Migraine: clinical symptoms and treatment. Diagnosis of migraine, how to identify the disease at an early stage What is migraine and its types


Ivan Drozdov 28.02.2018

Signs of migraine have similar symptoms to most neurological diseases, so it is necessary to make an unambiguous diagnosis based on examination without complex diagnostics migraines are almost impossible. To do this, a neurologist whose specialization includes must carry out a number of techniques, tests and tests to identify signs of migraine, as well as prescribe an instrumental examination to confirm the preliminary diagnosis.

Taking an anamnesis (patient interview)

During the initial examination of a patient with signs of migraine, a therapist or neurologist conducts a survey, specifying the following information:

  • whether similar problems were observed among close relatives in the current and past generations;
  • what lifestyle the patient leads, where he works, how he eats, whether he abuses bad habits or not;
  • what preceded the appearance of paroxysmal pain, what factors could cause it;
  • what chronic ailments are diagnosed in the patient and is there a relationship between their treatment and;
  • whether the patient had injuries (in particular to the back, cervical spine and head) or not;
  • whether there are factors in the patient’s life that cause emotional distress and severe stress that can lead to a depressive state.

To provide the neurologist with complete information about the duration and frequency of attacks, as well as about the events preceding the development of pain, it is necessary to keep a diary, noting all the moments described in it.

Criteria by which migraine is diagnosed

Migraine attacks appear at regular intervals and almost always have similar symptoms corresponding to a specific type of disease. One of the methods for diagnosing migraine is to assess the patient’s condition according to generally accepted criteria:

  1. 5 attacks of ordinary migraine or 2 attacks of classical migraine with the following symptoms were recorded:
    • the duration of a migraine attack is 4-72 hours;
    • headache is characterized by two or more symptoms: pain develops on one side; the nature of the pain is excruciating pulsation; intensity pain reduces normal activities; pain increases with bending, walking, monotonous physical labor;
    • the attack is aggravated by a painful reaction to light and sounds, nausea, vomiting, and dizziness.
  2. There are no other pathologies or disorders with symptoms characteristic of migraine.
  3. The patient suffers from headaches of a different form, while migraine is an independent disease and the attacks are not interrelated.

Painful attacks with the manifestation of corresponding symptoms should be recorded during a visit to the attending physician or a call to the medical team at home.

Physical examination for migraine

Having received general information about the patient’s lifestyle and condition, the doctor begins a physical examination, during which he visually examines, palpates the patient and conducts a set of tactile tests.

If a migraine is suspected, the doctor performs the following manipulations:

Is something bothering you? Illness or life situation?

  • measures arterial pressure, pulse and respiratory rate, body temperature;
  • superficially examines the fundus and the condition of the pupils;
  • determines the shape and size of the head by feeling and measuring;
  • palpates the temporal area and assesses the condition temporal artery;
  • palpates the area of ​​the jaw joints, cervical region, shoulder girdle and scalp to identify pain and muscle tension;
  • examines the arterial vessels of the neck with a phonendoscope to exclude inflammatory processes with similar symptoms;
  • determines the degree of sensitivity skin by tingling with a sharp object (for example, a needle);
  • feels thyroid gland to determine its size and condition;
  • checks coordination and balance using special tests and tests (for example, squatting or standing on one leg with eyes closed);
  • assesses the psycho-emotional state, in particular, concentration, memory activity, the presence or absence of hidden disorders in the form of depression, aggression or apathy to what is happening.

This diagnostic method is aimed at identifying neurological disorders observed with migraine, and excluding other pathologies with similar symptoms.

Consultation with specialized specialists

During the examination of the patient, the neurologist may refer him for examination to other specialized specialists to exclude pathologies that cause headaches similar to migraine. In such cases, consultation may be necessary. next doctors:

  • ophthalmologist - to examine the fundus of the eye, determine visual acuity, exclude inflammatory processes and infections (for example, conjunctivitis);
  • dentist - to assess the condition of teeth, presence or absence purulent pathologies, causing a throbbing headache similar to migraine;
  • ENT doctor - to examine the maxillary sinuses, organs of the inner and middle ear, and exclude such inflammatory processes as otitis media, Meniere's disease, sinusitis;
  • vertebrologist - to study the spinal system of the spinal and cervical spine, to exclude infringement vertebral arteries and the development of cervical migraine as a consequence.

An examination by the listed specialists will help determine the cause of headaches and rule out migraines, or, conversely, narrow the range of factors that provoke the development of pain and conclude that the attacks are caused by this particular illness.

Instrumental methods for diagnosing migraine

The final stage of diagnosing migraine is examination instrumental methods, which allows using specialized medical equipment and equipment to identify or exclude abnormalities in brain structures and vascular system, provoking migraine attacks.

results comprehensive survey allow the attending neurologist to determine the etiology of pain and the reasons for the manifestation of accompanying symptoms, in order to ultimately make or exclude a diagnosis of "".

article updated 08/21/2018

In most cases, migraines are easily recognized. No examination is necessary to confirm the diagnosis. The diagnosis of migraine is established based on the description of the headache and the absence of any signs of pathology during a medical examination.

Migraine called chronic illness, the main manifestation of which is a headache attack that meets the diagnostic criteria approved by the International Headache Society 3 beta (2013) [three main forms]:

Migraine without aura;
migraine with aura;
chronic migraine;
and
migraine complications;
possible migraine;
episodic syndromes associated with migraine.

Aura is a complex of neurological (focal) symptoms that occur immediately before or at the very beginning of a migraine headache. Depending on the vascular basin involved in pathological process, highlight:

■ typical aura (“classic”, migraine [when dyscirculation occurs in the posterior cerebral artery basin]) manifests itself in the form of homonymous visual disturbances: sparks, lightning-like flashes, scotomas, hemianopsia;

■ retinal migraine is an attack in which flickering, blindness in one eye or mononuclear scotoma occurs due to discirculation in the system of branches of the central retinal artery;

■ ophthalmoplegic migraine is characterized by migraine attacks, which are combined with transient oculomotor disorders (unilateral ptosis, diplopia, mydriasis on the side of pain, etc.); the disorders are thought to be due to compression of the oculomotor nerve by the dilated and swollen carotid artery and cavernous sinus or spasm and subsequent swelling of the artery supplying blood oculomotor nerve, which leads to its ischemia; this form of migraine deserves special attention, since it requires the exclusion of vascular anomalies (arterial, arteriovenous aneurysms);

■ hemiplegic migraine is characterized by the development of arm paresis or hemiparesis, combined with hemihypesthesia or paresthesia, and these manifestations can occur in isolation (hemiparesthetic form); movement disorders rarely reach the degree of paralysis and manifest themselves in the form of difficulty moving, mild weakness, clumsiness in the hand;

■ typical aura without headache - a typical aura, with sensitive or visual manifestations, with a gradual development of symptoms and a duration of no more than an hour, complete reversibility of symptoms and the absence of headache;

■ brainstem aura (formerly basilar-type migraine) is manifested by transient symptoms of discirculation in the basilar artery basin: a flash of bright light followed by bilateral visual impairment up to blindness, tinnitus, dizziness, ataxia, and sometimes even dysarthria; short-term paresthesias are possible in the arms, less often in the legs, accompanied by the appearance of a sharp attack of throbbing headache with a predominant localization in the occipital region, vomiting and short-term (30% of cases) loss of consciousness, which is due to the spread of the ischemic process to the area reticular formation brain stem.

The diagnostic criteria for migraine (headache), regardless of whether it is with or without aura, do not differ:

[1 ] (A. ... headache attacks that meet criteria B-D).
[2 ] B. Duration of attacks is 4 - 72 hours (without treatment or with ineffective treatment).
[3 ] C. Headache has at least two of the following characteristics: 1. unilateral location, 2. throbbing nature, 3. moderate to severe pain intensity, 4. headache worsening from normal physical activity or requires cessation of usual physical activity (eg, walking, climbing stairs).
[4 ] D. The headache is accompanied by at least one of the following symptoms: 1. nausea and/or vomiting, 2. photophobia or phonophobia.
[5 ] E. Not associated with other reasons (violations).

The “aura” of migraine with aura must also meet the diagnostic criteria:

[1 ] at least one aura symptom develops gradually over at least 5 minutes and/or various symptoms auras occur sequentially for at least 5 minutes;
[2 ] each symptom lasts at least 5 minutes but not more than 60 minutes.

The following fundamental differences in the diagnostic criteria for migraine without aura and migraine with aura should be noted: for migraine without aura, at least 5 attacks are required that meet the diagnostic criteria, and for migraine with aura - 2 attacks.

Thus, diagnostic signs migraine cephalgia are:

[1 ] as a rule (but not necessarily), hemicranial localization of headache;
[2 ] the pulsating nature of this pain;
[3 ] pronounced intensity of pain, aggravated by physical work, walking;
[4 ] the presence of all or one or two accompanying symptoms (nausea, vomiting, sensitivity to light and sound);
[5 ] attack duration from 4 to 72 hours;
[6 ] at least five (or two for migraine with aura) attacks in history that meet the above criteria.

For migraine with aura, the main criteria for aura to be considered migraine are:

[1 ] no aura symptom should last less than 5 or more than 60 minutes;
[2 ] complete reversibility of one or more aura symptoms indicating focal cerebral dysfunction;
[3 ] the duration of the “light” interval between the aura and the onset of the headache should not exceed 60 minutes.

note that if migraine attacks (both with and without aura) meet all the necessary diagnostic criteria except one, then the diagnosis “Possible migraine (with/without aura)” is made. At the same time, possible migraine should not be associated with other causes (disorders).

In a simplified schematic form, the diagnostic algorithm for diagnosing migraine is represented by the following “question-answer” sequence:

1 -th question: “Is this a sudden severe headache that has not occurred for the first time?” – answer: “Yes”;
2 1st question: “Is your headache associated with high fever, high blood pressure, head injury, or taking medications?” – answer: “Yes”;
3 -question: “Does the headache interfere with daily activities, work, or school for at least 1 day?” - answer: “Yes”;
4 th question: “Is the headache accompanied by nausea and/or vomiting, intolerance to light and/or sound?” - answer: “Yes”;
5 1st question: “Does the headache spread to one side of the head and is predominantly pulsating (in rhythm with the heartbeat)?” - answer: “Yes”;

Conclusion: “You have a migraine.”
The diagnosis of migraine can be helped by the possible presence in the patient of the following precursors of headache (developing gradually, vaguely expressed, and therefore not always noticed by the patient and identified only with a targeted interview): general weakness or feeling unwell; heightened or decreased perception; decreased mood or increased irritability; cravings for specific foods (sweet or sour foods); increased sensitivity to light and/or sound stimuli; excessive yawning; increased activity or decreased performance; difficulty speaking; tension in the neck muscles.

At any stage of the diagnostic process, monitoring a patient with migraine and his treatment, it is necessary to remember the “danger signals” for migraine:

NOTE :

Diversity clinical manifestations migraine can lead to objective difficulties, to a complex differential diagnostic search, or to erroneous diagnosis in patients with other pathologies. Three types of clinical situations can be distinguished:

[1 ] “masks” of migraine, or symptomatic migraine, when another disease occurs similar to migraine (for example, cerebral aneurysm before rupture, dissection of the vertebral or internal carotid artery, reversible cerebral vasoconstriction syndrome - RCV, antiphospholipid syndrome);

[2 ] borderline conditions, when migraine (symptomatic) and accompanying illnesses have similar developmental mechanisms (for example, CADASIL and MELAS syndromes);

[3 ] migraine as a “chameleon”, when true migraine is clinically difficult to distinguish from other pathologies; there is a need for a differential diagnostic search (migraine with aura - transient ischemic attack, migraine with visual aura - forms of occipital epilepsy, migraine with impaired consciousness - transient global amnesia, vestibular migraine - peripheral vestibulopathies).

more details in the article “Masks” of migraine: issues of differential diagnosis of acute headache” by A.V. Sergeev, Federal State Autonomous Educational Institution of Higher Education "First Moscow State medical University them. THEM. Sechenov" of the Ministry of Health of the Russian Federation (Journal of Neurology and Psychiatry, No. 1, 2018) [read]

In some patients, a typical migraine headache may last a total of 15 or more days per month (with 8 attacks having characteristics of migraine and being relieved by taking triptans or medications containing ergotamine) for more than 3 months. In this case, a diagnosis of “Chronic migraine” is made, but under the obligatory condition that there is no drug abuse (medicine abuse).

You should remember about such dangerous complications of migraine as status migraine and migraine infarction.

Migrainous status- this is a series of severe, successive attacks, which are accompanied by repeated vomiting, with light intervals of no more than 4 hours, or one severe and prolonged attack, lasting more than 72 hours, despite the therapy. Status migraine is a serious condition that usually requires hospital treatment.

Migraine infarction is a combination of one or more symptoms of migraine aura (lasting more than 60 minutes) with ischemic brain damage, confirmed by adequate neuroimaging methods. Moreover, these ischemic brain injuries are not associated with other causes (for example, cardiogenic embolism).

Criteria for diagnosing migraine according to (new changes to) the International Classification of Headache Disorders (ICHD), version 3 beta, 2013

Classification of migraine (ICHD-3, 2013):

1.1. Migraine without aura.
1.2. Migraine with aura.
1.3. Periodic syndromes childhood– precursors of migraine (abdominal migraine, benign paroxysmal vertigo of childhood, cyclic vomiting).
1.4. Retinal migraine.

1.5. Complications of migraine.
1.5.1. Chronic migraine.
1.5.2 Migrainous status.
1.5.3 Persistent aura without infarction.
1.5.4 Migraine infarction.
1.5.5 Migraine is a trigger for an epileptic seizure.

1.6. Possible migraine.

1.1. Migraine without aura

The diagnostic criteria for “migraine without aura” have not undergone significant changes. It is necessary to note that the unilateral nature of the headache is not a strictly necessary condition. A number of doctors are of the opinion that migraine is only hemicrania, and bilateral headache is impossible with this disease. But the criteria indicate the presence of two of the four characteristics of headache (item C). Thus, the headache can be bilateral if other criteria are met, for example, pronounced intensity and worsening with physical activity, pulsating nature of the pain.

Description: recurring headaches, manifested by attacks (attacks) of cephalalgia lasting 4 to 72 hours. Typical manifestations are unilateral localization of pain, pulsating in nature, moderate to severe intensity, worsening of headaches from ordinary physical activity and the presence of accompanying symptoms such as nausea and/or vomiting, photophobia and phonophobia.

Diagnostic criteria:

A. At least 5 attacks meeting criteria B-D
B. Duration of attacks is 4 - 72 hours (without treatment or with ineffective treatment).
C. The headache has at least two of the following characteristics:
1. one-sided localization;
2. pulsating character;
3. pain intensity is moderate to severe;
4. headache worsens with normal physical activity or requires cessation of normal physical activity (eg, walking, climbing stairs).
D. Headache is accompanied by at least one of the following symptoms:
1. nausea and/or vomiting;
2. photophobia and phonophobia;
E. Headache does not correspond to a greater extent to another diagnosis from ICHD-3 beta.

1.2. Migraine with aura

Previously used terms: classical migraine, associated migraine, ophthalmic, hemiparesthetic or aphasic migraine, complicated migraine.

Description: A disorder characterized by recurrent episodes of reversible local neurological symptoms (aura), usually increasing over 5 to 20 minutes and lasting no more than 60 minutes. A headache with the characteristics of a migraine without aura usually follows the symptoms of aura. In rare cases, the headache may be absent altogether or may not have migraine features.

Types of migraine with aura:

1. Migraine with typical aura (1.1. Typical aura with headache 1.2. Typical aura without headache);
2. Migraine with brainstem aura (formerly basilar type migraine);
3. Hemiplegic migraine (3.1. Familial hemiplegic migraine types 1, 2, 3 and migraine with mutations in other loci); 3.2. Sporadic hemiplegic migraine);
4. Retinal migraine.

Diagnostic criteria:

A. At least 2 attacks meeting criteria B and C.
B. One or more of the following fully reversible aura symptoms:
1.visual; 2. sensory; 3. speech and/or language-related; 4. motor; 5.stem; 6. retinal.
C. Two or more of the following 4 characteristics:
1. One or more aura symptoms gradually increase over a period of ≥5 minutes and/or two or more symptoms occur sequentially;
2. Each individual aura symptom lasts 5 - 60 minutes;
3. One or more aura symptoms are unilateral;
4. the aura is accompanied by a headache or the headache occurs within<60 минут после ауры.

1.3. Chronic migraine

The biggest changes affected section 1.3. Chronic migraine. Over the past years, there has been controversy over this issue. Various diagnostic criteria have been proposed. The result of the research carried out in this direction was the changes in the classification - the term “chronic migraine” moved from the category of complications to a separate group of migraine varieties, which emphasizes the significance of this disease. It is also important that the criteria for chronic migraine previously included only “migraine without aura” (attacks at least 15 days a month). Now, frequent attacks of “migraine with aura” can also be classified as chronic migraine. With chronic migraine, the characteristics of the headache change, which is reflected in the new version of the classification. Now, among the 15 or more headache attacks per month required for a diagnosis of chronic migraine, 8 attacks must have characteristics of migraine and can be relieved by taking triptans or drugs containing ergotamine. Other attacks may be of the nature of tension headaches. These changes will help clinicians more accurately diagnose chronic migraine.

Description: Migraine headache that occurs 15 or more days per month for more than 3 months in the absence of drug abuse ().

Diagnostic criteria:

A. Headache (migraine type and/or tension-type headache) occurring with a frequency of ≥15 days per month for >3 months and meeting criteria B and C.
B. The patient has already had ≥5 headache attacks that meet criteria B-D for 1.1 Migraine without aura and/or criteria B and C for 1.2 Migraine with aura
C. Headache ≥8 days per month for >3 months meets any of the following criteria:
1. criteria C and D for 1.1 Migraine without aura;
2. criterion B and C for 1.2 Migraine with aura;
3. headache at the beginning of the attack is regarded by the patient as migraine and is relieved by taking triptans or ergot derivatives.
D. Headache does not correspond to a greater extent to another diagnosis from ICHD-3 beta.

For patients meeting criteria for 1.3 Chronic migraine and 8.2 Medication overuse headaches, both diagnoses should be made. Once excess analgesic use is stopped, migraine will be classified as episodic or chronic based on the frequency of attacks. In the latter case, the diagnosis 8.2 Headaches associated with excessive use of medications for pain relief can be removed.

additional literature:

article “Criteria for diagnosing the main types of primary headaches according to new changes in the International Classification of Headache Disorders (ICHD), version 3 beta, 2013” ​​Lebedeva E.R., Osipova V.V., Tabeeva G.R., Olesen Es; Ural State Medical University, Russian Society for the Study of Headache, University of Copenhagen, International Headache Society (Ural medical journal, No. 03 (117), 2014) [read];

article “New classification and standards for the treatment of migraine” by M.I. Koreshkina, Headache Treatment Center of the Scandinavia Clinic, AVA-PETER LLC, St. Petersburg (Journal of Neurology and Psychiatry, No. 4, 2014) [read];

article “Migraine: new international criteria for diagnosis and principles of treatment based on evidence-based medicine and our own clinical experience” by O.G. Morozova, Kharkov medical Academy postgraduate education, Kharkov, Ukraine (International Neurological Journal, No. 3 (81), 2016) [read];

article “Genetic aspects of migraine” by S.V. Kopishinskaya, A.V. Gustov; State Budgetary Educational Institution of Higher Professional Education "Nizhny Novgorod State Medical Academy", Nizhny Novgorod (Journal of Neurology and Psychiatry, No. 7, 2015) [read];

article “Pediatric aspects of migraine in modern international classification headaches III beta (2013)” Yu.E. Nesterovsky, N.N. Zavadenko; Federal State Budgetary Educational Institution of Higher Education "Russian National Research Medical University named after. N.I. Pirogov" of the Ministry of Health of Russia, Moscow (RMJ, No. 13, 2017) [read];

Brief recommendations Russian experts on the diagnosis and treatment of migraine (RMZh, No. 9, 2017) [read] (or full version recommendations [read]);

article “Classification, diagnosis and treatment of chronic migraine: review of new data” by A.R. Artemenko, A.L. Kurenkov, K.V. Belomestova; First Moscow State Medical University named after. THEM. Sechenov; Scientific Center for Children's Health of the Russian Academy of Medical Sciences, Moscow (Journal of Neurology and Psychiatry, No. 11, 2013) [read];

presentation “Migraine: from correct diagnosis to effective therapy” Sergeev A.V., First Moscow State Medical University. THEM. Sechenov, Russian Society for the Study of Headache, University Headache Clinic

source: article “Acute symptomatic attacks: current state problems" B.P. Gladov, P.N. Vlasov, Department of Nervous Diseases, State Budgetary Educational Institution of Higher Professional Education, Moscow State Medical University named after. A.I. Evdokimov (materials scientific-practical conference“Current problems of practical neurology and evidence-based medicine” Kursk, 2013, pp. 79 - 91) [read]

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Migraine is expressed as a throbbing and pressing headache, which is unilateral and recurs at least 2-4 times a month. Similar condition usually accompanied by malfunctions gastrointestinal tract and vegetative nervous system.

Unpleasant sensations are usually localized in the temples and frontal lobe. A feeling of squeezing occurs in the eye area. Often the pain appears in the back of the head, then spreads to the forehead. Discomfort may increase during physical activity. Added to this pathological condition is increased sensitivity to bright light and loud sounds. Nausea is a frequent accompaniment of migraine.

The main symptoms of this neurological disease include the following:

  • severe unilateral headache;
  • nausea and vomiting, hypersensitivity to bright lights and loud sounds;
  • sensation of pulsation at the painful point;
  • increased discomfort with minor physical activity;
  • pain that does not go away even after taking an analgesic.

Attacks occur suddenly, but their frequency can be influenced by stress, disruption of the daily routine, and changes in diet. Excessive consumption of alcoholic beverages and certain foods (cheeses, chocolate and citrus fruits) can also trigger severe headaches.

Comorbid disorders in migraine

In addition to a neurological illness, other diseases are often diagnosed, since it is generally accepted that they have a comorbid relationship with each other. Such pathogenetic complications significantly worsen the patient’s quality of life.

It is worth noting that the choice of treatment method for comorbid disorders is one of the important measures to prevent migraine.

Such pathologies include the following:


Clinical types of the disease

One significant feature that separates the two types of migraine is aura- a complex of neurological symptoms that manifest themselves at the beginning of an attack or before its onset. Thus, a distinction is made between migraine with aura (up to 15% of all cases) and without it.

The formation of such neurological symptoms occurs in approximately 5-15 minutes, but they last no more than an hour. When pain occurs, the aura disappears. Patients experiencing migraine without aura almost never experience it. While in those suffering from a disease with a previous set of neurological symptoms, the types of illness may alternate. There have also been cases where the aura was not followed by a headache attack, but such episodes are extremely rare.

Visual impairment accompanies the most common form of aura – visual. Signs of the disorder include loss of the visual field, flickering, photopsia, and distortion in the perception of the size of surrounding objects. There are other forms of impairment, such as weakness of the limbs, deterioration of the sense of touch, and problems with speech.

If the disease begins with rare episodes of malaise, then in approximately 15% of cases the frequency and intensity of painful sensations increases over time.

Migraines can bother you every day, and the nature of the illness changes. In particular, some of the usual symptoms may disappear, and the pain, although reduced, lasts longer. A specialist often diagnoses chronic migraine if, within 60 days, pathology without aura occurs at least 15 times a month.

An important role in changing the nature of the disease is played by the abuse of analgesics or depression progressing against the background of frequent headaches.

As for the development of migraine only in women, their hormonal levels have a significant impact on the course of the pathology. In more than 1/3 of women suffering from migraine headaches, menstruation is a provoking factor of the disease. In 2/3 of women expecting a child, discomfort intensifies during the first months of pregnancy, but in the 2nd and 3rd trimesters, migraine attacks occur less and less often. Discomfort may increase when using hormonal contraception (in 80% of cases).

Diagnostics

The basis for identifying migraine is the patient’s complaints, as well as medical history. Wherein additional research are not carried out, since they are not very informative and can clarify the picture only if the course is unusual for the disease.

Examination of the patient rarely reveals neurological symptoms. A common point that unites almost all people suffering from migraine attacks is myofascial syndrome. During examination it is indicated painful sensations or increased tension in the pericranial muscles (one or more).

Another characteristic attribute is the presence of signs vegetative-vascular dystonia, including increased sweating of the palms and unusual color of the fingers. In addition, this pathology may be indicated by convulsive syndrome, resulting from increased neuro-reflex excitability.

Diagnostic criteria for types of migraine

To qualify as a neurological disorder without aura, at least five migraine attacks must meet the following criteria:

  1. Without medication, a severe headache lasts from 4 to 72 hours.
  2. Painful sensations:
    • localized in one part of the head;
    • have medium or high intensity;
    • worsen with minor physical exertion;
    • accompanied by pulsation.
  3. The pathological condition is accompanied by nausea and vomiting, as well as sound and photophobia.


To diagnose migraine with aura, it is important that at least two attacks meet the following criteria:

  1. During the aura, certain reversible signs are observed:
    • disturbances of visual perception (both positive, for example, flickering, and negative, when vision is completely impaired);
    • disorders of touch (from tingling sensations to numbness);
    • speech problems.
  2. At least two of the following symptoms occur:
    • duration – from 5 to 60 minutes;
    • one of the complex of neurological signs progresses for at least 5 minutes;
    • several manifestations of the aura appear one after another within 5 minutes;
    • unilateral disturbances of vision and touch.
  3. Painful sensations fit the criteria defining migraine without aura, and the disease occurs during the period of neurological symptoms or an hour after their onset.

Differential diagnosis

Migraine should be distinguished from tension headache, which is not so intense. During its course, no pulsating sensation can be traced (rather, the patient’s head seems to be compressed by a hoop), and the localization is not one-sided. With TTH, a person is rarely bothered by the symptoms accompanying migraine, such as photophobia and nausea.

In general, TTH develops against the background of deterioration of the patient’s condition due to prolonged stay in a position that is uncomfortable for the head and neck or chronic stress.

MRI and CT

To exclude possible nervous disorders, aneurysm or oncology, the attending physician has the right to prescribe a brain examination using computed tomography (CT) or magnetic resonance imaging (MRI).

This diagnostic method helped establish that migraine is caused by abnormalities, the effect of which is distributed throughout the head, although several decades ago opinions were expressed that migraine could not spread beyond the part where the pain was localized.

Let's sort it out clinical pictures obtained from computed tomography and magnetic resonance imaging:

  1. CT helps to identify factors in the development of neurological abnormalities, if they provoke the appearance of migraine pain. Otherwise, the attacks are most likely caused by increased intracranial pressure arising from a tumor or aneurysm.
  2. MRI helps to identify sources of ischemic genesis, which indicate the presence of pathology. If you conduct an examination during an attack of pain, you can track a decrease in blood flow as it weakens and a sharp expansion or narrowing of the blood vessels in the brain before the onset of the attack. These observations are substantiated by the causes of migraine.

What to do: MRI or CT

The final decision on the advisability of an MRI or CT scan is made by a neurologist after studying the medical history and obtaining a general picture of the patient’s health condition. In addition, the specialist must determine the parameters of the procedure, namely the diagnostic mode, the use of contrast enhancement, etc.

Magnetic resonance imaging helps to recognize migraine if it is found that the structure cerebral vessels has violations. As a rule, MRI of the central organ of the nervous system is performed in the following cases:

  • recovery period after surgery;
  • cerebrovascular accident;
  • severe migraine headaches that occur in one of the hemispheres of the central organ of the nervous system, which is a hallmark of the disorder;
  • risk of developing ischemic stroke.

If MRI does not detect abnormalities in the brain, it is recommended to use computed tomography. Severe attacks pain may be caused by the presence of a tumor. This research method allows us to identify such pathology.

It is worth repeating that the final type diagnostic procedure prescribed by a specialist. It is important to understand that both examination methods are not mutually exclusive. Moreover, each of them is able to bring new information into the overall picture, which makes it possible to exclude other options for the development of headache attacks.

The diagnosis of migraine is made primarily based on history, physical examination, and additional methods studies are used to exclude other types of headaches. With migraine, as a rule, no abnormalities are found on neurological examination. A thorough history is important not only because it is necessary for diagnosis, but also because the doctor thus shows his interest in the patient's health. It is necessary to establish a warm relationship from the very beginning. The peculiarity of migraine is that it requires not so much practiced examination skills as the ability to listen and ask questions.

Anamnesis

Patients with headaches are asked not only about the nature of the attacks, but also about all the factors that provoke migraine or affect its treatment. The doctor learns about the patient’s lifestyle, his family, work, diet, and sleep patterns. It is necessary to assess not only the somatic but also the mental status of the patient. In addition, it is important to collect information about the medicines, including about oral contraceptives among women. They also ask about bad habits- smoking and drinking alcohol. Since genetic factors appear to play a significant role in the pathogenesis of migraine, a family history should also be obtained.

It is important for the doctor to find out not only about migraine, but also about the patient’s health status in general, in order to understand whether the headache is a manifestation of another disease. In addition, concomitant diseases may be contraindications to the use of certain drugs (for example, acetyl salicylic acid at peptic ulcer stomach). In this regard, it is necessary to methodically ask about the functioning of all systems.

However, it is definitely necessary to first learn about headaches in detail. Below are the main questions to consider.

  • Frequency and periodicity of attacks.
  • The age at which they began.
  • Circumstances of the first attack.
  • The time of day at which headaches are most common (usually morning).
  • Factors that provoke migraine.
  • Symptoms preceding headache.
  • Localization of pain and its distribution.
  • Nature of pain.
  • Pain intensity.
  • Duration of attacks.
  • Factors that aggravate headaches.
  • Measures to relieve headaches.
  • Neurological symptoms that occur during attacks.
  • Symptoms of dysfunction digestive system(nausea, vomiting, etc.).
  • The patient's condition after the attack.

Physical examination

When examining a patient during a migraine attack, it is necessary to exclude acute intracranial pathologies - meningitis, encephalitis, subarachnoid hemorrhage, etc. This requires a thorough neurological examination. Unfortunately, it is difficult to carry out completely: for example, due to photophobia, testing the pupil's reaction to light causes significant discomfort in the patient. As a rule, changes in the functioning of the autonomic nervous system are noted. The pupils are usually unchanged. Tachycardia occurs more often and arterial hypertension, although bradycardia with hypotension is also possible. With complicated migraine, there is hemiparesis, unilateral sensory impairment, hemianopsia, unilateral visual impairment, and ophthalmoplegia.

It is also necessary to examine and palpate the scalp, ears, areas mastoid processes, nose and projections paranasal sinuses, eyes (including determining intraocular pressure), projection of blood vessels.

During a migraine attack, the patient appears to be in pain and sometimes groans in pain. Possible forced lying or sitting position. The face is usually pale or even ashen, the skin is covered with sticky sweat. The extremities are usually cold. Sometimes local swelling appears around the superficial vessels of the head. Possible slight fever and minimally expressed neck stiffness. Some patients experience cognitive impairment, including difficulty speaking.

During the interictal period, a neurological examination does not play a big role: the diagnosis is established mainly on the basis of anamnesis. Anisocoria is more common in patients with migraine than in the general population. Pain and tension in the head and neck area may persist between attacks, especially with frequent attacks. There may be tension in the carotid artery (on the same side as the headache).

If during a neurological examination the doctor detects significant abnormalities, additional examination methods are necessary to exclude other causes of headache.

Migraine, also known as hemicrania, is a widespread chronic neurological disease with a predominantly hereditary origin. Migraine is recognized as an independent form of cephalgic syndrome and is described in the International Classification of Diseases, 10th revision (ICD-10) under code G43.

A characteristic symptom of migraine is episodic or regularly recurring attacks of intense headaches. A distinctive symptom of hemicrania is the unilateral localization of pain, but isolated cases have been described in which a migraine attack developed on both halves of the head. Most often, pain is limited to the temporo-frontal-orbital area of ​​the head.

In migraines, paroxysmal (occurring in the form of seizures) dysfunction of the brain is caused by dysfunction of vasomotor regulation. Migraine pain is not associated with traumatic brain injury and is not caused by acute disorders blood circulation - strokes. Pain syndrome with hemicrania is not a consequence of benign or malignant neoplasms in the brain. Despite the fact that headache in migraine is of vascular origin, it is not associated with sharp increase blood pressure and is not a consequence of crises during hypertension. Pain in this pathology cannot be explained by benign intracranial hypertension (increased pressure inside the skull). Also, migraine pain is not associated with attacks of glaucoma (increased eye pressure).

According to clinicians, the number of people suffering from hemicrania exceeds the level of 15% of the general human population. To date, the diagnosis of migraine has been determined by examining 10% of patients who contacted medical institutions with complaints of severe paroxysmal headaches. The remaining 5% are people who were not properly examined or were misdiagnosed. According to clinical research this neurological pathology in most cases (over 70%) is determined in females and is hereditarily transmitted from mother to daughter.

In most patients, the first episodes of the disease occur during puberty. Most often, migraine in women and men is recorded in the age range from 18 to 30 years. As medical practice shows, on average, the frequency of attacks of cephalalgia ranges from once every two weeks to twice a week. However, separate category In patients, migraine attacks occur extremely rarely - several times a year, and in some patients, crises occur almost daily.

Although migraine does not pose a direct threat to a person’s life and cannot cause premature fatal outcome, this disease has insidious features. Excessive intensity of cephalalgia, too frequent migraine attacks deprive the individual of the opportunity to fully function in society and prevent timely and complete implementation professional activity. The inability of a subject with migraine status to work on a set schedule often requires the establishment of II or Group III disability.

Causes and risk factors

The conducted studies have established that the leading place in the etiology of migraine cephalalgia is occupied by genetic predisposition to vascular pathologies according to an autosomal dominant type of inheritance. However, on this moment Clinical studies cannot accurately explain the pathophysiological causes of migraine. There are several versions about the causes of hemicrania, including:

  • insufficient blood supply to the brain due to decreased lumen small arteries– arterioles;
  • neurovascular disorders – simultaneous damage to the nervous and vascular systems;
  • reduced reactivity blood vessels brain (deterioration in the ability to respond to changes in the external environment);
  • activation of the process of lipid peroxidation;
  • systemic failure in metabolic regulation caused by inhibition of serotonergic transmission;
  • change in cellular energy metabolism.

In most cases, in a particular patient it is possible to identify certain provoking factors that contribute to the development of a pain attack. The triggers for a migraine attack are:

  • psychogenic causes(stressful conditions, conflicts, mental overstrain) ;
  • changes in meteorological conditions;
  • premenstrual period and “critical days” in women;
  • failure in sleep-wake mode(lack of sleep or too much sleep) ;
  • taking contraceptives;
  • presence in the diet of nuts, cheeses, cocoa-based products, smoked products, citrus fruits;
  • consumption of weak alcoholic drinks (sparkling wines, champagne, beer );
  • presence of concomitant ailments(triad: chronically low blood pressure, impaired motility of the bile ducts, the presence of migraine attacks).

Types of migraine

Today at clinical medicine The ICHD-2 systematization, compiled in 2004 by The International Association for the Study of Pain, is used. The main types of the disease are the following forms of migraine:

  • without aura (simple);
  • complications (chronic type, status migraine, migraine infarction, etc.).

Most people suffering from this neurological pathology, experience attacks of simple migraine. Individuals predisposed to migraine crises with preceding aura may occasionally experience cases of simple migraine.

Clinical symptoms and features of migraine without aura

Main symptom of a migraine attack: very severe pain syndrome with a pulsating nature of pain. In 60% of patients, the pain attack occurs on one half of the head, but bilateral localization of pain is also possible. GB usually covers the area: forehead - temple - orbit with possible irradiation to the neck area.

Painful sensations may be aggravated by standard mental activity, with monotonous physical activity, with moderate movements. A pain attack reaches its peak intensity when exposed to any external irritants: bright light, loud sounds and noises, strong odors.

The standard duration of an attack of migraine cephalalgia is from 8 to 12 hours. Prolonged crises lasting up to 72 hours suggest status migraine, a complication of the disease.

The criterion for diagnosing this neurological disease the presence of at least one of the following symptoms:

  • photophobia (photophobia) – excessive sensitivity to light sources;
  • sound phobia (hyperacusis) – increased response to noises and sounds;
  • hyperosmia – abnormal sensitivity to odors;
  • nausea and/or vomiting (or nausea without vomiting) at the height of cephalgia;
  • coldness and tremors of the extremities;
  • lethargy, drowsiness;
  • the emergence of irrational fears;
  • depressive state (depressed mood, apathy);
  • desire to retire to a dark place;
  • causeless nervousness, excessive irritability.

Basic principles of migraine treatment

The treatment regimen for migraine cephalgia involves the following measures:

  • relief of a migraine attack with pharmacological drugs;
  • prophylactic use of migraine medication;
  • psychotherapeutic influence, hypnosis, autogenic training;
  • acupuncture;
  • exclusion or minimization of risk factors.

Drug treatment

How to relieve a migraine? Drug therapy may include the following migraine medications:

  • anilides in combinations, for example: Solpadeine;
  • salicylic acid derivatives, for example: acetylsalicylic acid(Acetylsalicylic acid);
  • non-steroidal anti-inflammatory drugs, for example: ketoprofen;
  • psychostimulants, for example: caffetamin;
  • alpha-blockers, for example: Dihydergot;
  • sedatives - anxiolytics, for example: Relanium;
  • serotonin receptor agonists, for example: eletriptan;
  • beta blockers, for example: metoprolol (Metoprolol);
  • antidepressants, for example: amitriptyline (Amitriptyline);
  • calcium channel blockers, for example: verapamil (Verapamil).

It is worth noting that at the current stage of development of medicine it is not possible to completely eliminate the disease, and for more than 30% of patients the prescribed treatment does not bring the desired effect. However, timely and consistent preventive use of migraine tablets can reduce the frequency of attacks and reduce the intensity of cephalgia.

Non-drug treatment and prevention of migraine

How to treat migraine without medications? Doctors recommend that all persons predisposed to the development of attacks of hemicrania follow the following rules.

Tip 1

To alleviate the condition during a migraine attack, you can take a hot bath or direct a stream hot water to the head area.

Tip 2

Bed rest in a well-ventilated room with dim lighting can reduce the intensity of pain during a migraine attack.

Tip 3

Tip 4

It is impossible to eliminate the disease if the traumatic factors are not eliminated. You should pay attention to everyday “irritants”, rethink the essence of problematic situations, and find sources of joy and satisfaction.

Tip 5

Persons prone to migraines should strictly adhere to the work and rest schedule and create conditions for a good night's rest. Doctors advise going to bed and waking up at the same time. If you are prone to migraines, in order to avoid tension in the muscles of the shoulder girdle and neck, it is advisable to sleep on your back, lying on a flat surface.

Tip 6

An important step to overcome migraines is to get rid of tobacco addiction. Research shows that smokers who hold a cigarette in their hands while driving or smoke in unventilated areas are at risk of becoming a victim of hemicrania.

Tip 7

An excellent method for strengthening blood vessels is to take it in the morning. contrast shower. Performing low-intensity physical exercise can improve vascular tone.

Tip 8

To stabilize the psycho-emotional state and achieve harmony in the inner world, it is advisable to master yoga techniques.

Tip 9

Loading within reasonable limits helps improve blood circulation and activates metabolic processes, promotes the removal of toxins and waste. However, during a painful attack, you should avoid playing sports.

Tip 10

Tip 11

Bright glare emanating from the TV screen and computer monitor can worsen the condition of a migraine patient. No less harmful factor is bright daylight. Therefore, measures should be taken to protect the eyes from excessive light.

Tip 12

For migraines, it is extremely important to create the right menu, excluding “dangerous” foods from the diet. You should eat food in small portions at equal intervals. Interruptions in diet often provoke attacks of cephalalgia.

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