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Migraine

Introduction

Migraine is a type of neurovascular headache and primarily a disorder of brain. It is a neural phenomena produced by blood vessel dilation, which causes headache and additional nerve activation. Patterns of migraine attacks differ widely among patients. Some times migraine can be unresponsive to treatment or confused with other diagnoses.

Classically migraine can be described as a paroxysmal disorder accompanied by headache that is usually unilateral at onset, which can be associated with nausea, anorexia, and vomiting. Migraine onset can be preceded by auras and disturbance of vision, sensation, motor coordination, or Mood.

Rare vascular headaches have been associated with mitochondrial myopathy, encephalopathy, lactacidosis, and headaches are a common variant of MELAS syndrome.

Diagnostic dilemma of migraine
Various factors such as location, duration, and qualities of the headache, including the conditions that provoke, relieve, or exacerbate the migraine should be observed carefully. A definitive diagnosis of migraine should include ascertaining if headache is chronic, has an acute onset, or is remitting-relapsing.

Three basic questions can make a diagnosis of migraine:

  • Degree of disability accompanying the headaches
  • Whether nausea links the headaches
  • Whether the patient sensitive to light.

Two positive answers would reveal that the condition is migraine.

Nonpharmacologic treatment of migraine
Nonpharmacologic approaches to migraine include:

 Patient education
 Stress management .
 Lifestyle modification
 Avoidance of migraine triggers.
If the number of migraine attacks exceeds 6 per month and interferes with the patient's daily routine, preventive therapy should be considered. Preventive measures are based on both pharmacologic and nonpharmacologic approaches

Goal of prophylaxis for migraine include:
Reduce the severity, frequency, and duration of attacks and their associated disabilities.

The USA National Headache Foundation consensus statement on migraine prevention has suggests that the clinicians should assess migraine-related impairment during and between attacks and also included revised guidelines for prophylactic therapy (Table1).

New Investigational therapies:
CGRP (Calcitonin gene-related peptide receptor) antagonists target key components of the trigeminal sensory neuro inflammatory response.

Cutting edge molecular profiling studies looking at gene expression during chronic pain are now being used to reveal the cell biology of pain and new potential therapeutic targets.

Hypotheses that primary CNS dysfunction, trigeminovascular activation, pain perception and activation of associated neural circuits is involved in affective functions, this provides a framework to design and test future migraine treatment strategies.

Conclusion
Migraine is one of the most common neurological disorders, involving periodical attacks of headache and nausea as well as a plethora of other symptoms. Migraine treatment has evoked a great response in the clinical domain in the past decade. Considerable progress has been made in the .treatment protocol. Novel and new approaches targeting specific cellular mechanisms could well enhance the migraine therapeutic index, which is a dire necessity for the troubled patient community. Days are not far ahead where migraine could no longer be a treatment headache.

References

  • Pearce JM5. Headache. In: Weatherall DJ, ledingham JGG, Warrell DA, eds. Oxford Textbook of Medicine.3rd ed. Vol 3. New York: Oxford University Press;1996:4022-4029.
  • Raskin NH. Headache. In: Kasper DL, Braunwald E, Fauci AS, et al, eds. Harrison's Principles of Internal Medicine. 16th ed. Vol 1. New York: McGraw-Hill; 2005:85-94.
  • Myra Partridge. Enhance migraine care by stepping up physician-patient communication. Information accessed from www.appneurology.com.2007; 3 (5):1-3 ason 06-07-07.
  • Ramadan NM. Current trends in migraine prophylaxis. Headache. 2007; 47 Suppl1 :S52-57.
  •  Modi S, lowder DM. Medications for migraine prophylaxis. Am Fam Physician. 2006; 73(1 ):72-78.
  • Hargreaves R. New migraine and pain research. Headache. 2007; 47 Suppl1 :S26-43.
     
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