Wednesday, June 18, 2008

Migraine and Triptans

Migraine and Triptans


Most of us have occasional headaches that are relieved by over-the-counter medications. When headaches are frequent or unrelieved by OTCs we usually consult a physician or tend to increase the doses of medications or even try home remedies… But at times, in some people/patients this does not bring and relief. The answer to this may be MIGRAINE. Unfortunately about of all the patients with migraine are not properly diagnosed and those who are, don’t receive proper treatment. .

Migraine has been first described in the EBERS PAPYRUS (of about 1550 BC is among the most important medical papyri of ancient Egypt. It is one the two oldest preserved medical documents anywhere). In 400 B.C Hippocrates used the method of “vomiting“ to treat migraines. It was Galen in 200 A.D who first introduced the term migraine from the Greek word hemicraine (meaning “half of the head”).

Migraine is caused by the vasodilatation of frontal branch of the superficial temporal-artery leading to neurogenic inflammation, due to release of chemicals like Neurokinin-(mediators of inflammation) from the primary sensory nerve fibres involved in pain transmission. Due to dilatation the nerve fiber coiling the artery gets stretched which gets depolarized and activated causing pain sensation.

Fig:Increased blood flow in an area of mesencephalon (arrow)

Various other theories claim to explain the pathophysiology of migraine
a. Depolarization theory
b. Vascular Theory
c. Serotonin Theory
d. Neural Theory
e. Unifying Theory (Combination of Vascular and Neural theories)

Early symptom, where development of the condition is prominent. Symptoms such as headache, fever etc. are seen during this phase.
2. Aura - A kind of disturbance seen in migraine sufferers before the migraine headache.
3. Pain - Headache phase where the actual migraine headache is seen. High levels of headache is prominent here.
4. Postdrome - The final phase of migraine headache.

Migraine may be diagnosed by symptoms and family history. Sometimes an MRI or CT scan is obtained to rule out other causes of headache like sinus inflammation or a brain mass. In the case of a complicated migraine, an EEG may be needed to exclude seizures. Rarely, a lumbar puncture (spinal tap) might be performed.

a.Bright lights, loud noises, and certain odors or perfume
b. Change in sleep patterns
c. High Stress
d. Smoking & alcohol
e. Allergic reactions
f. Menstrual cycle fluctuations & birth control pills
g. Foods containing tyramine.

Migraine with aura: Migraine precedes with visual disturbances before the headache starts.
Migraine without aura: Does not have the aura stage

Aura consisting of at least one of the following:
Fully reversible visual symptoms
Fully reversible sensory symptoms
Fully reversible dysphasia.

TREATMENT .... to be continued

23:40 18th may

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