Principles of Migraine Management
The most important aspect of management of migraine is to define diagnosis of migraine by the use of the criteria laid down by the International Headache Society. The management to a large extent also depends on the severity and disability the migraine headache is causing to the patient, because severe cases of migraine need appropriate preventive treatment along with treatment of acute attacks of migraine headache.
The next important aspect in the management of migraine headache is to educate the patient about the disease and to approach the disease practically. Patient education also encompasses to make the patient of migraine understand that the disease has an inherited tendency to headache and it is possible to modify and control migraine by lifestyle modifications (adjustments) and use of medications appropriately, although the disease cannot be cured. The better the patient understand the reality of migraine headache, the better the patient will be able to control the disease. Patient education about migraine also includes making the patient understand that it is not a serious and life threatening disease, the only exception is migraine in women on oral contraceptives.
Categories: Headache Tags: management, migraine
How Migraine is Diagnosed?
Diagnosis of migraine is mainly done by clinical examination and carefully taken history and high degree of suspicion and good clinical knowledge is essential for accurate diagnosis of migraine clinically. There are some clinical features (symptoms) which are generally seen only in migraine headache such as presence of aura, known as “migraine aura” with which the patient understand that he/she has migraine. The aura of migraine consists of visual disturbances such as flashing of lights or zigzag lines moving across the visual field of the patient, but migraine aura is seen only approximately 20-25% of the patients of migraine and can not be relied upon for diagnosis of migraine, although presence of migraine aura is diagnostic of the disease.
Migraine diagnostic criteria of the International Headache Society:
The International Headache Society has given simplified diagnostic criteria for migraine. According to the International Headache Society diagnostic criteria, “repeated attacks of headache which last for 4 to 72 hours in patients with normal physical examination and no other reasonable cause for the headache is migraine if at least 2 of the 4 major features and at least 1 minor feature is present”.
Categories: Headache Tags:
Know Few Aspects About Migraine
Migraine is one of the commonest forms of primary headache. If a type of headache does not have a secondary pathology or an exogenous cause it is termed primary headache, in other words headache is the primary disease, unlike secondary headache, where headache occurs as a result of some other cause such as infection or brain tumor.
Migraine is a fairly common problem (disease) with approximately 15% or women and 06% of men suffer from the disease. Migraine is in fact second most common form cause of headache. A typical migraine headache generally occurs in one side of the head, which helps to differentiate migraine headache from other types of headache, although it is always not possible. Migraine is generally episodic and the patient of migraine is sensitive to light, sound, movement etc. another important feature of migraine headache is that, headache can be triggered by certain factors such as light, sound, or movement, which are known as “triggers” or “activators”. The “triggers” of migraine help in the diagnosis of the disease pretty accurately even by a layman.
Categories: Headache Tags:
Prevention of Cluster Headache
Prevention is always better than cure and in respect of cluster headache also this is true. As cluster headache cause explosive, excruciating and recurrent retro orbital pain, it is important to prevent cluster headache whenever possible. There are several medications available for prevention of cluster headache and the choice of preventive medication depends on factors such as duration of the disease, duration of the bouts of cluster headache etc.
Drugs used in prevention of cluster headache:
Cluster headache patients with relatively short duration of disease or short bouts of cluster headache can be given an oral glucocorticoids (such as prednisolone) or methysergide (not available in United States and many other countries) as preventive measure for cluster headache and provide satisfactory result.For short term prevention cluster headache, Prednisone can be used for 10 days course, starting at the dose of 60 mg per day (1 mg per kg body weight and maximum of 60 mg per day) for one week which is followed by quick tapering of Prednisone in next three days. This regimen can prevent bouts of cluster headache in many patients.
Categories: Headache Tags: Cluster headache, Ergotamine
Treatment of Cluster Headache
Cluster headache is a very rare form of headache accounting approximately 0.1% of population. But the symptoms of cluster headache are very severe such as excruciating retro orbital pain, which is explosive in nature. The typical feature of cluster headache is periodicity, occurring for 1-2 months (with one or two bouts of attack of excruciating retro orbital pain) once a year. The excruciating retro orbital pain becomes severe very fast and need to be treated with fast acting drugs for control of headache.
An important aspect of therapy to be kept in mind for cluster headache is the rapidity at which the pain peaks, which makes the use of fast acting drugs a must and fortunately the drugs acts very well and give satisfactory result in most of the patients with cluster headache. General treatment measures such as use of 100% pure oxygen at high flow rate of 10-12 liters per minute for at least 15-20 minutes should be given in treatment of cluster headache. It is important to maintain high flow rate and purity of oxygen in treatment of cluster headache.Categories: Headache Tags: Cluster headache, Sumatriptan
