The migraine attack

Publié par happy-diet mardi 30 mars 2010

The migraine attack


The migraine attack has peculiarities that differentiate it radically from ordinary headache.

Furthermore, the migraine attack, sometimes isolated or uncommon this does not feel harassed as is the case for people with migraine installed and repetitive. Therefore we distinguish the migraine attack, sudden but brief, migraine as a disease that can become a real handicap.

The signs in emergency

It is a pain
o Pulsatile (beating).
o Violent, often reaching as half of the skull, or a localized area. Sometimes this may be the skull in its entirety that is the site of pain.
o Accompanied by visual disturbances, dizziness, nausea, vomiting.
o For a few hours to several days.
o The migraine attack is the result of 2 phenomena are linked: one vessel in the meninges, the other at the central part of the brain, the brainstem.
No. That would explain certain events: people with migraines reported a sensation of scalp painful to touch, others no longer support the weight of their branches for their glasses or earrings. That is simplifying the external stimulation (the weight of the glasses) could lead to internal pain (headache) that occur after.
The attitude of the doctor
Emergency treatment
o The doctor will check first place it is indeed a headache.
o If this is your first episode of migraine, the simple physician interrogation suffices for diagnosis. Indeed, 8 issues enough to know if a certain migraine or probable migraine.
o If you are experienced migraine, it will ensure your migraine history and your current medications.
o Can you make an injection, or give you medication which will in case of crisis specific or nonspecific.

The situation is usually different, because the person consulting firm rarely urgent. The doctor must reconstruct what happened by asking a few simple questions suffice to make the diagnosis. It will ask questions about your migraine history, medical and family.
o It will search all the aggravating factors (stress, overwork, sleep disorders, chronic fatigue, depression, eating habits, smoking, alcohol).
o There will be times you have to do a thorough review unless a specific doubts. This assessment (see above) however will be done routinely in hospitals in person over 55 years because of the uniqueness of a first migraine at this age.
o In addition to signs that could alert the physician to another pathology, no further review (scanner, radio, EEG) has not the slightest interest. They also come back perfectly normal.
o It is the same for radio sinuses, cervical spine, the eye examination or abdominal ultrasound.

In fact the diagnosis of migraine was made on clinical examination and questioning of the person.

Any question that arises is that of the chronic, the person and his doctor often feel like an admission of failure. You can help your doctor to get an idea. Just do not multiply unnecessary treatments, and noted in a diary the occurrence of crises, with the days, hours, duration and all the signs that have occurred, and taking medications with their doses.
No drugs are nonspecific anti-inflammatory agents selected among the most effective in this case, the aspirin in combination with Primperan * (metoclopramide), or paracetamol. The aspirin-metoclopramide improves digestive disorders. The physician usually uses some analgesics such as morphine.
No specific drugs for migraine are triptans (Eletriptan, Frovatriptan, Naratriptan, Rizatriptan, Sumatriptan, Zolmitriptan), ergotamine tartrate and dihydroergotamine nasal spray (1 spray early in the crisis) or by injection. These drugs all have cons-significant information, which is why they are only used by the doctor or the person only as a remedy (as recommended by the doctor).
o All triptans are as powerful as each other, yet they are perceived as more or less effective and less well tolerated (some triptans may cause drowsiness). It is therefore necessary to test therapeutic and groping to find the most effective.
o dihydroergotamine was more effective for severe migraine.
o In addition, some anticonvulsants are effective. This is the case of topiramate, which has allowed entry on the market (not reimbursed).
o Because of the mechanism, taken earlier triptans are effective from the moment the signs are felt outside, then they would be much less, once the crisis is settled. For anti-inflammatory, they would act in a second time, when the internal pain.
o This is why it seems he is better to take triptans and possibly immediately in case of resistance or back pain anti-inflammatory.
Treatment Strategy

It depends if the person has already been addressed by specific treatments or nonspecific. Indeed, some people "respond" to treatment and others do not. The physician's role is to evaluate the effectiveness of treatment used.
o The person follows a non-specific treatment of migraine. If this treatment is effective continues. By cons if it is not, it provides anti-inflammatory drugs associated with a triptan, the triptan is a remedy if the anti-inflammatory is insufficient. By cons, if the anti-inflammatory is cons-indicated or poorly tolerated, the triptan is given immediately.
o The person is already following special treatment: the case of ergotamine tartrate, we avoid change. In the case of triptan and it seems ineffective, the doctor will change triptan because some people respond well to some and less to others.
No drugs are usually given as soon as possible, without waiting for the headache is installed. Regarding triptans and ergotamine, it is better to await the onset of headache and do not take drugs to moement the aura.
o If the pain goes, your doctor will check your background therapy is well suited. If necessary he may prescribe you another if it appears that crises are converging.
o If the pain does not go in 2 hours, he will perform an injection of an anti-migraine-specific triptan base.
o And if despite all this, the pain does not pass, it will renew its injection by adding the appropriate a major analgesic opioid type. It is rare that this is necessary.
o In case of failure of any medication, or if it suspects a more serious problem, you will be hospitalized to rule out other causes of headache. He will do even more if this is your first attack, especially if there is a notion of loss of consciousness, fever, convulsions or neurological disorders.

They are not prescribed as first choice by the doctor:
o The CT or MRI are required if the headache was sudden, like a "bolt from the head", or that this headache is different from a usual headache, or if the doctor finds something wrong with the review.
o The electroencephalogram ne'est most prescribed, as well as plain radiographs, unless the doctor is looking for a different disease.
At the hospital

The attitude of the doctor is usually different, because it usually takes for migraine headaches that have already been traitrempents without success. In fact, if you are referred to the hospital is that the crisis does not subside, or if the doctor thinks there is something else. This event is rare. You will then be made a full assessment to eliminate a problem:
o Eye (looking for accommodation disorder, fundus and visual field
Vesicular o (ultrasound).
o Ovarian (hormonal dosage).
o Brain (CT or MRI) in search of a brain tumor and especially of a cerebral aneurysm, especially if the pain was brutal.
o Vascular (Doppler, arteriography may be) in search of an aneurysm

This balance is negative in most cases. If this is not the case, the diagnosis of migraine had been wrongly focused. Therefore it is unlikely that you do all these tests. If they are made, to find another cause that would not be a headache.

Subsequently, we will initiate a DMARD or we will amend your current salary if you follow one.
Signs before the crisis

The first signs of migraine you have learned to know:
o Tingling of the face (around the lips), to ends of members.
o An nausea.
o A sadness, depression, lack of appetite.
o Or euphoria associated with hyperactivity, bulimia brutal.
o All in a period of stress, overwork or particular conflict.
o Usually it is quickly relieved by injection by conventional painkillers like Aspégic * or antispasmodics containing noramydopirine. It combines with the degree of anxiety anxiolytic injection.
o But the first line of treatment is anti-inflammatory.
o If they are not effective, use of triptans in emergency allows to assign the crisis.
o Sometimes a spray containing dihydroergotamine may suffice, but it poses more problems for the use of triptans. Therefore they are less used in emergencies.
o In cases of recurrent seizures or not responding to treatment, the doctor may suggest subcutaneous injections or nasal spray products based triptan. These products can be used only in specific conditions that explain the medical history because the patient can not always offer. Also they are not allowed in combination with derivatives of ergot, which is a substantive treatment of migraine.
Successful treatment of the crisis

We consider that the treatment is effective if:
o you're relieved 2 hours after the crisis,
o that the drug taken is well supported,
No one drug intake is sufficient,
o and you can resume your normal activities 2 hours after the crisis,

If any of these criteria is not met, was that your treatment is not working optimally. Therefore tell your doctor.

The drugs are varied:
o Derivatives of ergot: * dihydroergotamine, methysergide *
o Beta-blockers, especially propranolol, metoprolol, timolol, atenolol, nadolol.
o Anti-inflammatory drugs.
o CCBs.
o Aspirin or paracetamol.

The list of drugs with a marketing authorization (Authorization on the market) are the following: dihydroergotamine, flunazirine, indoramine, methysergide, metoprolol, oxétorone, pizotifen, propranolol.

The amitriptine is effective in cases of intractable pain treatment

Other drugs are effective without an MA: atenolol, divalproex, gabapentin, nadolol, naproxen, timolol.

Aspirin, fluoxetine, the cyclandélate the dihydroergotryptine does not seem effective therapy.

Other drugs such as antidepressants, antianxiety medications are only aids and are not specific for migraine.

Psychotherapy is useful to help the person to withstand his attacks.

It is the physician choose the drugs that it deems most appropriate.

The use of alternative medicine is increasingly popular in pain centers:
o Homeopathy.
o Acupuncture.
o Mesotherapy.
o Cryotherapy.
o Ultrasound.

0 commentaires

Enregistrer un commentaire

Blog Archive