Migraine

1. Migraine
Presented By Miss Sudipta Roy
Designation : Associate Professor
East Point College Of Pharmacy , Bangalore

2. Definition.
• The term migraine is originated from Greek word
"hemicrania" meaning one side of the head.
• Migraine headache as an episodic neurovascular
phenomenon is characerized by recurrent attacks
of unilateral headache while headache is
recognized as the most well-known symptoms of
migraine. Migraine is one of the common causes of
recurrent headaches.
• Definition : Migraine is a familiar disorder
characterized by recurrent attacks of headache
widely variable in intensity , frequency and
duration. Attacks are commonly unilateral and are

3. • or A migraine is a headache that can cause severe
throbbing pain or pulsing sensation, usually on one
side of the head. It' often accompanied by nausea,
vomiting and extreme sensitivity to light and
sound. Migraine attacks can last for hour days, and
the pain can be so severe that it interferes with
your daily activities.

4. Phases of Migraine.
• There are four phases of Migraine :
• 1. Prodrome : In this phase , a change in mood or
behaviour (irritability , neck stiffness) that starts hour
or days before headache. It is experienced by 60% of
migraineurs with following symptoms :
• Being sensitive to light , sound or smell.
• Fatigue
• Food cravings or lack of appetite
• Mood changes
• Severe thirst
• Bloating
• Constipation or diarrhea.

5. Aura
• Aura is a warning or signal before onset of migraine attack. This
phase starts 5 to 20 minutes before migraine attack. It is experiened
by 20% of migraineurs with sensory and motor symptoms .
Symptoms include
• See black dots , wavy lines , flashes of light, or things that are not
there (hallucinations)
• Have tunnel vision
• Not be able to see at all
• Have tingling or numbness on one side of your body.
• Not to able to speak clearly.
• Have tingling or numbness on one side of your body.
• Not be able to speak clearly
• Have a heavy feelings in your arms and legs
• Have ringing in your ears
• Notice changes in smell , taste or touch

6. Migraine Attack (Headache)
• A migraine headache often begins as a dull ache
and grown into throbbing pain . It usually gets
worse during physical activity.The pain can move
from one side of your head to the other, can be
infront of your head , or can feel like it's affecting
your entire head. Most migraine headaches last
about 4 hours , but serves ones can go for more
than 3 days. It's common to get two to four
headaches per month . Some people may get
migraine headaches every few days, while others
get them once or twice a year. About 80% of people
have the following symptoms during this phase :

7. • Anorexia
• Nausea and vomiting
• Photophobia
• Phonophobia
• Pale and clammy or feel faint
• Tinnitus (ringing or buzzing in the ears)
• Postdrome :
• It is also called migraine hangover. It is the last stage of a
migraine. After a migraine attack , patient might feel drained
, confused and washed out for up to a day. Common
postdrome symptoms include fatigue , nausea, sensitivity to
light , dizziness , body aches , and difficulty concentrating .
Sudden head movement might bring on the pain again
briefly.

8. Etiology.
• Through migraine causes are not fully understood ,
genetics and environmental factors appear to play a
role . Changes in the brainstem and its interactions
with the trigeminal nerve, a major pain pathway ,
imbalnces in brain chemicals including serotonin
that helps regulate pain in the nervous system
might be involved. Other neurotransmitters play a
role in the pain of migraine , including calcitonin
gene-related peptide (CGRP).

9. Migraine Triggers.
• There are a number of migraine triggers , including :
• Hormonal changes in women.
• Alcohol , especially wine and too much caffeine , such
as coffee.
• Stress
• Sensory Stimuli : Bright or flashing lights , loud sounds,
strong smells such as perfume , paint thinner can
trigger migraines in some people.
• Sleep changes.
• Physical factors : Intense physical exertion, including
sexual activity , might provoke migraines.

10. • Weather changes : A change of weather or
barometric pressure can prompt a migraine.
• Medications :
• Oral contraceptives and vasodilators , such as
nitroglycerin , can aggravate migraines.
• Foods : Aged cheeses and salty and processed
foods might trigger migraines. So might skipping
meals.
• Food Additives: These include the sweetener
aspartame and the preservative monosodium
glutamate (MSG) found in many foods.

11. Pathophysiology.
• Migraine is a mixture of environmental and genetic
factors , starts by signals sent out by the overactive
nerve cells activating the trigeminal nerve. CSD
triggers the trigemino-vascular system , which in
turn releaes nitric oxide and calcitonin gene related
peptide thus inducing vasodilation and perivascular
nerve activity. The imbalances in brain chemicals
such as serotonin , which in turn cause
vasoconstriction can lead to migraine pains.

12. • Migraine Triggers (Hormonal changes , Stress , Sleep
Changes ) : Cortical Spreading Depression (CSD) and
abnormal brain stem activity activated -
• Trigeminovascular system that activates Blood Capillaries
(Releases NO , CGRP , Substance P, Neurokinin A -
cerebral validation-headache-migraine)
• Trigeminovascular system activates thalamus - cortex-
Headache
• Trigeminovascular system activates Hypothalamus-
Photophobia, Phenophobia-Migraine
• Trigeminovascular system activates- chemoreceptor
trigger zone -Nausea, Vomiting -Migraine.
• Enhanced serotonergic stimulation in brain stem -
Cerebral Vasodilation -Headache-Migraine

13. Diagnosis.
• Neurological examination to rule out other causes for
pain might include-
• Magnetic Resonance Imaging (MRI)
• An MRI scan uses a powerful magnetic field and radio
waves to produce detailed images of the brain and blood
vessels . MRI scans help doctors diagnosing tumors ,
strokes , bleeding the brain , infections and other brain
and nervous system (neurological ) conditions.
• Computerized Tomography (CT) Scan : A CT scan uses a
series of X-rays to create detailed cross sectional images
of the brain . This helps doctors diagnose tumors,
infections , brain damage , bleeding in the brain and other
possible medical problems that may be causing
headaches.

14. Treatment
• Many medications have been designed to treat
migraines . Medications used to combat migraines fall
into two braod categories.
• 1. Pain Releiving Medications : Also known as acute or
abortive treatment , these type of drugs are taken
during migraine attacks and are designed to stop
symptoms.
• a. Pain Relievers : These over-the-counter or
prescription pain releivers include aspirin or ibuprofen
(Advil , Motrin IB , others).
• Triptanes : Prescription drugs such as sumatriptan
(Imitrex , Tosymra) and rizatriptan (Maxalt, Maxalt-MLT)
are used to treat migraine because they blok pain
pathways in the brain.

15. • Dihydroergotamine :
• Available as a nasal spray or injection , this drug is most
effective when taken shortly after the start of migraine
symptoms for migraines that tend to last longer than 24
hours.
• Lasmiditan : This newer oral tablet is approved for the
treatment of migraine with or without aura.
• Preventive Medications :
• These types of drugs are taken regularly , often daily ,
to reduce the severity or frequency of migraines.
• Anti-nausea Drugs : These can help if your migraine
with aura is accompanied by nausea and vomiting .