DOCSLIB.ORG

Migraine: Spectrum of Symptoms and Diagnosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Migraine: Spectrum of Symptoms and Diagnosis KEY POINT: MIGRAINE: SPECTRUM A Most patients develop migraine in the first 3 OF SYMPTOMS decades of life, some in the AND DIAGNOSIS fourth and even the fifth decade. William B. Young, Stephen D. Silberstein ABSTRACT The migraine attack can be divided into four phases. Premonitory phenomena occur hours to days before headache onset and consist of psychological, neuro- logical, or general symptoms. The migraine aura is comprised of focal neurological phenomena that precede or accompany an attack. Visual and sensory auras are the most common. The migraine headache is typically unilateral, throbbing, and aggravated by routine physical activity. Cutaneous allodynia develops during un- treated migraine in 60% to 75% of cases. Migraine attacks can be accompanied by other associated symptoms, including nausea and vomiting, gastroparesis, di- arrhea, photophobia, phonophobia, osmophobia, lightheadedness and vertigo, and constitutional, mood, and mental changes. Differential diagnoses include cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoenphalopathy (CADASIL), pseudomigraine with lymphocytic pleocytosis, ophthalmoplegic mi- graine, Tolosa-Hunt syndrome, mitochondrial disorders, encephalitis, ornithine transcarbamylase deficiency, and benign idiopathic thunderclap headache. Migraine is a common episodic head- (Headache Classification Subcommittee, ache disorder with a 1-year prevalence 2004): of approximately 18% in women, 6% inmen,and4%inchildren.Attacks Recurrent attacks of headache, consist of various combinations of widely varied in intensity, fre- headache and neurological, gastrointes- quency, and duration. The attacks tinal, and autonomic symptoms. Most are commonly unilateral in onset; patients develop migraine in the first are usually associated with an- 67 3 decades of life, some in the fourth orexia and sometimes with nausea and even the fifth decade. The term and vomiting; some are preceded migraine is derived from the Greek by, or associated with, conspicu- word hemicrania, introduced by Galen ous sensory, motor, and mood dis- in approximately AD 200. turbances; and are often familial. In order to increase precision, the DIAGNOSIS International Headache Society (IHS) Early migraine descriptions stressed proposed and published its classifica- three features: the unilateral distribu- tion of headache disorders in 1988 and tion of the headache, the presence of revised it in 2004 (Headache Classifi- a warning (often visual), and nausea or cation Subcommittee, 2004). The IHS vomiting. The Ad Hoc Committee on criteria added photophobia and pho- Classification of Headache described nophobia and required an untreated vascular headache of migraine type as duration of 4 to 72 hours. Copyright @ American Academy of Neurology. Unauthorized reproduction of this article is prohibited. " MIGRAINE: SYMPTOMS AND DIAGNOSIS KEY POINTS: A Migraine headaches were formerly To establish a diagnosis of migraine At most, only divided into two varieties: classic and under the IHS classification, certain 30% of common, which are now called mi- clinical features must be present and migraineurs have classic graine with aura and migraine without organic disease must be excluded aura. The same aura. The aura is the complex of focal (Table 4-2). Several attacks, each patient may neurological symptoms that precedes lasting 4 to 72 hours (untreated), are have migraine or accompanies an attack. At most, necessary and must have two of the headache only 30% of migraineurs have ‘‘classic’’ following four pain characteristics: without aura, aura. The same patient may have unilateral location, pulsating qual- migraine migraine headache without aura, mi- ity, moderate to severe intensity, and headache with graine headache with aura, and mi- aggravation by routine physical activ- aura, and graine aura without headache. ity. In addition, the attacks must have migraine aura In addition to the symptoms de- at least one of the following associated without scribed in the IHS definition, other symptoms: nausea and/or vomiting, headache. symptoms of migraine are extremely and/or photophobia and phonopho- A If sufficient common. A wide variety of premoni- bia. Using these criteria, no single criteria but one tory symptoms may occur; nasal con- associated feature is mandatory for are present, the gestion and neck pain may be present; diagnosing migraine, although recur- headache is and the typical eye findings of cluster rent episodic attacks must be docu- called probable headache may occur with some regu- mented. Different patients or different migraine. larity (Table 4-1). attacks may fulfill entirely nonover- lapping criteria. If sufficient criteria but one are present, the headache is TABLE 4-1 Rates of Migraine called probable migraine. Table 4-2 Symptoms lists the current subtypes of migraine. A migraine attack usually lasts less Symptom Approximate % than a day; when it persists for more * than 3 days, the term status migrain- Throbbing 80 osus is applied. Although migraine often Unilaterality* 61 begins in the morning, sometimes Moderate to 97 awakening the patient from sleep at severe* dawn, it can begin at any time of the Worse with 95 day or night. The frequency of attacks activity* is extremely variable, from a few in a lifetime to several in a week. The median Nausea* 87 68 attack frequency is 1.5 attacks per month; * Vomiting 56 10% of migraineurs have one or more Photophobia* 85 attacks per week (Stewart et al, 1994). * The diagnosis of migraine with aura Phonophobia 80 requires at least two attacks with any Allodynia 65 two of three features: (1) one or more Nasal 70 fully reversible aura symptoms; (2) the congestion aura developing over more than 4 min- Neck pain 65 utes but lasting less than 60 minutes; and (3) the headache following the Stabbing pain 40 aura with a free interval of less than 60 Clusterlike eye 5 minutes. Migraine with aura is subdi- symptoms vided into migraine with typical aura *In International Headache Society criteria. (homonymous visual disturbance, uni- lateral numbness, or aphasia); migraine Copyright @ American Academy of Neurology. Unauthorized reproduction of this article is prohibited. KEY POINTS: A Most migraineurs TABLE 4-2 International Classification of Headache Disorders. 2nd Edition, with migraine Migraine Classification with aura also have attacks 1. Migraine without aura. A 1.1 Migraine without aura In contrast to a transient 1.2 Migraine with aura ischemic attack, 1.2.1 Typical aura with migraine headache the aura of migraine evolves 1.2.2 Typical aura with nonmigraine headache gradually and 1.2.3 Typical aura without headache typically consists 1.2.4 Familial hemiplegic migraine of both positive (eg, scintillations, 1.2.5 Sporadic hemiplegic migraine tingling) and 1.2.6 Basilar-type migraine negative (eg, scotoma, 1.3 Childhood periodic syndromes that are commonly numbness) precursors of migraine features. 1.3.1 Cyclical vomiting 1.3.2 Abdominal migraine 1.3.3 Benign paroxysmal vertigo of childhood 1.4 Retinal migraine 1.5 Complications of migraine 1.5.1 Chronic migraine 1.5.2 Status migrainosus 1.5.3 Persistent aura without infarction 1.5.4 Migrainous infarction 1.5.5 Migraine-triggered seizures 1.6 Probable migraine 1.6.1 Probable migraine without aura 1.6.2 Probable migraine with aura 69 1.6.5 Probable chronic migraine Data from Headache Classification Subcommittee. The International Classification of Headache Disorders. 2nd edition. Cephalalgia 2004;24(suppl 1):9–160. aura with nonmigraine headache or the headache, but occasionally it occurs without headache; familial and spo- with the headache or only during the radic hemiplegic migraine; and basilar headache. In contrast to a transient migraine. Other varieties of migraine ischemic attack (TIA), the aura of mi- include retinal migraine and childhood graine evolves gradually and typically periodic syndromes. Most patients with consists of both positive (eg, scintilla- migraine with aura also have attacks tions, tingling) and negative (eg, sco- without aura. The aura usually lasts 20 toma, numbness) features. If the aura to 30 minutes and typically precedes is stereotypical, the diagnosis of migraine Copyright @ American Academy of Neurology. Unauthorized reproduction of this article is prohibited. " MIGRAINE: SYMPTOMS AND DIAGNOSIS KEY POINTS: with aura is warranted, even if the the headache. If the headache is ab- A Almost any subsequent headache does not have sent, it is migraine aura without head- symptom or sign of brain typical migrainous features. Almost ache. Both may be associated with dysfunction any symptom or sign of brain dysfunc- premonitory symptoms. (Premonitory may be a tion may be a feature of the aura, but symptoms often extend into the head- feature of the commonly the aura is visual. ache or may begin in the headache migraine aura, Focal symptoms and signs of the phase). but commonly aura may persist beyond the headache the aura is phase. Formerly termed complicated Premonitory Phase visual. migraine, the IHS classification has Premonitory phenomena occur hours A Particularly in introduced two more-specific labels. to days before headache onset in about mid or late life, If the aura lasts for more than 1 hour 60% of migraineurs and can consist of the migraine but less than 1 week, the term migraine psychological, neurological, or general aura may not with prolonged aura was formerly (constitutional, autonomic) symptoms be followed by applied, but now the episode is called (Table 4-4). Psychological symptoms
Load more

Recommended publications
  • Cluster Headache: a Review MARILYN J
    • Cluster headache: A review MARILYN J. CONNORS, DO ID Cluster headache is a debilitat­ consists of episodes of excruciating facial pain that ing neuronal headache with secondary vas­ is generally unilateraP and often accompanied by cular changes and is often accompanied by ipsilateral parasympathetic phenomena including other characteristic signs and symptoms, such nasal congestion, rhinorrhea, conjunctival injec­ as unilateral rhinorrhea, lacrimation, and con­ tion, and lacrimation. Patients may also experi­ junctival injection. It primarily affects men, ence complete or partial Horner's syndrome (that and in many cases, patients have distinguishing is, unilateral miosis with normal direct light response facial, body, and psychologic features. Sever­ and mild ipsilateral ptosis, facial flushing, and al factors may precipitate cluster headaches, hyperhidrosis).4-6 These autonomic disturbances including histamine, nitroglycerin, alcohol, sometimes precede or occur early in the headache, transition from rapid eye movement (REM) adding credence to the theory that this constella­ to non-REM sleep, circadian periodicity, envi­ tion of symptoms is an integral part of an attack and ronmental alterations, and change in the level not a secondary consequence. Some investigators of physical, emotional, or mental activity. The consider cluster headache to exemplify a tempo­ pathophysiologic features have not been com­ rary and local imbalance between sympathetic and pletely elucidated, but the realms of neuro­ parasympathetic systems via the central nervous biology, intracranial hemodynamics, endocrinol­ system (CNS).! ogy, and immunology are included. Therapy The nomenclature of this form of headache in is prophylactic or abortive (or both). Treat­ the literature is extensive and descriptive, includ­ ment, possibly with combination regimens, ing such terminology as histamine cephalgia, ery­ should be tailored to the needs of the indi­ thromelalgia of the head, red migraine, atypical vidual patient.
    [Show full text]
  • Headache Diagnosis and Management 2018 Update in Internal Medicine October 25, 2018
    Headache Diagnosis and Management 2018 Update in Internal Medicine October 25, 2018 Laurie Knepper MD Associate Professor of Neurology University of Pittsburgh School of Medicine A 22 year old comes to the office with increasing headache. She had headaches as a child, for which she would have to leave school because she was vomiting. These decreased as she got older and were mainly before the onset of her period. Now, for the past 5 months, the headaches have been occurring 3-4 days/week. She become tired and yawny the day before, and with severe headaches, she has dizziness and difficulty focusing her eyes. The day after she is mentally foggy. The Primary Headache ICHD 3 (2013) • Migraine • 1.1 Migraine without aura 80% • 1.2 Migraine with aura 20-30% • 1.3 Chronic migraine 2.5% • Tension Type Headache • Trigeminal Autonomic Neuralgias • Cluster, Paroxysmal Hemicrania, SUNCT, Hemicrania continua • Other primary Headache disorders • Cough, exercise, sexual ,stabbing, Hypnic, New daily persistent Migraine without aura A. At least 5 attacks B. Lasting 4-72 hours C. At least two of: A. Unilateral B. Pulsating C. Moderate or severe pain intensity D. Aggravated by physical activity D. During headache at least one of: A. Nausea and/or vomiting B. Photophobia , phonophobia E. Symptoms not attributed to another disorder Epidemiology • Lifetime prevalence of headache: 66% Migraine: 18% women, 6% men • 28 million in US with migraines • Highest prevalence is mid life => decreased work • $13 billion cost each year- ER, lost income, etc • 40% of migraine patients would benefit from preventative meds Only 13% receive effective preventative treatment • Studies note most “ sinus headaches” are migraines •2/3 of migraines are managed by primary care! The anatomy of Migraine A 49 year old woman presents to your headache clinic for evaluation of new episodes of right arm numbness and speech difficulty.
    [Show full text]
  • Menstrually Related and Nonmenstrual Migraines in A
    MENSTRUALLY RELATED AND NONMENSTRUAL MIGRAINES IN A FREQUENT MIGRAINE POPULATION: FEATURES, CORRELATES, AND ACUTE TREATMENT DIFFERENCES A dissertation presented to the faculty of the College of Arts and Sciences of Ohio University In partial fulfillment of the requirements for the degree Doctor of Philosophy Brenda F. Pinkerman March 2006 This dissertation entitled MENSTRUALLY RELATED AND NONMENSTRUAL MIGRAINES IN A FREQUENT MIGRAINE POPULATION: FEATURES, CORRELATES, AND ACUTE TREATMENT DIFFERENCES by BRENDA F. PINKERMAN has been approved for the Department of Psychology and the College of Arts and Sciences by Kenneth A. Holroyd Distinguished Professor of Psychology Benjamin M. Ogles Interim Dean, College of Arts and Sciences PINKERMAN, BRENDA F. Ph.D. March 2006. Clinical Psychology Menstrually Related and Nonmenstrual Migraines in a Frequent Migraine Population: Features, Correlates, and Acute Treatment Differences (307 pp.) Director of Dissertation: Kenneth A. Holroyd This research describes and compares menstrually related migraines as defined by recent proposed guidelines of the International Headache Society (IHS, 2004) to nonmenstrual migraines in a population of female migraineurs with frequent, disabling migraines. Migraines are compared by frequency per day of the menstrual cycle, headache features, use of abortive and rescue medications, and acute migraine treatment outcomes. In addition, this study explores predictors of acute treatment response and headache recurrence within 24 hours following acute migraine treatment for menstrually related migraines. Participants are 107 menstruating female migaineurs who met IHS (2004) proposed criteria for menstrually related migraines and completed headache diaries using hand-held computers. Diary data are analyzed using repeated measures logistic regression. The frequency of migraines is significantly increased during the perimenstrual period, and menstrually related migraines are of longer duration and greater frequency with longer lasting disability than nonmenstrual migraines.
    [Show full text]
  • Headache: General Considerations CQ I-1
    I Headache: General Considerations CQ I-1 How is headache classified and diagnosed? Recommendation Headache should be classified and diagnosed according to the International Classification of Headache Disorders 3rd edition (beta version). Grade A Background and Objective In 2004, the International Headache Society (IHS) revised the first edition of the IHS guideline for the first time in 15 years, incorporating the latest advances in research, evidence and criticisms. The resulting document, International Classification of Headache Disorders 2nd Edition (ICHD-2) was published in Cephalalgia.1) In the same year, the ICHD-2 was translated into Japanese and published.2) From 2004, headache should be classified and diagnosed in accordance with the ICHD-2. The first recorded classification of headache was by Aretaeus (a physician born in 81 BC) of Cappadacia in the present day Turkey, who classified headaches into cephalalgia, cephalea, and heterocrania.3)-5) Heterocrania was described as “half head” headache, which is equivalent to migraine in the present day classification. The first consensus-orientated headache classification in history was the classification by the Ad Hoc Committee on Classification of Headache of the American Neurological Association (Ad Hoc classification) published in 1962.6) In this classification, headache was classified into 15 types, but no diagnostic criteria were included. In 1988, the Headache Classification Committee of the International Headache Society chaired by Olesen proposed the first international classification of headache disorders (IHS Classification,st 1 edition, 1988).7) The IHS Classificationst 1 edition first classified headache into 13 items, and further subdivided into 165 headache types. For each subtype, operational criteria were described.
    [Show full text]
  • Visual Perception in Migraine: a Narrative Review
    vision Review Visual Perception in Migraine: A Narrative Review Nouchine Hadjikhani 1,2,* and Maurice Vincent 3 1 Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA 2 Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, 41119 Gothenburg, Sweden 3 Eli Lilly and Company, Indianapolis, IN 46285, USA; [email protected] * Correspondence: [email protected]; Tel.: +1-617-724-5625 Abstract: Migraine, the most frequent neurological ailment, affects visual processing during and between attacks. Most visual disturbances associated with migraine can be explained by increased neural hyperexcitability, as suggested by clinical, physiological and neuroimaging evidence. Here, we review how simple (e.g., patterns, color) visual functions can be affected in patients with migraine, describe the different complex manifestations of the so-called Alice in Wonderland Syndrome, and discuss how visual stimuli can trigger migraine attacks. We also reinforce the importance of a thorough, proactive examination of visual function in people with migraine. Keywords: migraine aura; vision; Alice in Wonderland Syndrome 1. Introduction Vision consumes a substantial portion of brain processing in humans. Migraine, the most frequent neurological ailment, affects vision more than any other cerebral function, both during and between attacks. Visual experiences in patients with migraine vary vastly in nature, extent and intensity, suggesting that migraine affects the central nervous system (CNS) anatomically and functionally in many different ways, thereby disrupting Citation: Hadjikhani, N.; Vincent, M. several components of visual processing. Migraine visual symptoms are simple (positive or Visual Perception in Migraine: A Narrative Review. Vision 2021, 5, 20. negative), or complex, which involve larger and more elaborate vision disturbances, such https://doi.org/10.3390/vision5020020 as the perception of fortification spectra and other illusions [1].
    [Show full text]
  • The Migraine-Epilepsy Syndrome
    medigraphic Artemisaen línea Arch Neurocien (Mex) Vol 11, No. 4: 282-287, 2006 The Migraine- Epilepsy Syndrome Arch Neurocien (Mex) Vol. 11, No. 4: 282-287, 2006 Artículo de revisión ©INNN, 2006 de caso The migraine-epilepsy syndrome Enrique Otero Siliceo†, Fernando Zermeño EL SINDROME MIGRAÑA-EPILEPSIA represent a neural exitation. Since that the glutamate has in important rol in both patologys depending of the part of the brain more affected the symptoms might RESUMEN vary from visual to abdominal phemomena. La migraña y la epilepsia tienen varios puntos en común Key words: migraine epilepsy, EEG abnormalities, sintomática clínica y genéticamente lo que ha sido glutamate, diagnosis. postulado por más de cien años. El fenómeno referido como migraña-epilepsia sugiere que exista una he first steps of a practical, approach by patofisiología común. El síndrome de migraña o physicians in recognizing and treating neuro- epilepsia tiene fenómenos comunes de dolor adominal T logic diseases are to recognithat there are jaqueca anormalidades del EE y respuesta a droga various overlaps between migraine and epilepsy. antiepilépticas. En ocasiones el paciente puede tener Epileptic seizures and classic migraine episodes may un ataque migrañoso o una convulsión o en otras occur in the same patient. Migraine and epilepsy share ambas. La comorbilidad puede explicarse por estados several genetic, clinical, evolutive and neurophysio- de hiperrexcitabilidad neural. Alteraciones electroen- logic features. A relationship between epilepsy and cefalográficas son comunes en estos estados. En migraine has been postulated for over a hundred years apariencia el glutamato tiene un papel importante tanto and the syndrome of Migraine-Epilepsy illustrates this en la migraña como en la epilepsia.
    [Show full text]
  • Migraine: Current Concepts and Emerging Therapies
    Vascular Pharmacology 43 (2005) 176 – 187 www.elsevier.com/locate/vph Migraine: Current concepts and emerging therapies D.K. Arulmozhi a,b,*, A. Veeranjaneyulu a, S.L. Bodhankar b aNew Chemical Entity Research, Lupin Research Park, Village Nande, Taluk Mulshi, Pune 411 042, Maharashtra, India bDepartment of Pharmacology, Bharati Vidyapeeth, Poona College of Pharmacy, Pune 411 038, Maharashtra, India Received 23 April 2005; received in revised form 17 June 2005; accepted 11 July 2005 Abstract Migraine is a recurrent incapacitating neurovascular disorder characterized by attacks of debilitating pain associated with photophobia, phonophobia, nausea and vomiting. Migraine affects a substantial fraction of world population and is a major cause of disability in the work place. Though the pathophysiology of migraine is still unclear three major theories proposed with regard to the mechanisms of migraine are vascular (due to cerebral vasodilatation), neurological (abnormal neurological firing which causes the spreading depression and migraine) and neurogenic dural inflammation (release of inflammatory neuropeptides). The modern understanding of the pathogenesis of migraine is based on the concept that it is a neurovascular disorder. The drugs used in the treatment of migraine either abolish the acute migraine headache or aim its prevention. The last decade has witnessed the advent of Sumatriptan and the Ftriptan_ class of 5-HT1B/1D receptor agonists which have well established efficacy in treating migraine. Currently prophylactic treatments for migraine include calcium channel blockers, 5-HT2 receptor antagonists, beta adrenoceptor blockers and g-amino butyric acid (GABA) agonists. Unfortunately, many of these treatments are non specific and not always effective. Despite such progress, in view of the complexity of the etiology of migraine, it still remains undiagnosed and available therapies are underused.
    [Show full text]
  • Vascular Surgery for Chronic Migraine
    RESEARCH ARTICLE Vascular surgery for chronic migraine Elliot Shevel Background: The superficial branches of the external carotid artery have been shown to The Headache Clinic, Suite 243, Private Bag be the origin of headache pain in some individuals. Surgical ligation of the temporal X2600, Houghton 2041, artery was first described by Al Zahrawi. Since then, excellent results have been achieved South Africa surgically in those patients in whom the superficial vessels have been positively identified Tel.: +27 114 840 933; Fax: +27 114 824 167; as the source of the headache pain. Aim: To determine the improvement in quality of life E-mail: drshevel@ in patients suffering from chronic daily headache (CDH) following cauterization of headclin.com superficial scalp vessels. Patients & methods: In total, 65 patients with CDH, in whom the superficial scalp vessels were positively identified as the source of pain, underwent surgical cauterization of the relevant vessels. Results: The quality of life of CDH sufferers in whom the pain was shown to originate in the superficial scalp vessels was significantly improved following surgical cauterization of the relevant vessels. Conclusion: Surgical cauterization of superficial scalp vessels can be a valuable treatment modality in selected patients with CDH. The extracranial branches of the external carotid revised criteria [31], and in whom there was a pos- artery are an important source of pain in some itive diagnosis of extracranial arterial pain, were patients with primary headaches [1–16]. In these included in the study. The subjects were patients, surgical cauterization of the relevant recruited from patients attending The Headache arteries provides permanent pain relief [17–26].
    [Show full text]
  • Hormonal Contraceptive Treatment May Reduce the Risk of Fibromyalgia in Women with Dysmenorrhea: a Cohort Study
    Journal of Personalized Medicine Article Hormonal Contraceptive Treatment May Reduce the Risk of Fibromyalgia in Women with Dysmenorrhea: A Cohort Study Cheng-Hao Tu 1,* , Cheng-Li Lin 2, Su-Tso Yang 3,4, Wei-Chih Shen 5,6 and Yi-Hung Chen 1,7,8,* 1 Graduate Institute of Acupuncture Science, China Medical University, Taichung 404333, Taiwan 2 Management Office for Health Data, China Medical University Hospital, Taichung 404332, Taiwan; [email protected] 3 Department of Medical Imaging, China Medical University Hospital, Taichung 404332, Taiwan; [email protected] 4 School of Chinese Medicine, China Medical University, Taichung 404333, Taiwan 5 Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung 404332, Taiwan; [email protected] 6 Department of Computer Science and Information Engineering, Asia University, Taichung 413305, Taiwan 7 Traditional Chinese Medicine Research Center, China Medical University, Taichung 404333, Taiwan 8 Department of Photonics and Communication Engineering, Asia University, Taichung 41354, Taiwan * Correspondence: [email protected] (C.-H.T.); [email protected] (Y.-H.C.); Tel.: +886-4-22053366 (C.-H.T.) (ext. 3336) Received: 17 November 2020; Accepted: 11 December 2020; Published: 14 December 2020 Abstract: Dysmenorrhea is the most common gynecological disorder for women in the reproductive age. Study has indicated that dysmenorrhea might be a general risk factor of chronic pelvic pain and even chronic non-pelvic pain, such as fibromyalgia. We used the Longitudinal Health Insurance Database 2000 from the Taiwan National Health Research Institutes Database to investigate whether women with dysmenorrhea have a higher risk of fibromyalgia and whether treatment of dysmenorrhea reduced the risk of fibromyalgia.
    [Show full text]
  • Migraine Headache Prophylaxis Hien Ha, Pharmd, and Annika Gonzalez, MD, Christus Santa Rosa Family Medicine Residency Program, San Antonio, Texas
    Migraine Headache Prophylaxis Hien Ha, PharmD, and Annika Gonzalez, MD, Christus Santa Rosa Family Medicine Residency Program, San Antonio, Texas Migraines impose significant health and financial burdens. Approximately 38% of patients with episodic migraines would benefit from preventive therapy, but less than 13% take prophylactic medications. Preventive medication therapy reduces migraine frequency, severity, and headache-related distress. Preventive therapy may also improve quality of life and prevent the progression to chronic migraines. Some indications for preventive therapy include four or more headaches a month, eight or more headache days a month, debilitating headaches, and medication- overuse headaches. Identifying and managing environmental, dietary, and behavioral triggers are useful strategies for preventing migraines. First-line med- ications established as effective based on clinical evidence include divalproex, topiramate, metoprolol, propranolol, and timolol. Medications such as ami- triptyline, venlafaxine, atenolol, and nadolol are probably effective but should be second-line therapy. There is limited evidence for nebivolol, bisoprolol, pindolol, carbamazepine, gabapentin, fluoxetine, nicardipine, verapamil, nimodipine, nifedipine, lisinopril, and candesartan. Acebutolol, oxcarbazepine, lamotrigine, and telmisartan are ineffective. Newer agents target calcitonin gene-related peptide pain transmission in the migraine pain pathway and have recently received approval from the U.S. Food and Drug Administration; ​​​how- ever, more studies of long-term effectiveness and adverse effects are needed. The complementary treatments petasites, feverfew, magnesium, and riboflavin are probably effective. Nonpharmacologic therapies such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic feedback, and cognitive behavior therapy also have good evidence to support their use in migraine prevention. (Am Fam Physician. 2019; 99(1):17-24.
    [Show full text]
  • Reversible Cerebral Vasoconstriction Syndrome During Caesarean Section
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 19, Issue 3 Ser.9 (March. 2020), PP 35-36 www.iosrjournals.org Reversible Cerebral Vasoconstriction Syndrome during Caesarean Section. Tarunikachhonker, Rahul chauhan 1 Post graduate department of Anaesthesia National Institute Of Medical Sciences and Research, Jaipur Rajasthan 2 Senior resident Neurology department of Neurology Paras Hospitals Gurgaon. ----------------------------------------------------------------------------------------------------------------------------- ---------- Date of Submission: 05-03-2020 Date of Acceptance: 19-03-2020 -------------------------------------------------------------------------------------------------------------------- ------------------- I. Summary We describe a case of 21 year old female who during her emergency Caesarean section had thunderclap headache and generalised tonic clinic seizure due to reversible cerebral vasoconstriction syndrome(RCVS).The syndrome was caused by Phenylephrine given intravenously to correct arterial hypotension post spinal anaesthesia. Reversible cerebral vasoconstriction syndrome (RCVS) is characterised by severe headaches, with or without other acute neurological symptoms, and diffuse segmental constriction of cerebral arteries.The syndrome can be caused by several triggers including post partum, vasoactive drugs,immunosuppressant,blood products etc. Diagnosis and management can be challenging especially during post partum period. The aim of this case report is
    [Show full text]
  • Effects of the Menstrual Cycle on Medical Disorders
    REVIEW ARTICLE Effects of the Menstrual Cycle on Medical Disorders Allison M. Case, MD; Robert L. Reid, MD xacerbation of certain medical conditions at specific phases of the menstrual cycle is a well-recognized phenomenon. We review the effects of the menstrual cycle on medical conditions, including menstrual migraine, epilepsy, asthma, rheumatoid arthritis, irritable bowel syndrome, and diabetes. We discuss the role of medical suppression of ovulationE using gonadotropin-releasing hormone agonists in the evaluation and treatment of these disorders. Peer-reviewed publications from English-language literature were located via MEDLINE or from bibliographies of relevant articles. We reviewed all review articles, case reports and series, and therapeutic trials. Emphasis was placed on diagnosis and therapy of menstrual cycle– related exacerbations of disease processes. Abrupt changes in the concentrations of circulating ovar- ian steroids at ovulation and premenstrually may account for menstrual cycle–related changes in these chronic conditions. Accurate documentation of symptoms on a menstrual calendar allows identification of women with cyclic alterations in disease activity. Medical suppression of ovula- tion using gonadotropin-releasing hormone agonists can be useful for both diagnosis and treat- ment of any severe, recurrent menstrual cycle–related disease exacerbations. Arch Intern Med. 1998;158:1405-1412 The menstrual cycle, an event that punctu- Several theories have been proposed to ates the lives of most women, may be asso- explain these menstrual cycle–related effects ciated with diverse physical, psychological, on existing disease processes, including fluc- and behavioral changes. Not surprisingly, it tuations in levels of sex steroids, cyclic alter- plays a significant role in women’s health and ations in the immune system, and changing disease.
    [Show full text]