (no other causes cannot explain the cerebral Infarctus).

Treatment of the migraine

Prevention of the crises

The prevention of certain recognized factors as causing the crises is a simple and very effective angle of attack at those and those whose crises are subjected to an external factor. Among these factors, let us quote the alcohol, the Tabac, the Chocolat, some Fromage S, the psychic stress, the strong Odeur S, the luminous and sound aggressions.

Treatment of the crisis

In all the cases, the rest with calm, in the black, far from any sound and luminous aggression makes it possible not to worsen the crisis. Some gestures, variable from one individual to another, have a considerable effectiveness: hot or cold shower, bath, techniques of relieving, application of cold pocket on the head. In certain case, the patient put under Oxygène (between 2 and 6 liters minutes) can see his considerably decreased pain. To be effective, the treatment must be taken as soon as possible and as well as possible as of the Prodrome S of the migraineuse crisis, but after the end of possible the for the Triptan S. will have Indeed, will have would correspond it to a phase of vasoconstriction preliminary to a migraineuse vasodilation. Therefore, the too early absorption of triptans vasoconstricteurs could involve phenomena of Ergotisme. Initially, the drugs proposed are the Paracétamol, the anti-inflammatory drugs not stéroïdiens, the aspirine, with which one can associate the Métoclopramide (Anti-émétique Neuroleptique) which improves the digestive absorption and makes it possible to reduce the nausea S. Analgesics should be taken only in the event of crisis and never with the daily newspaper, under penalty of risking a daily chronic Céphalée (CCQ, or cephalgia by medicamentous abuse with Toxicomanie with the Analgésique S). In the event of failure of these molecules, the derived from the rye pin or the triptans can be introduce: they are specific agonists of the receivers serotoninergic of the extra and intracranial vessels. Their effectiveness is very good, at the price of side effects and counter-indications which it is necessary well to put out of balance with their therapeutic effect. In the event of ultimate need, morphine remains a means of ultimate recourse.

Basic treatment

The objective of the basic treatment is to effectively reduce the frequency and the intensity of the crises of migraines. He is proposed when the crises are frequent (from 3 per month) and/or invalidating (with an important repercussion on the activities from their intensity or their duration). The most used drugs are the Dihydroergotamine, the Propranolol (Béta-blocking), the Méthysergide, the Flunarizine, the Valproate of sodium and the Amitryptilline (Antidépresseur tricyclic, particularly effective if there exists a anxio-depressive component associated with the disease). It should be noticed that all these products were created for other indications that the migraine at the beginning (anti-epileptic, antidepressant etc).

One can also quote the Indoramine (Alpha-blocking) like specific basic treatment.

The selected Molécule must be taken regularly for 3 months, with behavior of a calendar of self-monitoring where are consigned the crises with quotation of their intensity and their duration, the catches medicamentous, the possible side effects, and especially effectiveness. In the event of effectiveness, the treatment is still taken 6 months, before being gradually stopped by hoping for a more or less complete and durable remission crises.

Today some of these treatments are sometimes associated with certain classes of drugs anti-epileptics whose anti-mirgraineuse action from now on is shown.

Frequent causes

The migraine is a disease Héréditaire, beginning before 40 years with genes multiple and subjected to many environmental factors which intervene in the release of the crises. menstrual Cycle: before the beginning of the rules, it occurs a fall of the rate of Oestrogène S which frequently induces a migraineuse crisis. Individual factors: concern, contrarieties, Overwork involving a Stress which can cause a crisis, large physical efforts or intellectuals. Weather conditions: wind, cold or abrupt temperature variation. Strong odors of certain plants or perfumes. Food factors: food allergies (eggs, chocolates, strawberries, seafood, alcohols, ices, pork-butcheries,…), too rich meals, mixture of alcoholic drinks, fast of long life.

Migraineu (X) its famous

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