The migraine attack
Definition
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.
Mechanism
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.
Cabinet:
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.
Medications
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.
Evolution
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.
Examinations
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.
Treatment:
Crisis:
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.
DMARD:
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.
Decreased energy: and if it was the thyroid?
Thyroid problems are seven times more frequent among women, and they occur most frequently at ages in their lives. A coincidence? Probably not.
Summary:
* 1. What do we see it malfunctioning?
* 2. Goitre and its treatment
No, it is no coincidence because the "protein taxi" which transports thyroid hormone in blood is also one that conveys the estrogen. It is therefore not surprising that fluctuations in female hormones ring on the activity of the thyroid.
At puberty, estrogen levels gradually increased, resulting in an increased need for thyroid hormones. If the girl lack of iodine, a small goiter may be formed. But treatment is rarely necessary.
During pregnancy, increased estrogen may lead to goitre if the woman lacks iodine. Hence the idea of additional input for those living in areas of relative deficiency. After delivery, 5% of women still have a thyroid "whack". They suffer more often from hypothyroidism, which is sometimes confused with the baby blues. It usually resolves spontaneously. Otherwise, treatment may be necessary.
The thyroid is mixed a little of everything in our body. And it starts early. From the fourth month of intrauterine life, thyroid hormones are involved in brain development, growth and skeletal ossification. Their role is then essential to "rotate" the body in good rhythm. They are, in fact, hormones reactions energy and activity. The number of calories burned at rest, it's them. The amount of fat circulating in the blood sugar levels, making proteins are also under their influence! In many circumstances, however, can destabilize this beautiful machine and caus
Spasmophilia
What?
It is a crisis of violent muscular contractions and uncontrollable, occurring in a context of anxiety or frustration as a result. It is a very common problem that affects mainly young women. The term tetany is often incorrectly used to spasmophilia because tetanus is a genuine reduction of calcium in the blood (serum calcium). The cause of spasmophilia about it is very controversial. For some doctors it is a temporary and transient decrease in serum calcium and magnesium, for others it is an acute manifestation of anxiety that the Anglo-Saxons call panic attack, for still others, it is modern form of hysteria.
The crisis
* This crisis occurs most often after an annoyance or in a situation of significant anxiety. The heat containment, work in offices or reporting relationships important to work are often the immediate causes.
* Sometimes the person feels that a crisis will occur, she becomes agitated, worried. But sometimes it falls upon him. Tingling come in his hands and around his mouth.
* Then the crisis rises gradually shaking occurs, the muscles of his arms contract. At his hands, extended fingers are close against each other, to give very specific form of labor midwife: the tip of the thumb is closer to the other four fingers. The person has more and more difficult to breathe she breathes quickly and widely, his head spinning a bit. It is contracted from everywhere.
* But what is most impressive is how she feels. According to people a number of sensations occur, often with the same words from print, printing die, the quickened heartbeat, heart oppression, lack of air, which stops the heart etc.. All the signs are around vital symptoms affecting the heart and respiration.
All of these signs warrant a call to the doctor.
What you can do
Two possibilities:
You are sure it is a crisis spasmophilia
* First, try not to panic (not easy): saying that you are not risking their lives because nobody ever died of a heart spasmophilia.
* The best thing is to get everyone in the room. Isolate the person in his entourage with you locking her in her bedroom for example. Do not leave her alone. Move away from dangerous of the (windows) and spread quietly dangerous items (weapons, knives, etc..)
* Attitudes to adopt: defuse the situation, reassure and listen to him speak in person accusatory: "It will calm down," the doctor will relieve you, "it's normal, you have the right to crack, etc.. Do not try to reason with, objection to its speech or otherwise to come inside. Try to be calm and neutral as possible. In general, especially if you're embarrassed, you unload on the arrival or impending physician consultation. Let her talk as much as possible of what troubled her.
* If his doctor has already prescribed, look in his pharmacy and anxiolytic family give him a tablet under the tongue.
* If it tingling in hands or around the mouth, or if it breathes so fast and intense, let him breathe his own air in a plastic bag. For that, take a large bag, open it to contain already the air and tell him to put the opening round his mouth (not on the head!). Make breathe as slowly as possible.
Not sure
In this case, ask the medical care and failing to Samu (15), or firefighters (18). They will send you the appropriate relief.
In the meantime, try to calm the person without interfering in any way (that sometimes it is most difficult).
The attitude of the doctor
In emergency
Usually the crisis is so impressive that the entourage turned to Samu or firefighters. But in almost all cases the appeal is excessive because the crisis pass with a simple injection. Therefore in most cases, the doctor on the phone regulator does not send medical team and delegates a general practitioner or casualty officer who will move on site. The doctor will quickly diagnose and through an injection calm the crisis. Sometimes the mere presence of the doctor and listen enough to what the crisis passes. The crisis was resolved in about ten minutes, without any sequelae.
Cabinet
Seizures are very rare because they occur mainly at home or at work. The doctor then typically reconstructs the crisis by the simple examination of what happened. He then prescribed a DMARD supervised by counseling.
Treatment
Once the crisis is over, treatment is based on several factors:
* Magnesium oral or oral calcium. Usually the choice is made for either drug. If calcium is required, there will probably also associated with vitamin D. This treatment is then more available to tetany.
* Anxiolytics.
* Psychotherapy. Especially this treatment allows control of these crises that are the foundation more often lived badly or psychological problems within the scope of psychosomatic.
Rides
Definition:
1. A wrinkle is a fissure that formed in the skin.
2. It can be caused by early contraction more or less permanent muscle expression, and reversible when you release the tension of these muscles.
3. It may be definitive signs of skin aging.
The different lines:
The expression lines:
1. These are fine lines, rather nice, at the corner of the eyes and mouth in people with thin skin and smile broadly.
2. They are also deeper wrinkles and vertical front among those who often wrinkled eyebrows, particularly the frown lines.
The ripples of aged skin:
1. They are due to rupture of elastic fibers and change the quality of supporting collagen.
2. The skin loses its ability to resume its initial tension after the attacks and movements. It is refined and constantly keeps the folds, which are growing slowly.
What can you do:
Protecting the skin from an early age against the effects of the sun, the wind dries out, and not smoking (smoking prevents cells to repair all their injuries).
When wrinkles are still moderate and elastic skin:
1. Care accelerating the renewal of the surface layer have a smoothing effect of varying importance, which deserves to be tried, unless they decided to call the surgery as soon as the results will fade. In this case, the specialist may advise you to be immediately intervention on skin that goes to extend it.
2. Cosmetics to fruit acids improve the overall appearance and help slow down their appearance.
3. Once wrinkles installed, your doctor may prescribe a cream with vitamin A acid (acid trétinoïque), more difficult to bear, but that impact may be more constant. It is an intermediary:
4. Peels, made by the doctor himself, and dermabrasion.
For wrinkles installed:
* If your desire is only to improve things in a natural way, the above methods are valid.
* The means of aesthetic medicine include: injections of collagen, filling the facelift.
* Another technique involves injecting a toxin called Botox. The wrinkle disappears in a few days, but it is necessary to renew it after 3 to 6 months.
Tobacco: why stop
Approximately 66 000 deaths in France are attributed to tobacco. Worse, the rise in female smoking mortality seems unstoppable: if you do not stop smoking in fifteen years there as many female deaths from lung cancer than breast cancer.
Smokers know how difficult it is to get rid of this dependency, so they drop out before it even begins! Do not hesitate, once the decision to seek medical advice (1).
Stop smoking without putting on weight
Smoking is spending 200 calories per day and when you stop the cravings is similar to that of hunger that makes us eat more.
Candies, gums are nicotine replacement products (such Nicorette gum 2mg and 4mg) that limit weight gain by managing risk at times. Patches (Nicopatch Laboratories Pierre Fabre) and inhaler (Nicorette home) are also interesting because they diffuse continuous nicotine in the body. A doctor may also prescribe Zyban for 2 months. It works effectively as an anti-hunger. After this difficult period, the desire to snack will not disappear but they will be less severe and frequent, and thus more easily manageable. Think Snack "smart" (yogurt, apples, eggs etc..) And play sports.
Another solution: gradually reduce its consumption
The Nicorette brand launched in 2004, gums and inhalers consistent with a reduction in the number of cigarettes. Taking these alternatives would, according to the mark, "reduce consumption by limiting the effects of withdrawal and lack," thus constituting "a first step to a complete stop. Nicorette Gum 2mg and 4mg and 10mg Nicorette inhaler. The stoppage must be tried within 6 months after starting treatment and if smoking was not observed in 6 weeks, consult a physician.
The benefits of smoking cessation
- From 24 hours, blood levels of nicotine and carbon monoxide fell by half. The oxygenation of body tissues is better and your complexion becomes clearer. The lungs have already begun to eliminate toxic substances (carbon, tar etc..) Cause cancer.
- After 2 hours at 12 weeks, the body has completely eliminated the nicotine. You gradually find the smell and taste, you breathe better and improves blood flow (hence complexion net)
- After 9 months, the respiratory capacity increased by 10% thereby reducing the risk of bronchitis and "clarifies" the voice.
- After 5 years the risk of lung cancer has been halved
Fatigue and anemia if it was?
Nothing is more commonplace than being tired after having had his rules, especially when one bears an IUD! However, if fatigue becomes more permanent and that you are pâlichonne breathless at the slightest effort, it may be that you are suffering from anemia.
Anemia is most often due to heavy menstrual periods or pregnancy as the child draws on reserves of her mother, sometimes with small repeated bleeding of digestive origin, including cases of hiatal hernia, or taking extended certain medications (aspirin-type anti-inflammatory drugs ...).
To diagnose this type of anemia by iron deficiency (called anemia), your doctor will prescribe a blood test by requesting a complete blood count (CBC) and determination of serum ferritin, which reflects the status of your reservations iron. Obviously, it would look as the cause of your anemia to be treated. Thus it will ask you questions about your eating habits, your menstrual cycle, your digestion, your medications ...
In all cases, the doctor will advise you to increase your intake of iron in the diet. After the blood test and if you are anemic, he will prescribe pills to make up your reserves. It is a treatment length of 4 to 6 months.
There are other types of anemia, more rare. They may be related to a deficiency of folic acid or vitamin B9 (megaloblastic anemia) during pregnancy, a vitamin B12 deficiency (pernicious anemia), a deficit or destruction of red blood cells (anemia due to chemotherapy treatments , to leukemia in inherited diseases) ...
Other medications may also cause iron deficiency (antacids, H2 antihistamines, anti-proton pump, tetracyclines).
Childbirth: How long?
One woman to another, the length of confinement varies from 2 to ... more than 20 hours! That vow birth as a letter to the Post Office or not, you necessarily pass through the following steps.
Contractions
You rush to motherhood, if they come back every 5 minutes for an hour. On arrival the midwife checks the opening of your cervix which is an average of 5 centimeters. Below this figure, it will return home. Beyond 5 cm, you will stay in the maternity and begin the countdown of your birth.
Preparation
Firstly, you are installed in a delivery room or a room in the space available and especially by the alleged time of the birth of your baby.
The midwife is there for you explain how your delivery will unfold, it prepares you regularly monitor the frequency of your contractions and dilation of your cervix. At this stage, the more often you have a few more hours in front of you. It is the longest period of birth. If you chose to give birth under epidural, this is when we will offer anesthesia.
Expulsion
It's always the midwife or your gynecologist, who controls your contractions and the opening of your cervix will decide when to make the final push and give birth to your baby. This stage lasts a few minutes in most cases but in some women this phase of expulsion may take up to 3 hours!
The issue
Your baby in your arms and yet your delivery is not completed. You need to expel the placenta. A step that often goes unnoticed for happy moms who take their babies in their arms do not even notice the midwives who still bustling around them. But sometimes the placenta does not come off: the obstetrician or midwife must then perform a "uterus". After you have lightly anesthetized, they go hand in your uterus to get the placenta, which could cause bleeding if left in place.
This ... delivery is completed and after two hours of observation you can finally earn your room. On average, among the first regular contractions and delivery, he spends 10 hours But you've understood this is not 10 hours of work. For you and for the future dad, all those minutes will go surprisingly fast.
