Migraine headache is one most common headaches defined as condition of chronic neurological disorder of moderate to severe headaches, and nausea that usually develop gradually over 5–20 minutes and last for less than 60 minutes and affected over 15% of the population in US alone, as a result of the change in the brain and its surrounding blood vessels.
Since it is a chronic condition with recurrent attacks, pain is usual very intensive and divided into 4 possible phases(A1)
1. The prodrome
The prodrome symptoms happen in 40–60% of those with migraines is an occurrence of early symptoms indicate the start of a migraine headache attacks, including altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food, etc.. In the study of a total of 893 migraine patients (IHS 1.1-1.7) were evaluated at first visit. Prodrome frequency, duration, and characteristics were analyzed in the total migraine population IHS 1.1-1.7 and IHS 1.1-1.6 migraine conducted by Leslie Kelman MD, found that A total of 32.9% of IHS migraine 1.1-1.6 patients reported prodrome symptoms with an average of 9.42 hours. IHS 1.1-1.7 migraine reported 29.7% and 6.8 hours, respectively. The most commonest symptoms were tiredness, mood change, and gastrointestinal symptoms; all three of these symptoms were present together in 17% of the patients with prodrome. The duration of prodrome was less than 1 hour in 45.1%, 1-2 hours in 13.6%, 2-4 hours in 15.0%, 4-12 hours in 13.1%, and greater than 12 hours in 13.2%. IHS 1.1-1.7 patients showed similar findings.(A2)
2. The aura
The aura, happens to approximately 20 -40% Migraine sufferers. In general, the symptoms of comprised focal neurological phenomena appear gradually over five to 20 minutes and last fewer than 60 minutes. But in some cases, a sudden onset of severe bilateral facial pain radiating bilaterally into the medial cervical region after defecation. The pain was accompanied by scotomas in the right visual field and hypaesthesia in both upper limbs of that required medical attention.
3. The pain phase
The headache phase of the migraine attack usually begins within 60 minutes of the end of the aura phase. The pain of the headache is intense, throbbing from moderate to severe, may be bilateral or unilateral at the onset, and occur on one side or alternate sides from one attack to the next.
4. The postdrome
After the pain phase, 68% of the sufferers may experience the postdrome of which can be lasted for average of 24 hours, including tiredness (71.8%), head pain (33.1%), cognitive difficulties (11.7%), ‘hangover’ (10.7%), gastrointestinal symptoms (8.4%), mood change (6.8%), and weakness (6.2%) with commonest symptoms being tiredness and low-grade headache(A3)
B. Causes and risk factors
B. A. Causes
1. Cigarette smoking
Researchers in Geisinger Wyoming Valley, Department of Neurology, Wilkes-Barre, PA, USA., may have found the link between cigarette smoking and the development of cranial autonomic symptoms with migraine, according to “A history of cigarette smoking is associated with the development of cranial autonomic symptoms with migraine headaches” by Rozen TD.(B.A.1)
2. Trigeminal nerve and autonomic reflex
Scientist at the Texas Tech University Health Sciences Center – Cell Physiology and Molecular Biophysics, Lubbock, TX 79430, USA. have found out that the Migraine Headaches were initiated by night guard-initiated irritation of the trigeminal nerve and a trigeminal autonomic reflex resulting in unilateral migrainous headache with autonomic signs, according to “Unilateral or “side-locked” migrainous headache with autonomic symptoms linked to night guard use” by Strahlendorf J, Schiffer R, Strahlendorf H.(B.A.2)
Some researchers suggested that migraine with aura may be result of the spreading depolarization which describes a wave in the gray matter of the central nervous system characterized by swelling of neurons, distortion of dendritic spines, a large change of the slow electrical potential and silencing of brain electrical activity (spreading depression) of that cause migraine headache and increase the risk of developing an ischemic stroke(B.A.3)
4. Hormonal contraceptives
Some reserachers suggested that women who use hormonal contraceptives and hormone replacement treatment may increase the risk of migraine occurrence.(B.A.4)
5. IgE levels
There are no direct evidence to associate migraine headache to cow’s milk or egg-white allergy. However, the elevation of egg-white-specific IgE levels in migraine-type headache may signify the possible presence of shared pathogenetic pathways in the development of migraine and food allergies(B.A.5)
Stress can have an impact on one’s mental and physical well-being, including migraine headache. Stress describes a negative concept, life events, and concomitant psychosomatic illnesses should be considered important when evaluating individuals with migraine, and gender aspects need to be taken into account(B.A.6)
7. Abnormal Calcium Channels
Abnormal Calcium Channels can interference with cells in the transportation of necessary minerals of which increase the risk of Migraine Headaches. some researchers found that mutated Ca(V)2.1 channels activate at more hyperpolarizing potentials and lead to a gain-of-function in synaptic transmission. This gain-of-function might underlie alterations in the excitatory/ inhibitory balance of synaptic transmission, favoring a persistent state of hyperexcitability in cortical neurons that would increase the susceptibility for cortical spreading depression (CSD), a mechanism believed to initiate the attacks of migraine with aura.(B.A.12)
Serotonin, a type of neurotransmitter, passes messages between nerve cells, low serotonin levels in the brain may increase the risk of the process of constriction of the blood vessels as it alters levels of dopamine and stress hormones, and may be part of a complex cellular membrane trafficking dysfunction involving not only the serotonin transporter but also other transporters and ion channels of which trigger a migraine (B.A.7)
9. Reduced Magnesium Levels
Magnesium, plays an essential in many intracellular processes and in migraine pathogenesis, low levels of magnesium may promote cortical spreading depression, hyperaggregation of platelets, affect serotonin receptor function, and influence synthesis and release of a variety of neurotransmitters of which can trigger migraine headache(B.A.8)
10. Maxillary alveolar mucosal inflammation
Migraine, tension-type headache and facial pain patients are found to be associated with a maxillary alveolar mucosal inflammation and can be treated by chilling, application of anti-inflammatory gel and low-level (non-cutting) laser. Local treatment also mediates cervical muscle spasm, adding to its overall effectiveness(B.A.9)
11. Menstrual Migraine
Menstrual Migraine is caused by fluctuation of the levels of estrogen and progesterone in a woman menstrual cycle, it can be treated by phytoestrogens without stimulation of the endometrium, with decreased risk with long-term use.(B.A.10)
12. Other causes
Beside the causes above, out of 126/179 replies, other factors triggering migraine attack include too much work (under the stress category 54/64), reflected sunlight (under the light category 35/44), too little sleep (under the sleep category 19/24), red wine (under the alcohol category 20/22), passive smoking (under the smoke category 11/11), menstruation (under the menstruation or break from the pill category 12/14) and perfume (under the fumes/heavy scents category 12/15). Hormones, light and stress were reported to cause at least 50 % of MA attacks in 62%, 47% and 42% of participants, respectively. No participants reported alcohol to be the trigger of 50% or more of their attacks. In the groups of participants with “light”, “fumes/heavy scents”, “smoke” or “physical effort” as triggers, nearly all patients reported that an exposure time to the trigger of less than 3 hours (90-100% of patients) was necessary to trigger an attack and a latency to onset of attack of less than 3 hours (90-100% of patients) in the study conducted by University of Copenhagen and Glostrup Hospital, DenmarkJ. (B.A.11)
13. Nitric oxide (NO)
Nitric oxide (NO), a free radical is a very important molecule in the regulation of cerebral and extra cerebral cranial blood flow, rterial diameters and nociceptive processing, in a very small dose. Glyceryl trinitrate (GTN), a pro-drug for NO, causes headache in normal volunteers and a so called delayed headache that fulfils criteria for migraine without aura in migraine sufferers(B.A.11)
B.B. Risk factors
Significant sex differences exist in migraine and other headache disorders, 75% of all migraine sufferers are women, it may be the result of menstrual cycle and pregnancy causes of the fluctuations of female hormones.
Migraine headache migraine affects population of all age, but children with the chronic disorder eventually will see the disorder either disappear or transit to mild-type headaches, when they grow into adulthood.
3. Family history
If one the family member of the direct family has experienced headache migraine, the risk of the same disease of the other members increased by 75%.
References can be found at http://medicaladvisorjournals.blogspot.ca/2012/03/primary-headaches-migraine-headaches.html
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