Migraine

Introduction to migraine Migraine is a type of periodic episode with family morbidity. It is characterized by paroxysmal hemiplegic headache with nausea, vomiting, and shame. After a period of rest, it occurs again in a quiet, dark environment or after sleep. The headache is relieved. It can be accompanied by nerves and mental dysfunction before or during a headache. basic knowledge Sickness ratio: 0.8%-1% Susceptible people: no special people Mode of infection: non-infectious Complications: nausea and vomiting, headache, dizziness, ataxia, tinnitus, disturbance of consciousness, arrhythmia

Migraine cause

Hormone changes and drug effects (35%):

Oral contraceptives can increase the frequency of migraine attacks. Menstruation is a common trigger or aggravating factor for migraine ("cyclical headache"). Pregnancy, sexual intercourse can trigger a migraine attack ("sexual headache"). Some susceptible individuals may experience typical migraine attacks after taking nifedipine (xintongding), isosorbide (xinxin) or nitroglycerin.

Weather changes, food additives and beverages (15%):

Especially the weather is getting hot, cloudy or wet. The most common are alcoholic beverages, such as certain red wines. Dairy products, cheese, especially hard cheese, coffee, nitrite-containing foods such as soups, hot dogs. Some fruits, such as citrus fruits, chocolate ("chocolate headache"). Some vegetables, yeast, artificial sweets, fermented pickled products: such as kimchi, MSG.

Exercise (10%):

Minor movements of the head can induce or exacerbate migraine attacks, and some patients are afraid to ride because of fear of migraine attacks. People who play football can cause headaches by head-to-head ("sportsman migraine"). Migraine can occur when climbing stairs upstairs.

1. Too much or too little sleep.

2, a meal missed or delayed.

3. Smoking or being in the smoke.

4, flash, the light is too strong.

5, nervous, angry, depressed, crying ("cry headache"), many women go shopping or to a crowded occasions can cause migraine attacks. Migrants can be exacerbated when someone is riding abroad, although they are less than 1 minute.

Among the stimulating factors, quantity, joint action and individual differences should be considered. For sensitive individuals, eating an orange may not cause headaches, while eating a few oranges may cause headaches. In some cases, eating a few oranges does not cause Headache attacks, but if there is also the influence of menstruation, this combination can cause migraine attacks. Some individuals will have seizures in the mall for a while, while some individuals will only have migraine attacks after waiting in the mall for a long time.

There are still many improvement factors in migraine. Some people can lie in a moment of migraine attack, which can relieve headaches. Some people close their eyes in a dimly lit room to relieve headaches. Some people like to press their eyes with both hands when they have a headache. In order to relieve headaches, some people can relieve headaches by washing their heads with cold water. Migraine tends to be relieved after menopause and 3 months after pregnancy.

Migraine prevention

Because many factors can induce migraine, pay attention to the care in daily life, avoid these factors on the body's invasion, careful living, conditioning diet, emotional and so on can prevent migraine attacks to a certain extent.

Migraine life conditioning

1, pay attention to the influence of climate, wind, dry, damp heat, storm, bright and dazzling sunshine, cold, thunder and other climate changes can induce migraine attacks, pay attention to avoid cold, keep warm, do not expose to rain, prevent induced disease .

2, pay attention to the impact of sleep, exercise or overwork, pay attention to regular sleep, exercise, strengthen work planning, organization, pay attention to work and rest, pay attention to eye regulation, protection is an important preventive measure for sensitive patients.

3, pay attention to indoor ventilation, quit smoking and alcohol.

4, pay attention to the effects of drugs, can induce migraine drugs such as contraceptives, nitroglycerin, histamine, reserpine, hydrazine, estrogen, excess VitA and so on.

Migraine complications Complications, nausea and vomiting, headache, vertigo, ataxia, tinnitus, dysfunction, arrhythmia

1. Chronic migraine: migraine headaches lasting more than 15 days per month for 3 months or more, and excluding headaches caused by overdose, may be considered as chronic migraine.

2, migraine persistence state: migraine attack duration 72 hours, and the degree of pain is more serious, but there may be a brief remission period due to sleep or drug application.

3, a continuous aura of infarction: refers to patients with aura migraine in a seizure, a threat or a variety of aura symptoms lasted more than 1 week, mostly bilateral. Other symptoms of this episode are similar to previous episodes. Neuroimaging was used to exclude cerebral infarction lesions.

4. Migraine infarction: In rare cases, ischemic infarction in the corresponding intracranial blood supply area after migraine aura symptoms, this aura symptom often lasts for more than 60 minutes, and ischemic infarction is confirmed by neuroimaging It is called a migraine infarction.

5. Epileptic seizures induced by migraine: In rare cases, migraine symptoms can trigger seizures, and seizures occur within or less than 1 hour after aura.

Migraine symptoms Common symptoms Dizziness, dizziness, night headache, headache, consciousness disorder, high blood pressure, neuropathic headache, dizziness, limb weakness, pale, strenuous exercise, headache

Clinical stage

Clinically divided into four phases:

Early headache (aura or intracranial systole): There are auras before the onset of headache, with illusion (such as seeing a flash or a color) or more forms of blind spots. Other rare people have dizziness, aphasia, confusion, paresthesia, facial or limb weakness, which lasts about 10 to 30 minutes or hours. This period is related to the localized ischemic brain.

Headache period: extracranial arterial dilatation causes pulsating headache, often accompanied by nausea, vomiting, pale, shame and other autonomic symptoms.

Late headache: edema around the extracranial artery, arterial hardening and tenderness, headache becomes persistent.

Late headache: a headache lasts for 2 to 3 hours and then falls asleep, and the headache disappears after waking up. Some patients have vascular headaches and have neck muscle contraction headaches, so headaches can last for several days.

Clinical typing

Clinically, migraine is divided into three types:

1. Typical migraine: There are congenital genetic factors and obvious characteristic auras, with the typical four periods mentioned above.

2, common migraine: no hereditary, due to its vascular reaction is light, the aura is not obvious or not, the headache is not sudden but gradually aggravated, lasting longer (hours to days), headache side often accompanied by nasal congestion , drooling, tearing, conjunctival congestion, shame and so on.

3, compound migraine: with transient or persistent neurological signs or mental symptoms, such as ophthalmoplegia and hemiplegic migraine.

4, migraine equivalence: migraine attacks are replaced by some periodic physical disorders, such as abdominal pain, autonomic symptoms, dizziness, mental disorders, etc., can occur alternately with typical migraine attacks.

Clinical manifestation

According to the international headache classification and diagnostic criteria developed by the International Headache Society in 1988, the clinical practice in China is summarized as follows.

Migraine without aura

(universal migraine) is the most common. Paroxysmal moderate to severe pulsatile headache with nausea, vomiting or photophobia. Physical activity exacerbates headaches. At the beginning of the attack, there is only mild to moderate dull pain or discomfort, and severe pulsating or jumping pain is reached after a few minutes to several hours. About 2/3 of them are side headaches, but also bilateral headaches, sometimes painful to the upper neck and shoulders. The headache lasts for 4 to 72 hours and is usually relieved after sleep. There is a clear normal gap period between attacks. If 90% of the attacks are closely related to the menstrual cycle, it is called migraine during menstruation. At least 5 episodes of the above episodes can be made, except for various organic diseases inside and outside the skull.

Migraine with aura

(Typical migraine) can be divided into two phases: aura and headache:

1, aura: the most common visual symptoms, such as photophobia, flashes of eyes, sparks, or complex visual hallucinations, followed by visual field defects, dark spots, hemianopia or brief blindness. A small number of patients may have numbness, mild hemiparesis or speech impairment. Most of the precursors last for 5 to 20 minutes.

2, headache period: often appears when the aura begins to subside. The pain starts from one side of the jaw, the back of the ankle or the frontal area, gradually increasing to the half of the head, or even the entire head and neck. The headache is pulsating, jumping or drilling, and the degree gradually increases to a persistent severe pain. Often accompanied by nausea, vomiting, photophobia, and timidity. Some patients have facial flushing and a large amount of sweaty conjunctival congestion. Some patients are pale, languid and anorexia. An episode lasts for 1-3 days, and the headache is usually relieved after going to bed, but it is weak for several days after the attack. Everything is normal during the episode. The above typical migraine can be divided into several subtypes:

(1) Migraine with typical aura: including ocular migraine, hemiplegic migraine, and aphasia. At least 2 occurrences of the above-mentioned typical episodes have occurred, and the diagnosis can be established after the exclusion of organic diseases.

(2) Migraine with a prolonged aura (complex migraine): The aura is still persistent during the onset of a headache, lasting longer than 1 hour and not more than 1 week. Neuroimaging examination revealed no intracranial structural lesions.

(3) Basal migraine (formerly known as basilar artery migraine): There are aura symptoms that are clearly derived from the brainstem or bilateral occipital lobe, such as blindness, bilateral temporal and nasal visual visual symptoms, dysarthria , dizziness, tinnitus, hearing loss, diplopia, ataxia, bilateral paresthesia, bilateral palsy or insanity. It disappeared within a few minutes to an hour, and then a pulsating headache in the bilateral occipital area was discovered. Everything is normal during the gap period.

(4) Migraine aura (with migraine allelic attack) without headache: There are various aura symptoms that are seen in migraine attacks, but there is time and no headache. When the patient ages, the headache can completely disappear and there is still a paroxysmal aura, but the symptoms are completely aura and there are fewer headaches. For the first time after the age of 40, an in-depth examination is required, except for thromboembolic TIA.

Ophthalmoplegia migraine

Very rare. Most of the onset age is under 30 years old. There is a history of headaches fixed on one side. After a severe headache (eyelid or post-temporal pain), the ipsilateral ophthalmoplegia appears. The above face is most common. Paralysis resumes after several days or weeks. The onset of paralysis was completely restored several times, but some eye muscle paralysis could be left without recovery after multiple episodes. Neuroimaging does not rule out intracranial organic lesions.

Childhood benign vertigo

(Migraine equivalence episode) has a family history of migraine but the child has no headache. It is characterized by multiple, short-lived vertigo episodes, as well as episodic balance disorders, anxiety, with nystagmus or vomiting. The nervous system and EEG examinations were normal. Everything is normal during the gap period. Some children can turn into migraine when they are adults.

Migraine persistence

A migraine attack duration of more than 72 hours (which may have a remission period shorter than 4 hours) is called a migraine persistence state.

Migraine examination

1. EEG examination: It is generally believed that the abnormal incidence of EEG in patients with migraine is higher than that in the normal control group, whether in the attack or intermittent period. However, the EEG changes in migraine patients are not specific. Because it can have normal waveform, common slow wave, spike discharge, focal spike, wave and various waveforms such as hyperventilation, abnormal response to flash stimulation, abnormal rate of electroencephalogram in children with migraine High, ranging from 9% to 70%, can occur spikes, paroxysmal slow waves, fast wave activity and diffuse slow waves.

2, cerebral blood flow chart examination: the main changes in the cerebral blood flow map of the patient during the attack period and intermittent period are asymmetric amplitude on both sides, one side is high or one side is low.

3, cerebral angiography: In principle, patients with migraine do not need cerebral angiography, only in patients with severe headache, highly suspected of subarachnoid hemorrhage, cerebral angiography, in order to exclude intracranial aneurysms , arteriovenous malformations and other diseases, no doubt, the majority of cerebral angiography in migraine patients is normal.

4, cerebrospinal fluid examination: routine examination of cerebrospinal fluid in patients with migraine is usually normal, under normal circumstances, the lymphocytes of cerebrospinal fluid can be increased.

5, immunological examination: generally considered that migraine patients with immunoglobulin IgG, IgA, C3 and E rosette formation can be higher than normal.

6, platelet function test: platelet aggregation in migraine patients can be increased.

Diagnosis of migraine

diagnosis

The diagnosis of migraine should be based on a detailed history, especially the nature of the headache and the associated symptoms, such as the location of the headache, the nature, duration, severity of the pain, accompanying symptoms and signs, history of previous episodes, induced or Aggravating factors, etc.

For patients with migraine, detailed general medical examination and neurological examination should be performed. Except for overlapping symptoms and migraine, similar or simultaneous conditions. Although there is no specific laboratory index for migraine, it is sometimes necessary for patients. Laboratory tests are very important, such as blood, urine, cerebrospinal fluid and imaging studies to rule out organic lesions, especially in middle-aged or old-aged headaches, and should exclude organic lesions when serious signs or When the aura is prolonged, some scholars recommend CT or MRI. Some scholars have suggested that when migraine attacks occur more than 2 times a month, you should be alert to the cause of migraine.

Differential diagnosis

1, tension-type headache: also known as muscle contraction type headache, its clinical features are: the headache is more diffuse, can be placed on the forehead, eyes, top, pillow and neck, the nature of headache is often dull pain, head pressure, tight Hoop feeling, the patient often said that wearing a hat, headache is often persistent, can be light and heavy, more scalp, neck tenderness point, massage the head and neck can relieve headache, more than the amount, neck muscle tension How many are accompanied by nausea and vomiting.

2, cluster headache: also known as histamine headache, Horton syndrome, manifested as a series of dense, transient, severe unilateral drilling pain, and migraine, the headache is more limited and fixed on one side of the ankle After the ball and the frontal forehead, the onset time is often at night, and the patient is awakened, the onset time is fixed, the onset is sudden without aura, and the beginning can be a burning sensation on one side of the nose or a feeling of pressure after the ball, followed by a specific Pain in the area, often painful, and facial flushing, conjunctival congestion, tearing, salivation, nasal congestion, a large number of patients with Horner sign, can appear photophobia, without nausea, vomiting, incentives can be a cluster of seizures Alcohol, excitement or taking vasodilators, the age of onset is often later than migraine, average 25 years old, male to female ratio of about 4:1, a rare family history.

3, painful ophthalmoplegia: also known as Tolosa-Hunt syndrome, is characterized by headache and ophthalmoplegia, involving inflammatory diseases of idiopathic orbital and cavernous sinus, the cause can be intracranial internal carotid artery Non-specific inflammation, may also involve the cavernous sinus, often manifested as intractable pain after the ball and periorbital, stinging, diplopia after several days or weeks, and may have III, IV, VI cranial nerve involvement Recurrence after several months of interval, angiography is required to rule out internal carotid aneurysm, and corticosteroid treatment is effective.

4, headache caused by intracranial space: early occupation, headache can be intermittent or morning weight, but with the development of the disease, more often become a persistent headache, progressive aggravation, symptoms of intracranial hypertension can occur Signs, such as headache, nausea, vomiting, optic disc edema, and may have focal symptoms and signs, such as mental changes, hemiplegia, aphasia, partial sensory disturbances, convulsions, hemianopia, ataxia, nystagmus, etc. Difficult, but need to pay attention, there are also migraine that has been manifested for more than ten years, and finally diagnosed as a huge hemangioma.

5, vascular headache: such as high blood pressure or hypotension, unruptured intracranial aneurysm or arteriovenous malformation, chronic subdural hematoma, etc. can have migraine headache. Some cases have localized neurological signs, seizures or cognitive dysfunction, and CT, MRI and DSA can show lesions.

6, migraine infarction: In rare cases, migraine can be secondary to ischemic stroke, migraine progressive disease and spontaneous regression two characteristics can be distinguished from stroke.

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