By: Dr. Abhishek Kr. Pandey, Medical Correspondent-ICN
Women have an 18% risk of having a migraine compared to a 6% chance in men. The higher prevalence in women is typically attributed to hormonal fluctuations especially estrogen.
LUCKNOW: Migraine headache is the most common disabling brain disorder. It is the commonest cause of recurrent, severe headache. One in every 10 people has migraine. It occurs mostly in adult population and shows female predominance .Unilateral throbbing type moderate to severe intensity headache is a common manifestation of the migraine though it may present with varied presentation.
Migraine is a common chronic headache disorder characterized by recurrent attacks lasting 4–72 hours, of a pulsating quality, moderate or severe intensity aggravated by routine physical activity and associated with nausea, vomiting, photophobia etc.
Many dental problems are related to headaches and many conditions can cause orofacial pain and headaches, which complicates a definitive diagnosis. Temporomandibular joint disorders, toothache, jaw and sinus pain often coexist with headaches. A toothache of nonodontogenic origin may require a team of dentists and physicians to diagnosis and manage. It is important for the dentist to recognize and understand the management of common headaches, such as migraine, and be able to differentiate between a nonodontogenic headache and a “real” toothache.
Migraine is believed to be induced by a neurochemical reaction involving the trigeminovascular system and not the result of a primarily vascular event. The most common trigger factors were emotional stress (79%), sleep disturbance (64%) and dietary factors (44%). Sleep and stress were significant trigger factors in patients with migraine with aura, whereas environmental factors were important trigger factors in patients with migraine without aura.
Women have an 18% risk of having a migraine compared to a 6% chance in men. The higher prevalence in women is typically attributed to hormonal fluctuations especially estrogen.
Almost everyone with migraine needs no investigation. The goal of investigating is to exclude other causes of migraine like symptoms. Diagnosis of Migraine can be made through history taking alternatives are rule out with help of orthopedic tests, Cranial nerve examination, Complete blood count, urinalysis and Cranial magnetic resonance imaging was performed if required.
The International Classification of Headache Disorders defines the migraine by following criteria.
(A). At least five attacks 1 fulfilling criteria B–D
(B). Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)
(C). Headache has at least two of the following four characteristics:
- Unilateral location
- Pulsating quality
- Moderate or severe pain intensity
- Aggravation by or causing avoidance of routine physical activity (e.g. walking or climbing stairs)
(D). During headache at least one of
- Nausea and/or vomiting
- Photophobia and phonophobia
Management of migraine includes- Lifestyle modification, Non pharmacological and pharmacological methods. The non pharmacologic management of migraine in clinical practice includes the application of cold or pressure to the head, reduction of activity and of sensory input in a quiet or dark environment and attempts to sleep and are supplemented by the use of pharmacologic therapies.
The pharmacological management of migraine headache includes the judicious use of analgesic for the rapid and sustained relief of headache. 5-HT1B/1D receptor agonists like sumatriptan, almotriptan, eletriptan, rizatriptan and zolmitriptan are available in market. Amongst the triptan, eletriptan followed by rizatriptan has higher headache response rate and safety profile. It should not be used more than 2-3 times in a week to prevent the emergence of medication overuse headache. They are contraindicated in individual with cerebrovascular disease and cardiovascular disease.
Paracetamol can be used in migraine as first choice to that patient where NSAIDS are contraindicated or not tolerated. Oral diclofenac potassium 50 mg is an effective treatment for acute migraine, providing relief from pain and associated symptoms. Flunarizine is a calcium channel antagonist, has moderate action as antihistaminics, serotonin receptor blocking and antidopaminergic. The starting dose is 5mg/day for initial 21 days which is increased to 10mg/day after it.
Among the tricyclic antidepressant, amitriptyline hydrochloride is the choice of drug for migraine management. The starting dose is 10 mg can be titrated up to 75 mg to achieve the maximal therapeutic effect. Response to these agents of usually within 4 weeks of starting of treatment. Dry mouth, weight gain, postural hypotension, drowsiness are common side effects of these agent.
Migraine is common cause of headache, early diagnosis and prompt treatment of migraine enhances the quality of life and prevents conversion of episodic migraine to chronic migraine. While many patients find that lifestyle adjustments such as regularizing meals and sleep can reduce the frequency of their attacks. Regularity of regimen with regard to meals, hydration, sleep and stress is always helpful in reducing the tendency to migraines.
