Manbir Online .. Migraine

Precipitating Factors

Although investigation have not conclusively proved that any factor causes migraine headache some patients do recognize certian factors that precipetate an attach. Certain dietary factors like Tyramine, monosodium glutamate, excessive alcohol, excessive analgesics, ergotamine, oral contraceptives act as triger to cause migraine.
Stress, menses, heat, noise, caffeine etc. can also cause migraine.

Diagnosis

Careful history is important.

Diagnostic criteria

Migraine without Aura
Attacks lasing for 4 to 72 hours At least 2 of the following: °Unilateral Pain °Pulsating Pain °Moderate to severe Pain °Pain aggrevated by movement	Plus at least One of the following °Nausea °Photophobia / Phonophobia

Migraine with Aura
Patient should have at least 2 attachs per month and at least 3 of the following. ° 1 or more reversible aura symptoms representing cortical or brainstem dysfunction. ° 1 aura symptom developing gradually over 4 minutes or 2 successive aura symptoms. ° Symptoms lasting for < 60 minutes. ° Headache following aura in < 60 minutes.

Prevention of Migraine

Preventive measures are to be considered when migraine attaks occur more than two or three times a month and disturb normal activity. Preventive medication is continued for 6 months and gradually withdrawn. Drugs used include 5-HT influencing drugs like Amitriptyline, Methysergide, Propranolol, Metoprolol, Nadolol, Nefedipine, Nimodipine,Verapamil, Pizotefen.