Migraine ( AMAL)

By: AMAL

 

Migraine

          Migraine is a chronic neurological disorder characterized by recurrent moderate to severe headaches often in association with a number of autonomic nervous system symptoms Typically the headache is unilateral (affecting one half of the head) and pulsating in nature, lasting from 2 to 72 hours. Associated symptoms may include nausea, vomiting, photophobia (increased sensitivity to light), photophobia (increased sensitivity to sound) and the pain is generally aggravated by physical activity.

       Classically the headache is unilateral, throbbing, and moderate to severe in intensity. It usually comes on gradually and is aggravated by physical activity. In more than 40% of cases however the pain may be bilateral, and neck pain is commonly associated. Bilateral pain is particularly common in those who have migraines without an aura. Less commonly pain may occur primarily in the back or top of the head. The pain usually lasts 4 to 72 hours in adults[19] however in young children frequently lasts less than 1 hour. The frequency of attacks is variable, from a few in a lifetime to several a week, with the average being about one a month The pain is frequently accompanied by nausea, vomiting, sensitivity to light, sensitivity to sound, sensitivity to smells, fatigue and irritability. In a basilar migraine, a migraine with neurological symptoms related to the brain stem or with neurological symptoms on both sides of the body, common effects include: a sense of the world spinning, light-headedness, and confusion. Nausea occurs in almost 90% of people, and vomiting occurs in about one-third. Many thus seek a dark and quiet room. Other symptoms may include: blurred vision, nasal stuffiness, diarrhea, frequent urination, pallor, or sweating. Swelling or tenderness of the scalp may occur as can neck stiffness. Associated symptoms are less common in the elderly. 

      The effects of migraine may persist for some days after the main headache has ended; this is called the migraine postdrome . Many report a sore feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache has passed. The patient may feel tired or "hung over" and have head pain, cognitive difficulties, gastrointestinal symptoms, mood changes, and weakness. According to one summary, "Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise.

      The underlying causes of migraines are unknown. However, they are believed to be related to a mix of environmental and genetic factors. They run in families in about two-thirds of cases and rarely occur due to a single gene defect. A number of psychological conditions are associated including: depression, anxiety, and bipolar disorder as are many biological events or triggers.

      The exact mechanism of the head pain which occurs during a migraine is unknown. Some evidence supports a primary role for central nervous system structures (such as the brainstem and diencephalon) while other data support the role peripheral activation (such as via the sensory nerves that surround blood vessels of the head and neck).The potential candidates vessels include: Dural arteries, pial arteries and extra cranial arteries such as those of the scalp. The role of vasodilatation of the extra cranial arteries, in particular, is believed to be significant.