followed by transient loss or impairment of consciousness or by a confusional state This is followed by a throbbing (usually occipital) headache, often with nausea and vomiting
Ophthalmoplegic Migraine Lateralized pain - often about the eye - is accompanied by nausea, vomiting, and diplopia due to transient external ophthalmoplegia
Rarely... Neurologic or somatic disturbance accompanying typical migrainous headaches becomes the sole manifestation of an attack (“migraine equivalent”) Very rarely, the patient may be left with a permanent neurologic deficit following a migrainous attack
PAIN MECHANISMS: Three key factors merit consideration: • the cranial blood vessels, • the trigeminal innervation of the vessels, and • the reflex connections of the trigeminal system with the cranial parasympathetic outflow.
Nonpharmacologic therapies include • education of the patient about the disorder, its mechanisms, approaches to treatment, and changes in lifestyle involved in the avoidance of triggers of migraine • in patients with migraine, the brain does not seem to tolerate the peaks and troughs of life well. Thus, regular sleep, regular meals, exercise, avoidance of peaks of stress and troughs of relaxation, and avoidance of dietary triggers can be helpful.
The patient should aim for a certain regularity of habits, rather than adhere to a long list of prohibitions of foods and activities.
The same manipulations intended to avoid triggering migraine will lead to different outcomes on different days.
Drugs for the treatment of migraine can be divided into • drugs that are taken daily whether or not headache is present to reduce the frequency and severity of attacks, and • drugs that are taken to treat attacks as they arise.
Treatment for attacks can be divided into nonspecific and migraine-specific treatments. Nonspecific treatments, such as aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs, opiates, and combination analgesics, are used to treat a wide range of pain disorders.
Analgesic Drugs Aspirin, acetaminophen, propoxyphene, and codeine are all superior to placebo Effervescent formulations Because gastric stasis often accompanies migraine attacks, metoclopramide enhances the effectiveness of analgesic drugs These drugs occasionally cause tardive dyskinesia which may be irreversible, and patients should be informed of this risk before beginning treatment
Analgesic drugs (cont) Two types of combined medications are often used in the treatment of migraine: isometheptene in combination with acetaminophen and dichloralphenazone aspirin in combination with caffeine and butalbital There is no evidence that these preparations are more effective than other analgesics
Nonsteroidal Anti- inflammatory Drugs Nonsteroidal anti-inflammatory drugs can be the first choice of treatment for patients with mild-to-moderately- severe migraine attacks Naproxen Aspirin in oral doses of 500 mg Ketorolac
- Fall '17