• MIGRAINE

    Synonyms: Megrim, Hemicrania, Sick Headache.

    Recurrent, paroxysmal, severe, incapacitating, unilateral, throbbing headache, with vomiting and preceded by visualor sensory disturbances. A peculiar form of headache, usually unilateral, and frequently associated with gastric and sensory disturbances.


    PATHOLOGY
    – Preliminary visual disturbances and cortical (sensory-motor) symptoms at onset of attack are due to:
    . Vasoconstriction of branches of internal carotid artery.
    – Subsequent throbbing headache is due to
    . Vasodilatation in distribution of external carotid artery.
    – Above features are related to release of following neuropeptides
    • 5-HT.
    . Histamine.
    . Serotonin.

    TYPES
    – Classical migraine
    . Migraine with aura.
    – Common migraine
    . Migraine without aura.
    . Commonest form.
    . Clinical presentation diffuse.
    – Acephalgic migraine
    . Migraine aura without headache.
    – Complicated migraine
    . Focal neurological signs.
    . Persist for 48 — 72 hours after resolution of headache.
    – Systemic migraine
    . Migrainous pain in other parts of body.
    • Commonest is abdominal migraine, with predominant gastro-intestinal features.
    – Status migrainous
    – Repeated migrainous headaches.
    – Cause dehydration (due to vomiting).

    ETIOLOGY (Causes of Migraine)
    Exact cause is not known.
    Predisposing causes
    – Familial predisposition common.
    – Personality

    • Energetic, intelligent, perfectionist.
    • Anxiety prone.
    • Obsessional.

    – Psychological disturbances.
    Precipitating causes
    – Anxiety.
    – Fatigue.
    – Change ¡n sleep pattern.
    – Emotional stress.
    – Hormonal disturbance
    Puberty.
    . Menopause.
    • Premenstrual tension.
    – FastIng or missing a meal.
    – Bright light.
    – Loud noise.
    – Allergic (chemical)
    . Cheese, chocolate, coffee, alcohol, smoking
    • Processed foods containing preservatives, artificial colours and flavours.
    – latrogenic:
    Oral contraceptives.
    Age: Yung adults.
    Sex: Common in females

    CLINICAL FEATURES
    Symptoms
    Unset
    – Sudden.
    Prodrome
    – Duration: 15—30 minutes.
    – Weakness.
    – Lethargy.
    – Euphoria or depression.
    – Yawning.

    Aura
    – Visual disturbances
    . Zigzag flashes of coloured lights (photopsia).
    • Stars and spots before eyes (fortification spectra).
    . Blurring of vision.
    . Photophobia.
    . Hemianopia.
    . Lachrymation.
    – Ssory disturbances
    . Numbness and tingling in face, extremities, lips, tongue.
    . Sensation of insects crawling on skin.
    – Motor disturbances
    . Weakness.
    . Giddiness.
    . Dysphasia.
    Headache
    – Onset:
    .In morning after waking.
    – Distribution:
    . Unilateral.
    – Location:
    • Commonly frontal, supraorbital, temporal.
    – Character
    • Paroxysmal.
    • Sharp, severe.
    . Throbbing, pulsating.
    . Reaches peak within hours.
    – Duration:
    • 24 — 48 hours.
    . Bouts of headache occur at intervals of days, weeks or months.
    . Daily headaches are never migrainous.
    – Worse from
    . Light (photophobia).
    . Noise (phonophobia).
    . Jar.
    – Better by
    . Rest.
    . Dark room.
    . Pressure.
    . Vomiting.
    – Associated with
    . Irritability.
    . Nausea.
    . Vomiting.
    • Sweating.
    . Diarrhoea.
    – After attack
    • Profuse urination.
    . Sleepiness.

    Signs
    – No abnormal physical signs.

    PROGNOSIS
    – Attacks tends to decrease after menopause.
    – Attacks persist throughout life.
    – Attacks fluctuate in severity, duration, frequency.
    – Some patients have years of freedom from at tacks.
    – Prognosis good.

    PREDOMINANT MIASM
    – Psoro-sycotic disorder.
    – (Role of histamine, hormonal disturbances)

    THERAPEUTIC AIM
    – To reduce intensity, duration, frequency of at tacks.
    – To prevent recurrence.

    GENERAL MANAGEMENT
    – Reassurance.
    – Assess patient’s habits, work, personality and stresses.
    – Try to modify personality traits.
    – Correct predisposing causes, if possible.
    – Psychotherapy.
    – Avoid and eliminate precipitating causes.
    – Avoid alcohol.
    – Eliminating diet to identify offending substance causing allergy.
    – Improve general health.
    – During attack
    . Adequate physical, mental rest.
    . Rest in dark, quiet room.
    . Avoid aggravating factors.

    HOMEOPATHIC TREATMENT OF MIGRAINE

    Suitable drugs are:
    – Argentum Nitricum.
    – Belladonna.
    – Cimicifuga.
    – Cocculus.
    – Coffea Cruda.
    – Cyclamen.
    – Gelsemium.
    – Ignatia.
    – Lac Caninum.
    – Lac Defloratum.
    – Lachesis.
    – Melilotus.
    – Natrium muriaticum.
    – Onosmodium.
    – Pulsatilla.
    – Sanguinaria.
    – Sepia.
    – Spigelia.

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    Theridion.

    Intercurrent
    – Sulphur.

    Categories: Brain & Nerves, Head & Neck

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