Anti Migraine

MIGRAINE
DEFINITION
Migraine is a common, recurrent, primary headache of

moderate to severe intensity that interferes with normal
functioning and is associated with GI, neurologic, and
autonomic symptoms. In migraine with aura, a complex of
focal neurologic symptoms precedes or accompanies the
attack.
This neurological disease can cause debilitating throbbing
pain that can leave you in bed for days! Movement, light,
sound and other triggers may cause symptoms like pain,
tiredness, nausea, visual disturbances, numbness and
tingling, irritability, difficulty speaking, temporary loss of
vision and many more. pulsing headache on one side of
your head.
Lasts for 4 to 72hours
∗ Worsens by routine physical activity
∗ Associated with nausea and/or vomiting
∗Accompanied by photophobia
Migraines happen with and without aura. Aura is a sensory
experience.Typical migraine aura (a complex
of reversible visual, sensory, or
speech symptoms).
∗ Aura typically occurs just before
or at onset of headache,
developing over 5 to 20 minutes
and lasting less than 60 minutes,
but it may not occur every time.
Without aura, headache as a primary symptoms.
Symptoms with aura are; Symptoms without aura
Fatigue lasts b/w 4 to 72 hr

Visual disturbances unilateral throbbing pain
Irritability Nausea and Vomiting
Tingling in head, near eyes sensitivity to light
Weakness sensitivity to sound
• Physical Triggers
• Lack of sleep or too Hormonal & Psychological
• much sleep Triggers
• Irregular sleep • Environmental Triggers
patterns • Photophobia
• Physical exertion • Weather changes
• Fatigue • Strong odor
• Vigorous activity • Repetitive visual patterns
• Irregular meal patterns • Air pollution
• Skipped meals,Head • Passive smoking
trauma, Food Triggers, • Travelling
Alcoholic • Menstruation
• Hormonal
Supplements
• Stress
• Anxiety
• Depression
beverages,Chocolate,Citrus fruit, Caffeine• Pickle
• Monosodium glutamate(a food additive found in some soups,
salad
dressings, meat.
AURA; group of sensory, motor, and speech symptoms that

usually acts like warning signals, that a migraine headache us
about to begin, Lasts for 10 to 60 minutes.
Aura symptoms may be seeing bright flash dots, sparkles, or

lights, blind spot in your vision, numbness or tingling skin,
speech changes, tinnitus, temporary vision loss, seeing wavy
and jagged lines, changes in smell or fun feeling.
There are several types of migraines, migraines with aura

(complicated) and migraine without aura (common), menstrual
migraine, migraine without head pain but aura symptoms are
there (silent or acephalgic), temporary paralysis, neurological or
sensory changes on one side of body (hemiplegia), temporary
loss or complete loss of vision (retinal or ocular) paralysis of
muscles of eyes, chronic migraine lasts for 15 days per month,
migraines with brainstem aura, u will have vertigo, slurred
speech, diplopia and vomiting. Status migrainosus severe type
of migraine, lasts for 72 hr, and certain medications causes this,
nausea and headache pain is extremely bad.
Four stages or phases of migraine

Prodrome, aura, headache and postdrome.
Prodrome; hours or days before headache, symptoms like

photophobia, phonophobia, hyperosmia, fatigue, craving, loss
of appetite, mood changes, severe tirst, bloating, constipation,
diarrhea.
Aura; These symptoms stem from your nervous system and

often involve your vision. They usually start gradually, over a 5-
to 20-minute period, and last less than an hour. You may See
black dots, wavy lines, flashes of light, or things that aren’t
there (hallucinations), Have tunnel vision, Not be able to see at
all, Have tingling or numbness on one side of your body, Not be
able to speak clearly, Have a heavy feeling in your arms and
legs, Have ringing in your ears, Notice changes in smell, taste,
or touch.
Attack; often begins as dull and achy pain, grows into throbbing
pain. Worse during physical activity, pain radiates can be in
front or entire brain. Lasts 4 hr.
Post drome; lasts up to days after headache. feeling tired,

happy, muscle pain, food craving and loss of appetite.
Causes of Migraines headache; starts when overactive nerve

cells send out signals that trigger your trigeminal nerve, which
gives sensation to your head and face. This cues your body to
release chemicals like serotonin and calcitonin gene-related
peptide (CGRP). CGRP makes blood vessels in the lining of your
brain swell. Then, neurotransmitters cause inflammation and
pain.
Genetics, gender due to influence of hormones, stress level and

smoking, emotional stress, missing a meal, certain foods and
beverages, daily use of pain reliving medications, lights,
changing in weathers, overly tired, dieting or not use of water,
sleep changes, loud noises, exposures to smoke and strong
smell
Pathophysiology
Pathogenesis may be related to a defect in the activity of
neuronal calcium channels mediating neurotransmitter release
in brainstem areas that modulate cerebral vascular tone and
nociception. The result may be vasodilation of intracranial
extracerebral blood vessels with activation of the
trigeminovascular system.
Noicereceptors activates, secretes neurotransmitters or

molecules, vasoactive peptides, sub P, CGRP (Calcitonin gene
regulating peptide).
These three acts on mast cells and also acts directly on the
vessels.
Mast cells release histamines and prostaglandins, which cause

the vasodilation of smooth muscles. Increases the diameter of
vessels. Increases the space of endothelial cells which in turns
leads to increase in Capillary permeability, and activation of
other Noicereceptors which are associated with the cranial
nerve 5 Trigeminal nerve (pics sensations from face). Activation
of action potential to trigeminal nuclei it sends signals to
thalamus and then sensory cortex for registering pain.
Now as a result what will occur;
a) In this situation serotonin levels becomes higher, its acts on

the receptor P5.H3 induce vasoconstriction, clump down
and causes aura.
b) No aura; low levels of hydrooxytriptamine receptors results
in decrease serotonin and cause vasoconstriction.
Increase cGRP, sub P, vasoactive peptide and low level of

hydrooxytriptamine cause activation of Noicereceptors,
ganglion to brain stem, thalamus, sensory cortex and pain is
sensed
Diagnostic Criteria;
Detailed history from patient, medication history, family and

past medical history.
MRI and CT scans to show structural changes.
Cerebral angiography
It shows occlusion, aneurysm, and vasodilation in cerebral

arteries
EMG underlying neck, scalp, facial muscle contraction.
LABORATORY TESTS • In selected circumstances and secondary

headache presentation, serum chemistries, urine toxicology
profiles, thyroid function tests, lyme studies, and other blood
tests, such as a complete blood count, antinuclear antibody
titer, erythrocyte sedimentation rate, and antiphospholipid
antibody titer may be considered.
Mangment and treatment.
Nonpharmacologic Treatment • Application of ice to the head

and periods of rest or sleep, usually in a dark, quiet
environment, may be beneficial. • Preventive management
should begin with identification and avoidance of factors that
provoke migraine attacks
Abortive therapy prophylactic therapy
Given during a migraine attack to abort an ongoing Given before a migraine attack for prophylaxis (To
migraine attack, and associated nausea and vomiting. prevent attacks from occurring) • To reduce the
e.g. Ergot Alkaloids, Triptans, and Analgesics (Aspirin, frequency and intensity of migraine attacks. e.g. Beta
NSAIDs, Acetaminophen, Opioids). Anti-emetics e.g. adrenergic blockers
Metoclopramide (Maxolon).

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MIGRAINE

Migraine is a common, recurrent, primary headache of

Symptoms with aura are; Symptoms without aura

Fatigue lasts b/w 4 to 72 hr

AURA; group of sensory, motor, and speech symptoms that

Aura symptoms may be seeing bright flash dots, sparkles, or

There are several types of migraines, migraines with aura

Four stages or phases of migraine

Prodrome; hours or days before headache, symptoms like

Aura; These symptoms stem from your nervous system and

Post drome; lasts up to days after headache. feeling tired,

Causes of Migraines headache; starts when overactive nerve

Genetics, gender due to influence of hormones, stress level and

Noicereceptors activates, secretes neurotransmitters or

Mast cells release histamines and prostaglandins, which cause

Now as a result what will occur;

a) In this situation serotonin levels becomes higher, its acts on

Increase cGRP, sub P, vasoactive peptide and low level of

Detailed history from patient, medication history, family and

MRI and CT scans to show structural changes.

It shows occlusion, aneurysm, and vasodilation in cerebral

EMG underlying neck, scalp, facial muscle contraction.

LABORATORY TESTS • In selected circumstances and secondary

Mangment and treatment.

Nonpharmacologic Treatment • Application of ice to the head

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