11/3/2023 0 Comments Migraine with aura not intractable![]() ![]() Preventive medications inhibit migraine pathophysiology through various mechanisms, such as blocking calcium and sodium channels, blocking gap junctions, and inhibiting matrix metalloproteinases, among other mechanisms. Commonly prescribed prophylactic medications include beta blockers like propranolol, anticonvulsants like sodium valproate, antidepressants like amitriptyline, and other off-label classes of medications. For individuals who experience four or more attacks per month, or could otherwise benefit from prevention, prophylactic medication is recommended. Specific medications such as triptans, ergotamines, or CGRP inhibitors may be used in those experiencing headaches that are refractory to simple pain medications. Initial recommended treatment for acute attacks is with over-the-counter analgesics (pain medication) such as ibuprofen and paracetamol (acetaminophen) for headache, antiemetics (anti-nausea medication) for nausea, and the avoidance of triggers. The accepted hypothesis suggests that multiple primary neuronal impairments lead to a series of intracranial and extracranial changes, triggering a physiological cascade that leads to migraine symptomatology. An older "vascular hypothesis" postulated that the headache of migraine is produced by vasodilation and aura by vasoconstriction, but this mechanism has been disproven. Migraine is believed to be caused by a mixture of environmental and genetic factors that influence the excitation and inhibition of nerve cells in the brain. Disease burden can range from episodic discrete attacks, consisting of as little as several lifetime attacks, to chronic disease. Although primarily considered to be a headache disorder, migraine is highly heterogenous in its clinical presentation and is better thought of as a spectrum disease rather than a distinct clinical entity. Up to one-third of migraine sufferers experience aura: a premonitory period of sensory disturbance widely accepted to be caused by cortical spreading depression at the onset of a migraine attack. ![]() Exacerbation of headache symptoms during physical activity is another distinguishing feature. Other characterizing symptoms may include nausea, vomiting, cognitive dysfunction, allodynia, and dizziness. Migraine ( UK: / ˈ m iː ɡ r eɪ n/, US: / ˈ m aɪ-/) is a genetically influenced complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea and light and sound sensitivity. Ibuprofen, paracetamol (acetaminophen), triptans, ergotamines Subarachnoid hemorrhage, venous thrombosis, idiopathic intracranial hypertension, brain tumor, tension headache, sinusitis, cluster headache Headaches, nausea, sensitivity to light, sound, and smell
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