What is a migraine ?
Migraine is a neurovascular disorder in which attacks caused by neural stimuli which results after a sudden temporary constriction, a dilation of the blood vessels. This is often accompanied by a throbbing headache. The average prevalence of migraine in Western countries is 11%. It is striking that migraine in the population of the Netherlands avoids considerably more than in all other European countries.
Migraine symptoms
Research with brain scanners has shown that the brain is activated during a migraine attack. The headache which occurs in a typical migraine attack is usually felt on one side of the head, but can also be double-sided action. The pain does not always occur on the same side.
A distinction is made between migraine without aura (occurs in two-thirds of the patients) and migraine with aura, also known as ophthalmic or oogmigraine (1/3 of the cases). A migraine patient may have several types, in the course of his life.
Migraine should be distinguished from cluster headaches and tension headaches. Ordinary migraine manifests itself mainly as a throbbing headache. Arranged the patient experience nausea and vomiting. The various symptoms are not all migraine sufferers for.
People who suffer from migraine often can not tolerate bright lights and noise. Often, in a family for several migraine patients, suggesting a hereditary factor. Study after an attack usually does not cause physical revealed. Repeated attacks medical advice is recommended, though it was only because there medicines exist that work preventively or shorten an attack.
Features:
- Visual aura: blurred vision, flashes of light, partial loss of vision by flikkerscotomen. These visual sensations may move through the field of view, and often take the form of vibrating jagged or curved zigzag lines, triangles or colored. These visual symptoms usually disappear within an hour, and are more common in older people than in young people. They can sometimes act alone and are sometimes followed by a headache attack. Sometimes join other neurological deficits (eg paralysis of an arm, can not get out the words, sensory disturbances) in the previous (prodromal) phase. Sometimes remains after these prodromal a headache attack even out, and it's called "sans migraine aura" also called "migraine sans migraine."
- Throbbing headache, usually on one side of the head
- Pain that worsens with physical activity, especially by stooping
- Strong sensitivity to light (photophobia) and sound (phonophobia)
- Nausea
- Hypersensitivity to certain smells.
- Loss of concentration
- Dry mouth
Experience
Because the heart rate gets even gives some more pressure on the blood vessels, every heartbeat gives a momentary increase in pain. This is referred to as about "throbbing pain" is spoken. Normally, listen to a conversation is almost impossible. Furthermore, the mind takes off, so for severe migraine something about it is almost impossible. Many patients go then preferably located in a quiet dark room in bed.
Migraine causes and triggers
About the origin is much more uncertain. Several factors are:
- hereditary component. A first degree relative of a migraine patient has a 1.9 times greater chance of getting migraine without aura and a 1.4 times greater chance of getting migraine with aura. Migraine is largely (up 50%) genetically determined.
- hole between the atria. People with migraine with aura are much more likely than non-migraineurs (50-60% vs. 25%) have a patent foramen ovale. However, because a large portion of the population has such a hole, but no migraine, which hole is probably not the cause. The most likely explanation is that both the hole and the migraine are collectively inherited.
- vasoconstriction. Often, it is suggested that to do with the blood vessels has migraine. It seems as if the flow of blood is impeded here, after which the feeder picks up again. The brains themselves can not feel pain, but the blood vessels that run more on the outside edge of the brains can. The causes are different views. Recent research at the Leiden University Medical Center indicates that vasoconstriction or -verwijding possibly not a factor in migraine.
- less oxygen. One possible cause is that the brains have temporarily less oxygen. When there is more then some oxygen comes in the brains, the blood vessels to dilate and go as migraine may result. Migraines can therefore occur in someone who has fainted, or anyone with altitude sickness.
- disturbed energy supply of the brains. Several studies show that the energy supply is disrupted in the brains. It is believed that the brains are therefore more susceptible to headaches and related neurological problems, at times when the brains need more energy, the amount of oxidizable substances is limited in brains and as the amount of oxygen in the brains is small. This could possibly explain the urge to eat energy-dense foods, such as chocolate, just before a migraine attack. Also could possibly explain this lack of energy why migraine sufferers often experience mood swings prior to an attack.
- hormonal changes. This can act as a trigger factor, the best known examples are menstruation and menopause.
- emotional stress. Note that this relationship is challenged increasingly.
- physical exertion
- certain scents
- insufficient fluid intake
- food tolerance. Trigger Factor determine on the basis of what is pre-eaten.
7 triggers are worked out in percentages:
- Stress and anxiety 70%
- Severe fatigue 62%
- Violent emotion 56%
- Deficit / too much sleep 48%
- Occurrence of menstruation 44%
- Difficulties at work 33%
- Sudden cessation of activities at the end of the week 27%
Migraine treatment
Migraine medicine
For mild attacks paracetamol can be used. At heavier attacks the preference is for a NSAID, such as ibuprofen, or a drug selected from the group of triptans. There are no differences in effectiveness between the two groups.
A combination preparation of acetylsalicylic acid and metoclopramide (Migrafin) is used in migraine attacks, in particular in the presence of nausea and vomiting.
Beta blockers such as metoprolol or propranolol, flunarizine and the anti-epileptic valproic acid and topiramate can reduce the frequency of attacks, although they are not specifically designed for migraine. Ergotamine are now virtually non-prescribed because of the danger of ergotism.
A hormone treatment reduces the number of migraine during menstruation, in the next weeks may increase the number of attacks.
Or co-enzyme Q10 or magnesium in the treatment of migraine children are employed, is not yet certain.
In attack announced by an aura and is usually associated with food intolerance triggers a large production of stomach and bile acid, an acid inhibitor, Famotedine 40mg, be extremely effective.
Medical devices
Medical devices of biofeedback and neurostimulation type are also important, especially in situations where taking certain medications is contraindicated, or even more, to the intake of large doses, which are responsible for development to daily chronic headaches, too reduce or prevent.
Biofeedback allows himself to try to allow the patient to become aware of an organic function and even change it during relaxation sessions. This method seems to have proved its effectiveness in the treatment of tension headaches and migraines. A 2009 study seems to show that in comparison with relaxation biofeedback does not contribute significantly to the improvement.
Neurostimulation was initially used by means of implantable devices, similar to pacemakers, for the treatment of severe chronic migraines, with encouraging results. But the use of implantable material and the associated surgery to limit this technique to very serious situations Recently, a technology developed for external neurostimulation through the skull (Cefaly) applicable at the supra-orbital (upper branch trigeminal nerve V1) or suboccipital level (large occipital nerve ), which made it possible for a much broader application of neurostimulation in the treatment and prevention of migraines.
Acupuncture
Acupuncture can help prevent migraines, but is less effective than drugs. Research shows that it is a highly potent placebo effect.
Heart and lung surgery
The surgical closure of a so-called open foramen ovale, an opening between the upper chambers of the heart which normally closes soon after birth, can migraine symptoms disappear. This surgical closure was not always done because of the migraine, but migraine often reduced by there.
Also, the closing of arteriovenous malformations in the lungs, which have the effect of a right-left shunt, is found to reduce migraine symptoms.
However, critics have their doubts about the results, because of the limited amount of evidence for a positive effect, because most surveys in their methodology are not set up properly. The studies found were not random and / or performed blindly. In addition, these surgical procedures are not yet regular and are not applied by default.
Research from 2005 shows that migraine sufferers are more likely to cerebral infarction and / or stroke. This may be related to the possible patent foramen ovale.
Economic impact
Migraine is a common neurological disorder. This, in combination with the heavy symptomatology, ensures that migraine has a great effect on the economy. The total annual cost of migraine in Europe are estimated at 27 billion euros.
History
It has been suggested that light experiences of mystics as the writer Hadewijch were due to migraine.
Until 1990 it was only by doctors paid little attention to headache. Lack of knowledge they went there often assumed that migraine was something psychologically and that the pain would not be a real physical pain. From about 1995, there was still interest in headache and through studies and guidelines increasingly been considered as a serious condition. From 2000, there are several drugs available that specifically fight migraines.