Migraine Flashcards
What is migraine?
- A complex neurological disease
- Strong headache often accompanied by visual disturbances, photophobia, phonophobia, nausea/vomiting & fatigue
- Typically lasts 4-72 hours
- Onset usually before middle age
- Affects approximately 20% of women & 6% of men
What causes or triggers Migraine ?
- Unknown but theory of abnormal brain activity affecting nerve signals, chemicals & blood vessels in the brain
- Believed to have a genetic component
Risk factors:
* Family history - family member with migraines
* Age - Migraines can begin at any age but the first often occurs during adolescence. Usually
peak in 30s, gradually becoming less severe & less frequent
* Sex - Women are three times more likely than men to have migraines
* Hormonal changes. For women who have migraines, headaches might begin just before or shortly after onset of menstruation. They might also change during pregnancy or menopause. Migraines generally improve after menopause
What is the pathophysiology of Migraine ?
- **Aura may be due to dysfunction of ion channels **causing cortical depolarisation (excitation) followed by hyperpolarisation
- Neurotransmitters such as serotonin and dopamine may be involved
- Headache associated with vasodilation of extracranial vessels may be related to hypothalamic activity
- Activation of trigeminovascular system likely important
- Blood proteins
What are the signs and symptoms of Migraine ?
Different types migraine which all present differently:
* Migraine with aura - most often visual such as blurred vision or flickering lights, and come on gradually
* Migraine without aura - most common type, one sided headache with a throbbing pain, worsens if walking, often comes with nausea
* Vestibular migraine - vertigo and balance issues together with normal S&S
* Menstrual migraine - linked to period
* Hemiplegic migraine - temporary weakness on one side of their body, can last from an hour to days. Headache may follow the weakness
* Silent migraine – aura no pain
Added note!
Silent Migraines - sometimes referred to as acephalgic migraines & how typical symptoms of migraine but without pain.
As pain is the most common manifestation of a migraine, silent
migraines can easily be missed as a diagnosis & may be mistaken for TIA or MS.
Around 4% of people with migraine will have silent migraine
What are typical tests and treatments for Migraine ?
No specific test for diagnosis
* History taking - reflex, co-ordination
* Symptom diary
* Tests to rule out other causes
**Treatment **
* Identify & avoid triggers eg noise, lighting, wine and cheese
* Rest
* Acute medications, as & when migraines happen: Analgesics, Triptans, Anti-emetics, Transcranial magnetic stimulation
* Prophylactic medications (taken to prevent migrain attacks, so taken every day): Beta blockers, Angiotensin ll blockers, Anti-convulsants, Calcitonin Gene-Related Peptide pathway monoclonal antibodies, Calcium channel blockers, Tri-cyclic antidepressants
* Botox for chronic migraine - unclear how it works but likely affects nerves
* Greater occipital nerve block - injection with local anesthetic, blocks the nerve levels of pain, for chronic
* Neuromodulation - devices that increase or decrease brain activity
What is the impact of migraine?
Can be quite serious, and affects:
* Work - lose days
* Education
* Relationships
* Mental health
* Medication side effects - digestive upset, tingling etc
How might herbs or holistic treatments help migraine?
Holistic management
* Gut-brain axis - support gut function
* Identify & address triggers eg sleep
* Prophylactic management…Tanacetum parthenium, Petasites hybridus, Valeriana officinalis, Tilia spp., Melissa officinalis, Stachys officinalis
* Acute management - pain reliving, nausea preventing etc: Zingiber officinalis, Salix alba, Harpagophytum procumbens, Mentha x piperita, Lavandula augustifolia, Rosmarinus officinalis, Achillea millefolium, Gaultheria procumbens, Viburnum oculus
* Supplements such as B2 & CoQ10
* Refer to other therapies if appropriate - acupuncture, massage etc as people can have MSK impact
