“I would love to remove my head.”
This phrase will be familiar to those people who have suffered a special type of headache, which first starts from one side then expands to the other areas.
I know that you have reached the conclusion of what we are going to talk about. It’s a migraine headache, also called a vascular headache. Migraine headaches are by far underestimated, underdiagnosed, and undertreated.
Some of you may have a doubt that when the skull and the brain are not having any pain receptors, how are we experiencing things like migraines?
This is cleared by the facts from the literature that migraine is related to the nociceptors present in the muscle surrounding the vascular channels in the skull and face. These are the culprits for the sufferings.
What Exactly Does Migraine Mean?
The word migraine is said to be derived from a Latin word, “hemicrania”. On dissecting this word, we get two halves as “hemi”( meaning half) and “crania”(meaning skull). This name itself will teach us more than what we need to understand what migraine exactly is.
Migraine in medical language is communicated as sudden, pulsating, throbbing pain, which most commonly starts from one part of one side of the skull and expands to other areas, which may or may not be preceded by auras.
Auras are always a thing spoken in mystical subjects. Here also, we come across aura, which is the warning sign to the patient that the migraine is going to pitch in.
Auras come through the basic senses and the feelings, such as visual disturbances, tingling sensations, nausea, sensitivity changes to sound or light. Even though there is an immense number of studies being done on this part, there are no solid conclusions on why and how these aurae are produced.
How Do We Classify Different Types Of Migraines?
As migraine is a vague term for headaches with the above features, it needs to be well classified and studied. By this, appropriate treatment and preventive measures can be systematically devised easily.
There are a variety of ways to classify migraines. The most commonly used and accepted method of classification is based on the aura.
Migraines can either be those
Apart from this, classification can also be done based on the chronicity, part of the human physiological system that may be related to the symptoms & aura, underlying defect, etc.
Pathophysiology of Migraine
Every effect in this existence will have a cause for it. Let us see what are those chain reactions lead to this presentation.
Even though the pathogenesis may occur in any nerve inside the skull, the most commonly affected nerves are the trigeminal nerve and its divisions along its course.
Due to any of the many triggering factors, these nerves were found to release an important and most efficient vasodilator, Calcitonin Gene-Related Peptide (CGRP). This chemical mediator, along with Substance P and Neurokinin A dilate the blood vessels.
Based on the studies on animal models, edema is hypothesized to be because of the extravasation of plasma with its plasma protein from the vessel into perivascular space. This event will make the dura inside the skull to get stretched. And obviously, stretching cause irritation of the nerve endings innervating the meninges, which in turn produce pain. This meningeal stretching and irritation is the point of origin of the migraine headache.
It is also found that this above event will be exaggerated by the lack of a substance called serotonin (5-Hydroxytryptamine). This substance is produced in a manner that makes up the pulsating nature of migraine pain.
So in conclusion,
Edema → Stretching of dura → Nerve irritation → Pain
How do we manage migraines?
There are two broad domains in the management of migraines. One is to treat the episode which already pitched in. Another is to prevent the attack onset.
Treating the acute episode revolves around two main groups of medications viz, ergot alkaloids and Triptans.
The main mechanism is based on the activity of the serotonin on the blood vessels, which we discussed before.
The next approach is based on the saying, “Prevention is better than cure”.
This is achieved by eliminating the triggering factors which are of greater favor in the prevention of the next episode.
The prophylactic drugs fall in the categories of,
Yes, apart from the above methods, other possible but not completely proven methods also are employed against migraines. Such approaches include acupuncture practices, biofeedback & relaxation, massaging & chiropractic therapies, and vitamin supplementation.
Recently there are 2 classes of drugs by the names, ditans, and CGRP antagonists, which are proven to be effective in the case of migraine management.
Even though there are a variety of choices for alleviating migraines, the most comfortable and affordable choice is the usage of common analgesics like paracetamol, aspirin, and other NSAIDs.
References:
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