Heavy headache with rather sudden onset, mostly on one half of the head (but which can change). Can occur at any time of the day, but also in the middle of the night or early in the morning. The patient feels a general malaise, is pale in the face, cannot bear noise or light but darkens his room and goes to bed. Often he feels sick and sometimes has to throw up after which he feels better. The migraine fades away, eventually also after a sleep. For some patients the malaise is often harder bearable than the headache itself.
A typical migraine attack lasts between some hours and three days.The frequency of common migraine should not increase some times a month. If it is more frequent there may be something wrong with the diagnosis.
The most annoying thing about the common migraine is that it preferably occurs at the days off or at weekends. See also the migraine FAQs part one.
As with common headache the careful interview is the prevailing diagnostic measure. The clinical examination is most often normal. During a heavy attack a stiff neck (meningism) can sometimes be noticed. Also tender spots at the vertebral joints can be palpated (so called irritation zones) which disappear after chiropractic manipulation.The major part of the patients has a normal or slightly low blood pressure. Although frequently assumed there are no common psychological properties in migraineurs.
A minor part has unspecific changes in the standard EEG, mostly on one temporal side, due to vasomotor dysregulation. The photosynchronisation is usually distinct, especially also in the slow frequencies. In advanced neurophysiological examination an increased attention potential might be found.
Radiological examinations are mostly normal. Sometimes in young individuals you find enhanced impressions in the skull which should be cross-checked with a CT to rule out an increased intracranial pressure. The vertebral column is often stretched, with functional examinations isolated blockades or hypermobilities can be seen.
Whereas migraineurs have no specific properties of their characters in common they all seem to lead an overspeeding life. Therefore a psychoanalytical approach to recognize this factor in the individual patient may seem valuable after which a chance to change the overdriving lifestyle can be taken. Otherwise relaxing techniques such as yoga, autogenic training or biofeedback can be tried. Patients should keep a diary in order to detect possible connections to food incompatibility or other external factors. See also the migraine FAQs part three
Most of the medicaments mentioned below have an impact on the Serotonin metabolism.Today the migraine attack is best and fastest be treated with Sumatriptan which can be injected subcutanously (8-16 mg) or taken orally (50-300 mg). The patient must not have coronary heart disease or hypertension and he must not take Ergotamine prophylactically. The medicament is unfortunately very expensive.
The classical treatment of an attack is with Ergotamine, either intramuscularly or rectally. In most preparations there is also Caffeine and perhaps Codeine plus a spasmolytic agent.
Most recently simple inhaling of lidocaine solution as a nasal spray has become propagated as migraine pain killer.
The most reasonable treatment of an attack according to major consent of headache specialists today is however the application of a mild antivertiginosum and gastrointestinal procinetic such as Metoclopramide or Domperidon which should be taken early after onset of symptoms. Later the patient can take Aspirin© or Paracetamol. See also the migraine FAQs part two.
If migraine attacks occur more frequently than once in a month a prophylactic treatment can be considered. Such a medication can consist of:
Some of these medicaments may have side effects such as increase of weight, tiredness, drowsiness, problems with low blood pressure, bradycardia and others.
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