6 Trigger Factors of Migraine Attacks

6 Trigger Factors of Migraine Attacks

Migraine   October 29, 2013

Cause of migraine is not known clearly, but this can lead to a primary vascular disorder that usually occurs in women, and many have a strong tendency in the family. Migraines are also caused by the occurrence of a combination of vasodilation (widening of blood vessels) and the release of a chemical substance from nerve fibers that surrounds the blood vessels. When a migraine attack, the temporal artery (the artery that runs around the temple) will be widened. The widening will cause stretching of the nerve fibers around arteries thus stimulating these nerve fibers to release chemicals. This substance will cause inflammation, pain and migraine incredible.

Various factors that can trigger a migraine attack is determined by the presence of hereditary biological defects in the central nervous system. Among others:

1. Hormonal
Hormonal fluctuations are the trigger factor. the presence of glucose increased only 14% of women had an attack during menstruation. Reduced migraine attacks during pregnancy because estrogen levels are relatively high and constant, contrary porspartum first week, 14% of patients experienced severe attack due to lower levels of extradition. Use of the contraceptive pill also causes the frequency of migraine attacks.

2. Menopause
Migraine generally will increase the frequency and severity at the time of menopause. However, some cases improved after menopause. Hormonal therapy with low-dose estrogen can be given to treat migraine attacks after menopause.

3. Food
Variety of foods / substances can trigger a migraine attack. Common migraine triggers are alcohol based vasodilatory effect, where wine and beer are strong triggers. Foods containing tyramine, an amino acid derived from thyroxine.

4. Monosodium Glutamate
Is the most common migraine triggers, namely: headache accompanied by anxiety, dizziness, parastesia and hands, as well as abdominal pain and chest pain.

5. Environment
Environmental changes in the body which include hormonal fluctuations in the menstrual cycle and hormonal changes can lead to getting out of bed acute migraine attacks. Changes in the external environment include the weather, season, air pressure, altitude, and late meals.

6. Sensory stimuli
Flashing light, glare, bright sunlight, or the smell of perfumes, cleaning chemicals, cigarettes, sura noise and extreme temperatures.

Clinical Manifestation and Pathophysiology of Migraine

Clinical Manifestation and Pathophysiology of Migraine

Migraine   October 25, 2013

Clinical Manifestation of Migraine

Migraine is a chronic condition. Most of the migraine attacks are also accompanied with another headache. Migraine headache is often described as a severe headache, throbbing and attacking head on one side. Some pain is felt in the forehead, around the eyes and behind the head so obscure symptoms with another headache. Although most of the migraine attack on one side of the head, but often also found symptoms of migraine headaches on both sides of the head. Side of the head migraines too often turns on every time attack. Be careful when the affected side of the head is always the same, another possibility is the occurrence of a brain tumor. Patients with migraine often tormented in performing daily activities, especially when the attack occurred. Other accompanying symptoms of migraine include, nausea, vomiting, diarrhea, facial pallor, cold hands feet, and the patient will be sensitive to light and sound. Due to an increased sensitivity to light and sound then migraine sufferers had to lie in a quiet and dark room. Migraine attacks usually subside within 4 to 72 hours.

Nearly 70% had a family history of migraine. Most of the women. The first attack in the migraine usually starts during adolescence and young adulthood, and then tended to decrease at the age of 5 and 6 decades. Usually there is a triggering factor. Patients generally have a perfectionist personality, rigid, and impulsive.
The clinical features of migraine is usually a throbbing headache but unilateral and bilateral or switched sides. Migraine attacks typically 2-8 times per month, once the attack duration between 4-24 hours or longer isa, moderate-severe pain intensity, accompanying symptoms, among others,: nausea, vomiting, photophobia and / or phonophobia, pale face, vertigo , tinnitus, irritable. On migraine with aura, the symptoms prodromalnya is skotomata.teikopsia (fortification spectra), photophobia (light flashes) paresthesias and visual hallucinations exhausted, feeling tired, very hungry and feeling nervous / anxious.
Headaches often appear at the wake, but it can happen at any time.


Pathophysiology of Migraine

Signs and symptoms of migraine on the result of cerebral cortical ischemia varying degrees. Typical attack starts with a scalp artery vasoconstriction and retinal blood vessels and cerebral. Extracranial and intracranial blood vessels dilated, which causes pain and discomfort. Studies suggest that arterial dilatation hyperpermeable and cause local inflammation that sterilize, which causes pain in surrounding areas and arterial dilatation. The state aims to enable existing substances in the blood vessels (histamine, serotonin, plasmokinin) who participated in cleaning the inflammatory reaction.

Migraine attacks commonly activate the sympathetic nervous going. The meaning of the sympathetic nerve is the nerve that is part of the human nervous system is responsible for controlling the body's response to stress and pain. Increased sympathetic nervous activity in the intestine causes nausea , vomiting and diarrhea. Sympathetic activity will also lead to slow gastric emptying resulting in drug delivery to the small intestine to be absorbed will also be hampered. Barriers to drug absorption that is the problem for people with migraine when administered orally administered drug. Increased sympathetic activity also decreases the flow of blood so that the skin will appear pale and cold. Increased neural activity will also lead to increased sensitivity to light and sound.

There are various theories that explain the occurrence of migraine.

Vascular theory, disruptions vasospasm causing cerebral blood vessels constrict, causing brain hypoperfusion which began in the visual cortex and spread forward. Continued deployment of frontal headache and cause phase begins.

Theory of cortical spread depression, which in the migraine threshold value decreases neuronal excitation of neurons so easily happen, then apply shortlasting depolarization wave, by potassium - liberating depression ( decreased release of potassium ) that results in a prolonged period of depressed neurons. Furthermore, there will be deployment of depression that would suppress the activity of neurons as it passes through the cerebral cortex.

Theory of neovascular (trigeminovascular), the vasodilatory effect NOS activity and NO production would stimulate the trigeminal nerve endings in blood vessels, releasing CGRP (calcitonin gene related). CGRP binds to its receptor on mast cells and will stimulate spending meningens inflammatory mediators that lead to inflammation of neurons. CGRP is also working on the cerebral arteries and the smooth muscle that will lead to increased blood flow. In addition, CGRP will work on post junctional second order neurons site that acts as the transmission of pain impulses.

5 Types of Migraine

5 Types of Migraine

Migraine   October 25, 2013

Migraine is a recurrent headache is idiopathic, with pain attacks lasting 4-27 hours, usually one-sided, throbbing nature, moderate-severe pain intensity, the more intense by regular physical activity, can be accompanied by nausea, photophobia and phonophobia. Migraines can occur in children with pain more often bifrontal location.

1. Classic Migraine

Preceded by a visual aura, a scotoma, flash of light, vision fireflies or black and white stripes, or blurred vision for 10-20 minutes. Then comes the headache, throbbing, unilateral, which is more severe, lasts between 1-6 hours. Will usually subside within 6-24 hours but sometimes longer. Accompanying symptoms are often encountered are nausea, vomiting, photophobia, phonophobia, irritable and malaise.

Classic migraine attack can be divided into three phases, namely:

1). Aura phase

When migraine with aura is connected, the aura can be more than 30 minutes and can give sufficient time for the patient to determine which drugs would be used to prevent attacks in the. This period is the manifestation of the characteristics of sensory, particularly visual disturbances (glare).

Other symptoms may occur in the presence of:

1. Pins and needles
2. Itchy feeling on the face and hands
3. Confusion being
4. A little weak on the extremities
5. Dizziness

Period aura, is associated with vasoconstriction without pain that begins with early physiologic changes characteristic of classic migraine. Cerebral blood flow studies conducted during the headache phase of migraine attacks showed that all reduced cerebral blood flow throughout the brain, with a further loss of autoregulation and CO2 responsiveness damage.

2). Headache phase

At the time of initial symptoms began to diminish, these symptoms followed by unilateral headache (two-thirds of patients) and pulsed. Severe headache and was not able to make and is often associated with photophobia, nausea, and vomiting. Duration of this state varies, with the distance of a few hours in a day or all day.

3). Recovery phase

Is the period of muscle contraction neck and scalp are associated with local muscle pain and tension. Fatigue and exhaustion are common physical cause back pain headaches. During the post-headache phase, the patient may sleep for a long time.

2. Common Migraine

Headache arise without any prior prodromal visual aura as the classic migraine and usually lasts longer.

3. Association Migraine

At this migraine, headache accompanied by transient neurological deficits, for example in oftalmoplegik migraine, hemiplegic migraine, and migraine with aphasia. Deficit neurogis This usually occurs prior to or after the headache (migraine association) or in the absence of headache (migraine dissociation).

4. Complicated Migraine

At this migraine, neurological deficit arising will settle due to cerebral infarction. Therefore, the constrictor phase should not be given so as not to aggravate the infarction.

5. Status Migraine

Is a migraine attack that lasts more than 24 hours due to sterile inflammation around the blood vessels are dilated.