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MIGRAINE

MIGRAINE

           RECURRENT ,EPISODIC ATTACKS OF HEADACHE,VARIED IN INTENSITY,FREQUENCY AND length,COMMONLY UNILATERAL IN ONSET AND related to eating disorder someday WITH NAUSEA AND vomit,COSPICUOUS SENSORY,MOTOR AND MOOD DISTURBENCES.


ETIOLOGY


1.AGE


-onset could also be in childhood ,typical seem in adolescent and continues at till sixth decade.

2.SEX


-More common in girls

3.HEREDITORY INFLUENCES


-The transmitted issue being abnormal response of bone and different vasculature to bound external or endogenous stimuli.

4.PREDISPOSING FACTORS


-Prolong fast

-prolong exposure to sun light-weight

-some food like chees ,chocolates,citrus fruite ,coffee.

-mild associated head injury like heading soccer.

-chnges in degree of stress.


MECHANISMS


-famillial tendency towards increased vascular  contract ability in megrim patient manufacture sequence of constriction band dilatation.

-stimuli that ordinarily manufacture healthy flush might manufacture AN incordinated circulatory response in megrim patients leading to constriction of tiny vessels and dilatation of arteries and veins.

-serotonin discharged from plateletes causes
Vascular  construction.serotonin then gets absorbed into vessels wall and together with domestically discharged Lipo-Hepin and neurokinin produces pain.

CLINICAL FEATURE OF MIGRAIN


1.PRODROME


-vague yawning
-euphoria(excited happiness)
-lethargy

2.AURA


-Usually visual,flashing lights,zig-zag castellation,ball and filament of sunshine begin peripherally and centaraly,fragmentation.

-aura generally lasts 0.5 hour and is succeeded headache.

3.HEADACHE


-Unilateral or hemicranial or presently becomes generalised.

-starts as imprecise pain and builds up to a throbbing intensity related to pallidness ,anorexia,nausea,vomiting and photophobia.

-it could also be last for many hours and when vomit ,headache might decrease in intensity and followed by sleep.

-in some cases headache persist for forty eight hours or a lot of.

-during the headache the superficial cerebral artery could also be full and pulsing.

MANAGEMENT

A.DURING ATTACK OF MIGRAIN


1.ANALGESIC

-NSAIDS like diclofenac is given p.o. or by IM injection if vomit is in conjunction with headache.

2.ERGOTAMINE

-Most necessary medication for severe attacks

-ergotamine tartrates zero.25 to 0.50 mg IM or orally one to two mg pill ideally together with a hundred mg alkaloid

3.  5-HT one AGONISTS

- square measure thought to modulate centeral pain mechanism by reducing levels of the transmittent substance thyroid hormone factor connected amide.

-injection sumatriptan half dozen mg s.c. offers relife from headache in sixty minute,with corresponding improvement in nausea ,vomiting and photophobia.

-oral dose of 100mg sumatriptan tab provides relief at intervals two hours.


4. GENARAL MEASURES

-Lying in darkened and quite space and ice pack to the top might facilitate.


B.REDUCING FREQUENCY AND SEVERETY OF subsequent  megrim ATTACKS


1.ELIMINATION OF TRIGGER FACTORS

2.RELAXATION EXERCISES

3.DRUGS

(a)SEDATIBES like tab amitryptiline a hundred mg in the dead of night.

(b)SEROTININE INHIBITORS like tab flunarizine ten mg /day

(c)PROPRANOLON 20mg b.d. could also be helpful in some cases.

(d)CLONIDINE twenty mg b.d. is effective

(e)ERGOTAMINE TARTARATE

-1 mg orally or zero.25 mg by self administered injection is dictate for old.

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