Question

Explain in details diagnosis process and different treatment strategies of Migraine?

Answer 1

Explain in details diagnosis process and different treatment strategies of Migraine?

1. Diagnostic criteria

According to International Headache Society for migraine without aura ( 5, 4, 3, 2, 1 criteria)

• five or more episodes of headache, lasting 4-72 hours ( 4 hrs to 3 days)
• Any two of the symptoms present( Unilateral , throbbing or pulsating, worsened by movement, intensity can be moderate or severe).+ Any one of the following that is nausea and vomiting, photophobia, phonophobia.
• Not attributed to other disorder

Migraine with aura

1. Atleast two attacks fulfilling criteria 2 and 3
2. Aura consisting of at least one or two

• - fully reversible visual symptoms ( positive signs including seeing flickering lights, spots or lines and negative features like loss of vision)
• - fully reversible sensory symptoms incuding positive features ( pricking with pin and needles) negative features like numbness.
• - fully reversible from speech disturbances.

3. Aleast two of the following

• visual symptoms and or unilateral sensory symptoms
• Atleast one aura symptom gradually develop over 5 mts or multiple aura symptoms occur in succession over 5 mts.
• each symptoms last more than 5 mts and less than 60mts.( >5 mts < 60 mts)

4. Not attributed to other disorder.

2. History about triggers. headache diary whether it starts with aura or not.

3. EEG to detect abnormal neuronal impulses

4. CT brain to find brain structure abnormalities, arterial artifacts.

Treatment strategies

pharmacological measures :

Analgesics - NSAIDs to alleviate pain by reducing synthesis of Prostaglandin

Antiemetics - to manage nausea and vomiting

Ergot alkaloids- it acts on the serotoninergic, dopaminergic receptors. recommend for acute management and long term treatment.

Triptan- Sumatriptan, rizatriptan. These drugs modulate neuotransmitter release from neuronal vesicles.

Beta adrenergic blockers- Propranolol - reduce synaptic activity

Calcium channel blokers -increase antinociception. reduce vasular contraction and increase blood flow to brain.

Tricyclic antidepressants-Amytripline -increase antinociception

Sodium valproate -lower neuronal excitability and enhance antinociception.

Non pharmacological management

• Avoid triggering factors
• Behavioural training- relaxation training, stress reduction measures- yoga, meditation, muscle relaxation exercises, biofeed back, psychotherapy.
• Acupuncture
• Life style modifications
• Adequate sleep
• Avoid heavy exercises, practice relaxation exercises
• Maintaining hydration
• Maintaining personal hygiene
• Avoiding stimulant food, perfumes, sounds.