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Migraine - diagnosis, types and management


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Migraine Dr. Angelo Smith M.D WHPL

How Does Migraine Impact Patients and Families?:

How Does Migraine Impact Patients and Families? Missed ≥ 1 day of work/school 25% Work/school productivity reduced by ≥ 50% 28% Did no household work 48% Household productivity reduced by ≥ 50% 34% Missed family or social activity 29% School, Work, and Social Impact in Previous 3 Months

What Is Migraine?:

What Is Migraine? A neurological disorder characterized by hyper excitability of the nervous system You don’t get migraines, you have migraine Your body is more sensitive to stimuli that can cause a headache attack Defining characteristics Recurrent headache attacks lasting 4-72 hours One-sided, pulsating, moderate-to-severe pain Presence of 2 of 3 key characteristics: inability to function, photophobia/phonophobia, nausea/vomiting



What Causes Migraine?:

What Causes Migraine? 1 Migraine originates deep within the brain 2 Electrical impulses spread to other regions of the brain 3 Changes in nerve cell activity and blood flow may result in visual disturbance, numbness or tingling, and dizziness 4 Chemicals in the brain cause blood vessel dilation and inflammation of the surrounding tissue 5 The inflammation irritates the trigeminal nerve , resulting in severe or throbbing pain

Types of Migraine:

Types of Migraine Type How common? Migraine without aura 70% Migraine with aura 25% Migraine variants and complicated migraine 5%

Aura’s (events that happen before actual migraine pain developes):

Aura’s (events that happen before actual migraine pain developes) scotoma (blind spots) Fortification (zig-zag patterns) Scintilla (flashing lights) Unilateral paresthesia/weakness Hallucinations Hemianopsia (blindness in one half of the visual field)

The Stages of a Migraine Attack:

The Stages of a Migraine Attack

Migraine and Women:

Migraine and Women Hormonal fluctuation plays an important role in migraine for many women 60% of women with migraine experience “menstrual migraine” Headaches are associated with changes in estrogen levels right before menses and most often occur up to 2 days before or during menses Oral contraceptives may either exacerbate or alleviate the frequency, severity, and duration of headaches


Old concept woman

Menstrual Migraine:

Menstrual Migraine Menstrual migraine differs somewhat from other migraine Pain may persist longer and be more severe Headache attack is more likely to be accompanied by nausea or vomiting Headache occurs more frequently Menstrual migraine is more difficult to treat

Migraine and Men:

Migraine and Men Recent online survey by NHF showed that migraine is the most common headache diagnosis in men (36%) Yet, many men do not discuss migraine with their healthcare practitioners Nearly 1/3 of men suffering from headache have not been diagnosed Nearly 1/4 did not visit their doctor because they felt they should “tough it out”

Nonpharmacologic and Complementary Therapies:

Nonpharmacologic and Complementary Therapies Relaxation training Hypnotherapy Biofeedback training Cognitive/behavioral management Acupuncture Nutritional supplements (B 2 and others) Physical therapy and/or massage

Lifestyle changes for Migraine:

Lifestyle changes for Migraine

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