VASCULAR HEADACHE (MIGRAINE)ShivaB.PhamacyShiva.pharmacist@gmail.com

Migraine - DefinitionMigraine 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 MigraineProdromeAuraHeadachePostdrome

PRODROMEVague premonitory symptoms that begin from 12 to 36 hours before the aura and headacheSymptoms includeYawningExcitationDepressionLethargyCraving or distaste for various foods Duration 15 to 20 min

AURAAura is a warning or signal beforeonset of headacheSymptomsFlashing of lightsZig-zag linesDifficulty in focussingDuration : 15-30 min

HEADACHEHeadache is generally unilateral and is associated with symptoms like: Anorexia NauseaVomiting PhotophobiaPhonophobiaTinnitus Duration is 4-72 hrs

POSTDROME (RESOLUTION PHASE)Following headache, patient complains ofFatigueDepressionSevere exhaustionSome patients feel unusually freshDuration: Few hours or up to 2 days

Migraine TriggersFoodDisturbed sleep patternHormonal changesDrugsPhysical exertionVisual stimuli Auditory stimuli Olfactory stimuli Weather changes HungerPsychological factors

COMPLICATIONS OF MIGRAINEAccording to theInternational 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 MIGRAINEChronic MigrainesAs the name suggests, the problem withchronic migrainesis 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 MIGRAINEStatus MigrainosusThe symptoms ofstatus migrainosusare 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 MIGRAINEPersistent Aura without Infarction (PAWI)There are a number of rare complications of migraines, andpersistent 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 MIGRAINEMigrainous InfarctionAccording to the International Headache Society, amigrainous infarctionoccurs when, during a migraine with aura, a patient also has astrokein the area of the brain from which the symptoms of the aura originate.

COMPLICATIONS OF MIGRAINEMigraine SeizureAmigraine seizureis 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 CLASSIFICATIONAccording to Headache ClassificationCommittee of the InternationalHeadache Society, Migraine has beenclassified as:Migraine without aura (common migraine) Migraine with aura (classic migraine)Complicated migraine

MIGRAINE: CLINICAL FEATURES

Migraine Without AuraMigraine With AuraNo aura or ProdromeAura or prodrome is presentUnilateral throbbing headache may be accompanied by nausea and vomitingUnilateral throbbing headache and later becomes generalisedDuring headache, patient complains of phonophobia and photophobiaPatient complains of visual disturbances and may have mood variations

NURSING DIAGNOSIS1. Acute pain r/t stess and tension, irritation / nerve pressure, vasospasm, increased intracranial pressures. 2. Ineffectiveindividualcoping 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.

ASSESSMENTIn theassessmentof 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.

ASSESSMENTType 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.

ASSESSMENTMigraine 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.

ASSESSMENTMigraine 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: DIAGNOSISMedical HistoryHeadache diaryMigraine triggersInvestigations (only to exclude secondary causes)EEGCT BrainMRI

DIFFERENTIATING COMMON PRIMARY HEADACHESStrictly unilateralTension 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 moderateCluster 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 TREATMENTAPPROACH TO MIGRAINE

LONG-TERM TREATMENT GOALS FOR THE MIGRAINE SUFFERERReducing the attack frequency and severityAvoiding escalation of headache medicationEducating and enabling the patient to manage the disorderImproving the patients quality of life

MIGRAINE MANAGEMENTNon-pharmacological treatment

Identification of triggersMeditationRelaxation trainingPsychotherapyPharmacotherapy non-specificAbortive therapy

MIGRAINE: ABORTIVE THERAPYNon-specific treatment

DrugDoseRouteAspirin500-650 mgOralParacetamol500 mg-4 g Oral

Ibuprofen 200- 300 mgOralDiclofenac50-100 mgOral/IMNaproxen500-750 mgOral