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MIGRAINEMohammed Nabil J AlAli
5th Year Medical StudentAt King Faisal University
Group B (210006209)
- DEFINITION- SIGNS AND SYMPTOMS- MANAGMENT
OUTLINES :
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“Migraine is a familial disorder characterized
by recurrent attacks of headache widely
variable in intensity, frequency and duration.
Attacks are commonly unilateral and are
usually associated with anorexia, nausea and
vomiting”
The word derives from the Greek (hemikrania) : pain on one side of the head ( hemi- "half“ , kranion "skull” )
DEFINITION
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According to stage :
Vague symptoms that begin from 12 to 36 hours before the aura and headache
is the complex of neurological symptoms that occurs just before or at the onset of migraine headache
resolution stage , recovery -Deprresion - fatigue For hours to two days
from 4 to 72 hours
SIGNS AND SYMPTOMS
1- Prodrome 2 -Aura
4 -Postdrome
3 -Headache
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Throbbing or pulsatile headache, with moderate to severe pain that intensifies with movement or physical activity
Unilateral and localized pain in the frontotemporal and ocular area, but the pain may be felt anywhere .
Pain builds up over a period of 1-2 hours, progressing posteriorly and becoming diffuse
Headache lasts 4-72 hours
Nausea (80%) and vomiting (50%), including anorexia and food intolerance, and light-headedness
Sensitivity to light and sound
Typical symptoms include the following:
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May precede or accompany the headache phase or may occur in isolation
Usually develops over 5-20 minutes and lasts less than 60 minutes
Most commonly visual (can be sensory, motor, or combination )
Visual symptoms may be positive or negative
Scintillating scotoma is the most common positive visual phenomenon .
DIAGNOSTIC CRITERIA
Migraine with Aura :
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DIAGNOSTIC CRITERIA
Migraine without Aura :
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Non-pharmacological
Pharmacological
- Identification of triggers- Meditation ( Yoga )- Relaxation training- Psychotherapy
Classified as : -Abortive ( acute phase )
- Prophylactic (preventive).
MANAGMENT
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Selective serotonin receptor (5-hydroxytryptamine–1, or 5-HT1) agonists (triptans)
Ergot alkaloids (eg, ergotamine, dihydroergotamine [DHE])
AnalgesicsNSAIDsCombination productsAntiemetics
Pharmacological ( Abortive )
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Pharmacological ( Prophylactic )
Frequency ( greater than 2 per month) Duration of attacks ( longer than 24 hours) Cause major disruptions in the patient's
lifestyle, with significant disability that lasts 3 or more days
Abortive therapy fails or is overused Symptomatic medications are contraindicated
or ineffective Use of abortive medications more than twice
a week Risk of permanent neurologic injury[
Some indications :
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Antiepileptic drugsBeta blockersTricyclic anti-depressantsCalcium channel blockersSelective serotonin reuptake
inhibitors (SSRIs)NSAIDsSerotonin antagonistsBotulinum toxin
Pharmacological ( Prophylactic )
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In December 2013, the FDA approved the Cerena Transcranial Magnetic Stimulator (Cerena TMS), the first device to relieve pain caused by migraine headache with aura for use in patients aged 18 years and older .
Uptodate
Any Question ?
04/11/2023 http://www.healandhealth.com 14
REFERENCES
Thank you
Prevention is Better
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