The migraine Is a pathology that affects the central nervous system, it presents in the form of headache or intense and recurrent headache, usually Pulsatile and associated to different autonomic symptoms (Buonanotte and Buonanotte, 2013).
It is a medical condition that usually appears in the form of temporary crises, lasting for hours or days. Within its clinical course, some of the Signs and symptoms that accompany migraines are nausea, vomiting or sensitivity to light, among many others (Mayo Clinic, 2013).
Specifically, migraines are one of the most common types of headache, along with tension headaches. Thus, more than 15% of General population presents the diagnostic criteria of this pathology (Riesco, García-Cabo and Pascual, 2016)
Migraine is a pathology that falls within the group of diseases that are more prevalent or common among women. In addition, Prevalence tends to decrease with age (Riesco, García-Cabo and Pascual, 2016).
Although the etiologic cause of migraine has not been accurately known for several decades, it has been associated with dilatation and / or constriction of The cerebral blood vessels (Cleveland Clinic, 2015). However, other positions are currently under investigation.
The diagnosis of migraine is usually made based on clinical criteria. This pathology is a recurring condition in the medical services of Urgencies, so the first phase of medical management consists of the precise identification of the signs and symptoms present in each case.
In the case of treatment, there are numerous medical interventions to control the clinical picture associated with migraine, pharmacological therapies and not Pharmacological. In addition, different interventions aimed at preventing attacks or migraine attacks have also been described.
Features of migraine
The pain that affects To the brain Or the"extremity"head is called headache. This type of disorder is one of the problems that the human being Has been historically concerned, for more than 3,000 years before Christ (Buonannotte and Buonannotte, 2013).
Headache is a medical condition that has been clinically referenced in findings as old as the Ebers Papyrus, the writings of Hippocrates Or Galen, among many others (Buonanotte and Buonanotte, 2013).
Currently, recurrent headaches or headaches are considered to be one of the most common pathologies affecting the central nervous system (WHO, 2016).
The World Health Organization notes that approximately half of the adult population has experienced at least one episode of headache during the Last year (WHO, 2016).
In addition, it states that headache is a significantly painful and disabling medical condition, within which Migraine, tension headache and headache in outbreaks (WHO, 2016).
The headache may have a primary origin, without an etiological medical cause, or secondary in which an associated pathology can be identified.
Specifically, most primary-source headaches are due to a migraine.
As we have pointed out, migraine is a type of headache. It is considered a complex neurological disorder that can systematically affect everything The organism, giving rise to a wide variety of symptoms (Migraine Action, 2016).
It is a pathology that can be presented differently among those affected, so that its signs and symptoms may be overlooked or confused with Other diseases (Migraine Action, 2016).
Although the clinical features of migraine have been accurately described, it remains a poorly understood disease. In addition, in most People who have it, remains undiagnosed and consequently untreated.
Migraine presents with severe and severe headache, accompanied by symptoms such as nausea, vomiting eye pain, vision of spots or spots, Sensitivity to light / sound, etc. (Nall, 2015).
It usually appears as an attack or temporary crisis, however, migraine is considered a public health problem with significant costs Social and economic (Migraine Action, 2016).
About us
Most of the headaches present a primary origin, that is, without an explicitly associated medical cause or pathology (Riesco, García-Cabo and Pascual, 2016).
Specifically, numerous investigations have indicated that more than 90% of the total cases of headache or primary headache are due to migraines And / or tension headaches (Riesco, García-Cabo and Pascual, 2016).
Migraine is the third most common disease in the world. In the United States, it has been estimated that approximately 18% of women, 6% Of men and 10% of children, migraine sufferers (Migraine Research Foundation, 2016).
Although, the figures on the prevalence and incidence of this pathology are not precise, it has been pointed out that approximately 15% of the population Of the world can meet the criteria for establishing a diagnosis of migraine (Riesco, Garcia-Cabo and Pascual, 2016).
Thus, different institutions have pointed out that this neurological disease has a worldwide frequency of approximately 38 million (Migraine Research Foundation, 2016).
As for the distribution by sex, migraine is more frequent in women than in men, around double or triple, mainly due to Hormonal influences (WHO, 2016).
On the other hand, in relation to the typical age of presentation, it usually appears in the stage between puberty and adolescence. In addition, Particularly affect people between the ages of 35 and 45 (WHO, 2016).
In addition, it is a pathology whose frequency tends to decrease as the age advances, more significantly after 50 years of age (Riesco, García-Cabo and Pascual, 2016).
Health records indicate that in the United States every 10 seconds a person goes to the emergency room with severe headache or
(Migraine Research Foundation, 2016).
In addition, despite the fact that those affected by migraine usually present these attacks once or twice a month, approximately 4 million suffer form Chronic, presenting signs and symptoms at least 15 days a month (Migraine Research Foundation, 2016).
Signs and symptoms
Migraine is often associated with an intense, recurrent, throbbing headache that is restricted to one side of the head.
Although, the characteristic signs of this pathology are described in different clinical classifications, the symptoms can Presented in innumerable ways, varying significantly between all the affected people (Buonannotte and Buonannotte, 2013).
Thus, although the common factor is pain, there have been described alterations restricted to other areas such as sensory and sensory manifestations, Cognitive, affective, autonomic or motor (Buonanotte and Buonanotte, 2013):
Headache
Headache is defined as discomfort or pain that can be located anywhere on the head (Cristel Ferrer -Mapfre Salud, 2016).
In this way, headache or headache is the central symptom of migraine. Typically, this symptom is described as pulsatile, however, Not all patients perceive it in the same way.
In emergency medical services, many people report feelings of oppression, weight, tearing or tension in the head, especially in the Moments.
The intensity of this malaise is variable, between the episodes and between the affected ones, as well as their duration, which is modified according to the Administration or not of an appropriate treatment.
Usually, episodes of pain present a temporality of hours or days and usually appear unilaterally, that is, it is more frequent than Affect one side of the head.
As to its precise location, a higher prevalence of fronto-temporal pain has been observed, that is, behind the eye or surroundings.
In addition, another important aspect is the association of the increase of pain with the movement, reason why the patients tend to the stillness and to the search Of rest situations.
Autonomous manifestations
Alterations and autonomic changes can occur both in the course of an episodic and in the resolution of these.
Usually, the headache is accompanied by paleness, sweating, tachycardia, cold hands, hypo or hypertension or bradycardia.
In addition, grathrointestinal discomfort, is another of the most common findings in migraines. Nausea and vomiting may occur before or after Pain, however, are much more frequent at the end of crises.
Other less common gastrointestinal signs and symptoms are constipation, bloating or diarrhea .
In addition, fluid retention and weight gain is a frequent situation in the moments prior to the development of an episode of migraine, Especially in women.
On the other hand, it is also common for patients to report feeling dizzy during crises, mainly associated with the intensity of pain And the presence of other symptoms such as Vertigo .
Sensory Manifestations
Although some of the sensorial manifestations may be eclipsed by the headache, they may be visual, somato-sensory, Olfactory, auditory and / or gustatory.
Specifically, about 80% of the affected individuals tend to appear excessive sensitivity or intolerance to intense light, brightness or radiance. Similarly it happens with the elevated sounds, or the typical ones of a conversation between several people.
As for the olfactory manifestations, in some cases the presence of osmophobia has been observed, that is to say, aversion to certain odors, as well as Hyperosmia or increased general sensitivity to odors.
In addition, the presence of positive symptoms, especially in the visual area, has also been described. Many patients report spotting spots or spots Bright, especially in the stages of greater intensity of pain.
On the other hand, in the case of the somatosensory sphere, it is possible the development of sensations of tingling and paresthesia in the extremities.
Cognitive Manifestations
Alterations related to the psychological and cognitive spheres of the affected persons are varied and can appear in any of the phases of The episodes or crisis of migraine.
The main cognitive changes have been related to the presence of space-time disorientation, confusion and / or executive dysfunction.
In addition, in the most disabling stages of migraine attacks, those affected may show language-related alterations, specifically There is a significant difficulty in articulating simple words and / or sentences.
On the other hand, regarding the manifestations related to the psychological sphere, the presence of anxiety, hostility, anxiety, Feelings of depression, irritability, tendency to isolation, feeling of fatigue, etc.
Motor Manifestations
As we pointed out earlier, the increase in severity and intensity of pain can be associated with the performance of motor activities and acts, For this reason it is frequent to observe motor inactivity or Akinesia In the crisis phases.
In addition, in severe cases, the development of temporal muscle paralysis has been described, especially in the extremities.
How long and what are the phases?
Migraine is a headache that varies from moderate to severe, occurs in a pulsatile form and usually affects a single side of head.
Migraine is usually temporary, so attacks or episodes usually last for 4 to 72 hours (National Institute of Neurological Disorders and Stroke, 2015).
As for the time of onset, it has been observed that this type of headache is more frequent during the morning, in the first moments of the day, Especially upon awakening (National Institute of Neurological Disorders and Stroke, 2015).
In addition, in many migraine sufferers the timing of presentation is predictable, as they are associated with events or precise circumstances that We will describe later.
On the other hand, as we have pointed out, migraine is a medical condition that appears in the form of an episode or crisis, so that during its clinical course, Can be differentiated several phases (National Institute of Neurological Disorders and stroke, 2015).
In this way, migraine crises consist mainly of three main phases: a) prodromes, b) aura and c) headache (Riesco, García-Cabo and Pascual, 2016).
to) Prodromes
The prodromal phase is the one that precedes the own and / or characteristic symptoms of the migraine and can last a period that goes from few hours to 2 days.
Normally, the most common symptoms in the prodromal phase include inhibitory and excitatory disturbances:
- Inhibitory alterations : Reduced processing speed, attentional difficulties, generalized mental retardation, asthenia (Weakness, fatigue or tiredness) or anorexia (lack of appetite or lack of appetite).
- Excitatory disturbances : Irritability, recurrent yawning, feeling of euphoria or aversion to certain foods.
B) Aura
The aura phase occurs in about one-third of people with migraine episodes. This phase is characterized by a symptomatology Focal that precedes the headache immediately or coincides with its onset.
The symptoms of the aura phase are usually transient and progressive, being present in about 60 minutes.
As in the previous phase, it is possible to distinguish negative and positive symptoms:
- Positive symptoms : Perception of spots or flashes, colored images in zigzag, photopsies, tingling, paresthesia, etc.
- Negative symptoms : Light sensitivity, ataxia , Muscle weakness, altered level of consciousness, etc.
C) Headache
This is the phase, in which the headache develops completely. Usually, this symptom tends to last approximately 4 hours when There is a treatment, whereas it can last up to 72 if no type of therapeutic intervention is performed.
Apart from this, other authors such as Blau (1987), perform other classifications of stages of migraine attacks, in this case, a Characterized by 5 fundamental phases (Buonanotte and Buonanotte, 2013):
- Prodrome : Phase characterized by the appearance of premonitory signs and symptoms. The characteristic courses of this phase may Including systemic, physical, psychological, etc. findings, have to occur temporarily, several days before the development of the migraine crisis.
- Aura : This phase has a sudden presentation and its characteristic signs and symptoms are usually established in just minutes. Specifically, it is defined as an episode of cerebral dysfunction that occurs in the moments before the presentation of the headache or in the phases initials.
- Headache : Headache is the cardinal symptom of this pathology and, as we have already mentioned, the duration of this disease Phase will vary depending on the therapeutic measures adopted.
- Resolution : This is the phase, in which the most intense symptoms begin to remit, reducing the severity significantly.
- Posdromo the final phase : The last phase of a crisis of sight may last briefly or reach several hours. In most of the Cases, patients feel tired and / or exhausted, unable to perform their usual work and personal activities. In other cases, Patients may suffer from various body aches, euphoria, anxiety or anorexy .
Types of migraine
The National Institute of Neurological Disorders and Stroke (2015) notes that migraine attacks are usually classified into two main types:
- Migraine with aura : In this type of migraine, previously known as the classic migraine, the headache is accompanied by Sensory alterations, especially visual.
- Migraine without aura : This type is the most common form of migraine. Headache occurs with no predecessor symptoms, sudden and Abrupt In this way, the intensity of the pain usually appears accompanied by nausea, vomiting, light sensitivity, etc.
In addition to these basic types of migraine, others have been described as abdominal migraine, basilar migraine, hemiplegic migraine, migraine Associated with menstruation, headache-free migraine, ophthalmoplenic migraine, retinal migraine and migraine status (National Institute of Neurological Disorders and Stroke, 2015).
Causes
The specific causes of migraine are not known with exactness, although it is known that they are related to diverse alterations or cerebral changes And genetic (Cleveland Clinic, 2015)
Migraine is classified into primary headaches, that is, headache in which it is not possible to identify an etiological cause Diagnosis is based on the development of medical history, physical examination and compliance with a list of criteria and Clinical characteristics (Riesco, García-Cabo and Pascual, 2016).
Thus, the search for the specific etiological causes of migraine has passed through its history through different stages and stages (Sánchez-del-Rio González, 2013):
In the early decades, exactly in the 1980s, the etiological theory considered most plausible was vascular. This was based on the Presence of diverse alterations in the cerebral blood vessels that were considered fundamental for the development of the headache.
Thus, for many years both medical specialists and researchers thought that migraines were specifically associated with dilatation (Expansion) and constriction (narrowing) of blood vessels located on the brain surface (Cleveland Clinic, 2015)
However, around the 1990s, the neurovascular theory was proposed. Specifically, this theory proposed the trigeminalovascular system Responsible, consisting of the Trigeminal nerve And the parasympathetic area of the facial nerve which, upon activation, leads to dilation of the vessels Sensitive cranial blood vessels.
In spite of this, in the last years an attempt has been made to generate a more integrative and complex model or theory, from which the trigéminovascular system Functions as an anatomical substrate to explain the pathophysiology of migraine. However, it is conditioned by the presence of different Genetic, epigenetic, internal / external, that have to favor the activation of the mechanism of pain.
In this way, current research has pointed out that this medical pathology, migraine, has a strong genetic and / or hereditary component (Riesco, García-Cabo and Pascual, 2016).
At least 3 genes related to a particular variant, familial hemiplegic migraine, have been identified. Specifically, the existence of Mutations in these genes implies the intracellular and extracellular increase of different substances (calcium, potassium and glutamate), which results in a Stage of cellular hyperexcitability and, therefore, the development of signs and symptoms characteristic of the different stages of migraine (Riesco, García-Cabo and Pascual, 2016).
In general, specialists and researchers point out that it is possible that migraine is an entity with a multiple character, that is, that its expression Is due to the presence of diverse genetic changes interacting reciprocally with certain environmental factors (Riesco, García-Cabo and Pascual, 2016).
Most Common Migraine Triggers
As we have pointed out in the previous section, the exact causes of migraine attacks are not known precisely, however, their occurrence has been Associated in many cases to the presence of certain events or events (National Institute of Neurological Disorders and Stroke, 2015):
In most cases, crises or episodes of migraine have to appear in the first moments of the day, in the morning upon waking.
However, this is not the only predictable moment, since many others affected the occurrence of headache menstruation Or to Stressful job .
Although the factors that can trigger a migraine episode can vary considerably among those affected, they have been recorded Some of the most common:
- Sudden weather and climate changes.
- Missing or excessive sleep.
- Presence of strong odors, chemicals, gases or fumes.
- Sudden emotional changes.
- Episodes of high stress and stress.
- Excessive or unusual physical or mental exertion.
- Presence of loud, constant or sudden noises.
- Episodes of dizziness and temporary loss of consciousness.
- Low levels of blood glucose.
- Alterations and hormonal changes.
- Lack of power.
- Drug use / abuse.
- Presence of intense or intermittent lights.
- Abstinence from substances (tobacco, caffeine, alcohol, etc.).
- Consumption of certain foods (cheeses, nuts, chocolate, fermented products, pickles, cured or processed meats, etc.
Concerning statistical data, approximately 50% of people with migraine associate their episodes with the consumption of some foods or the Presence of certain odors.
Diagnosis
At present, there is no test or laboratory test that indicates the unequivocal existence of migraine.
Typically, the health care provider diagnoses migraine based on clinical findings. In this way, the accomplishment of the familiar medical history and Individual, the questionnaire about the presence and development of symptoms and physical examination is fundamental (National Institutes of Heatlh, 2014).
Thus, the purpose of these initial interventions will be to determine the presence / absence of a set of defined clinical criteria for the diagnosis Doctor of migraine.
The International Classification of Headache offers the following diagnostic criteria for migraine without aura phase (Riesco, García-Cabo and Pascual, 2016):
A) Presence of at least 4 crises and B-D criteria
B) Episodes of recurrent headache lasting between 4 and 72 hours.
C) Recurrent headache or headache occur with at least two of the following characteristics:
- Restricted to a single side of the head (unilateral location).
- Pulsating sensation.
- The intensity of the pain can vary from moderate to severe.
- The intensity of the pain is conditioned or worsened by habitual or routine physical activity.
D) At least one of the following events during the headache phase:
- Nausea and / or vomiting
- Sensitivity to light (photophobia) or sound (phonophobia).
E) There is no other diagnosis and / or medical condition that explains this situation.
In addition to compliance with these diagnostic criteria, it is possible to use various laboratory tests to rule out the presence of other types of Pathologies: computed tomography, magnetic resonance or electroencephalogram (National Institutes of Health, 2014).
On the other hand, it is also common the use of a specific neuropsychological, to determine the presence of other complications such as Problems of memory, attention, problem solving, orientation, etc.
Treatment
There is no curative treatment for migraine, however, a wide variety of specific therapeutic interventions have been designed For the treatment of their crises.
Generally, the treatments used in migraine are based on the prescription of drugs to relieve pain or to prevent the occurrence of crisis.
The specific choice of therapy depends fundamentally on the characteristics of the person affected and the episodes of migraine. In addition, Fundamental to consider the presence of other medical conditions.
Thus, the Mayo Clinic (2013), makes a description of the most used therapeutic measures:
Drugs for the treatment of pain
Medications used for the treatment of pain are often used during the migraine crisis phase and the objective is to relieve and Stop the progression of symptoms that are already present.
Some of the drugs most commonly used are analgesics (aspirin or anti-inflammatories), triptans, ergotamine, anti-nausea drugs, The opioid drugs or the Glucocorticoids .
Drugs for crisis prevention
In this case, the medications used for crisis prevention are usually prescribed for regular consumption, usually taken on a daily basis Reduce the frequency of migraine in the most severe cases.
Some of the most commonly used drugs include cardiovascular medication, Antidepressants Or antiepileptic medication, among others.
In addition to pharmacological treatments, other types of therapeutic interventions have also been described with the fundamental objective of modifying Different life habits and, in addition, to avoid the exposure to the trigger events.
Normally, experts recommend performing muscle relaxation or breathing exercises, perform a restful sleep with sufficient hours, Avoid stressful situations, avoid the consumption of harmful substances, etc.
In addition, it is also recommended to prepare a crisis diary, in which the symptoms, intensity and frequency of Migraine, since they will be useful for the development of an individualized therapeutic intervention and as effective as possible.
References
- Bouonanotte, C., & Bouonanotte, M. (2016). Migraine. Neurol. Arg. , 94-100.
- Cleveland Clinic. (2015). Migraine . Obtained from Cleveland Clinic.
- Mayo Clinic. (2013). Migraine . Obtained from Mayo Clinic.
- Migraine Action. (2016). Migraine Information . Obtained from Migraine Action.
- Migraine Research Foundation. (2016). What is Migraine? Retrieved from the Migraine Research Foundation.
- Nall, R. (2015). What is a Migraine? Retrieved from HealthLine.
- NIH. (2014). Migraine . Obtained from MedlinePlus.
- NIH. (2015). Headache: Hope Through Research . Retrieved from the National Institute of Neurological Disorders and Stroke.
- WHO. (2016). Headache . Obtained from World Health Organization.
- Riesco, N., Garcia-Cabo, C., & Pascual, J. (2016). Migraine. Med Clin (Barc) , 35-39.
- Sánchez-del-Río González, M. (2013). Migraine: the ignition of the brain. Rev Neurol , 509-514.