What is a migraine? Acute Attack Treatment

In many cases, people have chronic headaches that occur on one side or alternately on both sides, and brain examinations do not reveal any problems, so they think they have migraines. The actual situation is that migraines are a type of primary headache, and they have clear diagnosis and treatment rules. Let's learn about the relevant knowledge today.

Migraine

Migraine is the second most common disabling neurological disease in the world. Its clinical features are recurrent, mostly unilateral, moderate to severe throbbing headaches, often accompanied by nausea, vomiting, photophobia, and phonophobia. Migraine is often comorbid with anxiety, depression, sleep disorders, etc., and may increase the risk of cognitive dysfunction and cardiovascular and cerebrovascular diseases.

Types of migraines

Migraine without aura

Most people belong to this type, accounting for about 80%. It is mainly a throbbing headache on one side, accompanied by nausea, vomiting, sweating, fear of light, fear of sound, and hypersensitivity of the skin. Here I will talk about fear of light and fear of sound. It is not true fear, but strong light and noisy sound will aggravate the headache. Children and adolescents may have bilateral throbbing headaches. Fatigue, lack of concentration, stiff neck, sensitivity to light and sound may occur a few hours or a day or two before the headache. Similar symptoms may also appear when the headache is about to end.

Some migraines without aura are related to the menstrual cycle. There are two main types: simple menstrual migraine and menstrual-related migraine. The former refers to migraine that occurs within 5 days from 2 days before menstruation to 3 days after menstruation, and it occurs every month in the past three months; if there is headache outside the menstrual period, it is called menstrual-related migraine.

Migraine with aura

About 10% of cases have auras, which usually occur 15-30 minutes before the headache. The most common auras are visual, mainly flashes, dark spots, and ripples; there are also other auras such as paresthesia, speech disorders, limb weakness, and even some posterior circulation symptoms such as dizziness, tinnitus, and hearing loss.

Chronic migraine

Headaches occur on at least 15 days per month for at least 3 months, and the headaches have migraine features on at least 8 days per month.

Migraine Complications

Status migraineus refers to a duration of more than 72 hours; persistent aura without cerebral infarction refers to aura lasting at least 1 week; migraine cerebral infarction refers to migraine with aura and new infarction foci on imaging; migraine aura-induced epileptic seizure refers to an epileptic seizure during or after a migraine with aura in patients with headache.

Syndromes that may be associated with migraine

Cyclic vomiting syndrome: recurrent vomiting and severe nausea, the attack pattern is often fixed, accompanied by paleness and easy fatigue, nausea and vomiting at least 4 times per hour, each attack lasts more than 1 hour, the attack period does not exceed 10 days, the interval between attacks is more than 1 week, and the interval between attacks is completely relieved. **Abdominal migraine: **Mainly occurs in children aged 3-10 years old, and some adults with migraine also have abdominal migraine, at least 5 or more recurrent moderate to severe pain near the midline of the abdomen, the nature of which is dull pain or only soreness. Most children with abdominal migraine will have migraine in adulthood.

Therefore, many children who have recurrent unexplained abdominal pain should ask their parents whether they have a family history of migraine. If abdominal migraine is diagnosed, it may become a real migraine in adulthood.

Migraine triggers

There are often obvious triggers before a migraine attack. Studies have shown that 85% of patients have triggers, and often multiple triggers. Common triggers include: weather changes, stress, anxiety, depression, crying, hunger, sleep disorders, overwork, light stimulation, noise, strong smells and diet.

Common Misconceptions About Migraines

When a migraine occurs, does the pain only occur on one side?

The typical headache of a migraine is unilateral throbbing pain, but 40% of patients have bilateral headaches, and some patients have full headaches. The pain is most common in the temples, but it can occur anywhere on the head, face, or neck. The location of the headache can change within the same attack or between different attacks.

What is the cause of migraine?

The specific cause is not yet fully understood, but it is believed to be related to genetic, endocrine, diet, mental state and other factors that lead to changes in neurotransmitters such as serotonin and calcitonin gene-related peptide in the brain and abnormalities in neural pathways. Although the cause is unknown and cannot be completely cured, effective clinical control of symptoms can be achieved, just like we treat hypertension.

How to use medicine for acute migraine

Since headaches are common, many people think that they can just endure it or take some painkillers, but this is not true. Patients with migraines that occur more than 1-2 times a month often use acute treatment. Acute treatment aims to quickly relieve migraine symptoms, reduce the development of headaches, restore patients' ability to study, work and live as soon as possible, and reduce the need for follow-up visits.

Acute drug treatment includes nonspecific drugs and specific drugs.

1. Common non-specific drugs include analgesics (ibuprofen, diclofenac, acetaminophen), antiemetics (metoclopramide, domperidone), sedatives (valium, promethazine) and neuroleptics (chlorpromazine).

2. Specific drugs include triptans (sumatriptan, zolmitriptan and rizatriptan), ergotamines (ergotamine, dihydroergotamine, ergotamine caffeine), and gemepams (remegepam, ubegepam).

For mild migraine, use painkillers first. If symptoms persist after 1 hour, use triptans. For moderate to severe migraine, it is recommended to use triptans early, and if necessary, use painkillers together. For migraine with aura, use painkillers. Use triptans at the beginning of the headache. If one triptan is ineffective, switch to another. Note that oral analgesics should not exceed the maximum daily dose.

The combined use of multiple analgesics may increase the risk of adverse events; long-term use of combination analgesics is more likely to lead to drug dependence or drug overdose pain than single-ingredient analgesics; if attacks occur too frequently or symptoms gradually worsen, a professional doctor should be asked to evaluate whether preventive treatment needs to be initiated.

Author: Yue Jianning

Source: Department of Pain, Xuanwu Hospital