VASCULAR HEADACHE (MIGRAINE)

Shiva B.Phamacy Shiva.pharmacist@gmail.com

Migraine - Definition
Migraine is a familial disorder characterized

by recurrent attacks of headache widely

variable in intensity, frequency and duration.

Attacks are commonly unilateral and are

usually associated with anorexia, nausea and vomiting -World Federation of Neurology

Phases of Acute Migraine

Prodrome

Aura
Headache Postdrome

PRODROME

Vague premonitory symptoms that begin from 12 to 36 hours before the aura and headache Symptoms include Yawning Excitation Depression Lethargy Craving or distaste for various foods Duration 15 to 20 min

AURA
Aura is a warning or signal before

onset of headache
Symptoms

Flashing of lights
Zig-zag lines

Difficulty in focussing

Duration : 15-30 min

HEADACHE

Headache is generally unilateral and is associated with symptoms like: Anorexia Nausea Vomiting Photophobia Phonophobia Tinnitus Duration is 4-72 hrs

POSTDROME (RESOLUTION
PHASE)
Following headache, patient complains of

Fatigue Depression Severe exhaustion Some patients feel unusually fresh

Duration: Few hours or up to 2 days

Migraine Triggers

Food Disturbed sleep pattern Hormonal changes Drugs Physical exertion Visual stimuli Auditory stimuli Olfactory stimuli

Weather changes
Hunger Psychological factors

COMPLICATIONS OF MIGRAINE

According to the International Headache Society's classification of headaches, there are five separate complications of migraines: chronic migraine, status migrainosus, persistent aura without infarction, migrainous infarction, and migraine seizures. Many times each of these complications causes worry and distress beyond the pain itself.

COMPLICATIONS OF MIGRAINE
Chronic Migraines As the name suggests, the problem with chronic migraines is that they continue over a long period of time. The name "transformed migraine" is also used, since chronic migraines can evolve (or transform) from episodic to almost daily headaches. Symptoms may be mild, but migraines can occur in addition to the daily discomfort.

COMPLICATIONS OF MIGRAINE
Status Migrainosus The symptoms of status migrainosus are similar to whatever your "typical" migraine symptoms may be. The main difference is that in status migraines the symptoms are continuous for more than 72 hours. There may be periods of relative relief, but these generally last no longer than four hours.

COMPLICATIONS OF MIGRAINE
Persistent Aura without Infarction (PAWI) There are a number of rare complications of migraines, and persistent aura without infarction (PAWI) is one of them. As the name suggests, migraine aura is a necessary feature of PAWI. Not a lot is known about PAWI, but there are a few treatments that can be used.

COMPLICATIONS OF MIGRAINE
Migrainous Infarction According to the International Headache Society, a migrainous infarction occurs when, during a migraine with aura, a patient also has a stroke in the area of the brain from which the symptoms of the aura originate.

COMPLICATIONS OF MIGRAINE
Migraine Seizure A migraine seizure is an epileptic seizure that follows a migraine with aura. Auras can come in a variety of forms, but most have some sort of visual change or loss, including zigzagging lines, bright flashes, or a temporary blind spot.

MIGRAINE CLASSIFICATION
According to Headache Classification Committee of the International

Headache Society, Migraine has been

classified as:

Migraine without aura (common migraine) Migraine with aura (classic migraine) Complicated migraine

MIGRAINE: CLINICAL FEATURES

Migraine Without Aura
No aura or Prodrome

Migraine With Aura

Aura or prodrome is present

Unilateral throbbing headache Unilateral throbbing headache may be accompanied by nausea and later becomes generalised and vomiting During headache, patient complains of phonophobia and photophobia Patient complains of visual disturbances and may have mood variations

NURSING DIAGNOSIS
1. Acute pain r/t stess and tension, irritation / nerve pressure, vasospasm, increased intracranial pressures.

2. Ineffective individual coping r/t situations of crisis, personal vulnerability, not adequat support systems, work overload, inadequate relaxation, severe pain, excessive threat to himself.
3. Deficient knowledge : about the condition and treatment needs r/t lack of recall, did not know the information, cognitive limitations.

ASSESSMENT
In the assessment of headache, a few important things to consider. Among them are: Localized headaches usually associated with migraine headaches or organic disorders. Headaches are usually caused by complete or psychological causes of increased intracranial pressure. Migraine headaches can move from one side to the other. Headaches are accompanied by an increase in intracranial pressure usually occurs during sleep or waking headaches wake patients from sleep.

ASSESSMENT
Type headache sinuses arise in the morning and the afternoon to get worse. A lot of headaches associated with stress conditions. The pain is dull, annoying, escalate and continue to exist, often occurs in the psikogenis headache. Organic materials that cause pain and its still growing steadily.

ASSESSMENT
Migraine headaches can accompany menstruation, headaches can be preceded by eating foods that contain monosodium glutamate, sodim nitrate, tyramine as well as alcohol. Sleeping too long, fast, inhaling the toxic odors in the workplace where insufficient ventilation can cause headaches. Oral contraceptive medications can aggravate migraines. Each found the secondary of a headache needs to be studied.

ASSESSMENT
Migraine headaches can accompany menstruation, headaches can be preceded by eating foods that contain monosodium glutamate, sodim nitrate, tyramine as well as alcohol. Sleeping too long, fast, inhaling the toxic odors in the workplace where insufficient ventilation can cause headaches. Oral contraceptive medications can aggravate migraines. Each found the secondary of a headache needs to be studied.

MIGRAINE: DIAGNOSIS
Medical History Headache diary Migraine triggers Investigations (only to exclude secondary causes) EEG CT Brain MRI

DIFFERENTIATING COMMON PRIMARY HEADACHES

Strictly unilateral Tension headaches: Do not have the associated features like nausea, vomiting, photophobia, phonophobia. The muscle contraction leads to headache. Headache quality is of a tightening (non-pulsating) quality. Usually bilateral. Intensity is mild or moderate Cluster headaches: Severe unilateral pain. Headache associated with lacrimation, nasal congestion, rhinorrhea, facial sweating or eyelid edema. Pain lasts for 15 to 180 minutes. More common in men

THE TREATMENT
APPROACH TO MIGRAINE

LONG-TERM TREATMENT GOALS FOR THE MIGRAINE SUFFERER Reducing the attack frequency and severity

Avoiding escalation of headache medication Educating and enabling the patient to manage the disorder Improving the patients quality of life

MIGRAINE MANAGEMENT

Non-pharmacological treatment Identification of triggers Meditation Relaxation training Psychotherapy Pharmacotherapy non-specific Abortive therapy

MIGRAINE: ABORTIVE THERAPY

Non-specific treatment
Drug
Aspirin Paracetamol Ibuprofen Diclofenac Naproxen

Dose
500-650 mg 500 mg-4 g 200- 300 mg 50-100 mg 500-750 mg

Route
Oral Oral Oral Oral/IM Oral