Migraines, all about it!

Strictly "Headache" is the medical word to describe discomfort or headache. However, a headache is rarely seen as an isolated symptom.
Some entities classified generically as "Headache" show a wide variety of symptoms other than pain (see below, for example, the characteristics of migraine).
"Headache" and "migraine" are synonymous?
No. The migraine headache is one of the most frequent, meaningful and well characterized. But there are many others.

How many types of headaches are there?

The International Classification of Headache includes 14 major types. These main types are divided and subdivided into more than 200 different ways.
For example: migraine, one of the major types, divided into about 20 different ways.
There will be a simple division?
From a practical point of view, we divide headaches into two broad groups:
- Primary (or idiopathic)
- Secondary (or symptomatic).
What are Primary Headache?
We can say that the primary headache is a disease by itself, not translating or expressing other health problems.

The primary headaches are the majority (90%).
Examples: tension-type headache, migraine, cluster headache.

What are secondary headaches?

The secondary headaches are symptoms of diseases of the nervous system or other organs of the human body.
Headache secondary can translate common situations. Examples: influenza, intoxication or alcohol withdrawal, small head injuries, hypoglycemia (low blood sugar), hypertension crisis.

Headache secondary may be a symptom of severe diseases of the nervous system (meningitis, tumours, bleeding due to rupture of aneurysms) are a minority.

Having such a variety of Headache, how do doctors distinguish them from each other?
The key to diagnosis in medical history: history (interview) and physical examination, including neurological examination. However, it is sometimes necessary to use additional tests.

After all, what is the neurological examination? It is a further examination?
The neurological examination did not take an additional test or technology.
The neurological examination is a set of tests done in the office, with the help of some simple tools (ophthalmoscope, reflex hammer, tuning fork, pin, sources of cold and heat).
The doctor can test, with varying emphases, different functions of the brain, cerebellum, brainstem, spinal roots, plexuses, nerves, muscles and endplate.

The neurological examination has a coherent sequence, but must be adapted on a case by case depending on the clinical history (previous interview). The interpretation of the neurologic examination requires solid knowledge of anatomy and physiology of the nervous system, and must be combined with the patient's life and medical history.

In the case of headache, the observation of the eye, using an ophthalmoscope, is a very important part of the neurological examination.
What is a Migraine?
Migraine is a primary entity and paroxysmal (episodes lush intervals by periods without symptoms). Symptoms often prevent work or study.
The pain is usually:
- Pulsed (as if the heart beat in the head), this pant is worsened by physical exertion or movements of the head.
- Hemicranial (only one side), but may be located anywhere in the head.
- Accompanied by nausea, vomiting, intolerance to light (photophobia), noise (phonophobia) and some odors, people usually seek a dark, quiet place where to rest or sleep.
An episode can last from a few hours to three days.

Between crises, usually no complaints.
The frequency is very variable; there are people who have 2 attacks per week, others will have only a few lifelong.
Some types of migraines are more complex symptoms (migraine with aura).

All Migraines have all these features?

No. The features described above are the most significant. It is mandatory that they are all simultaneously present. The diagnosis is made by all and not for any particular feature (even if very classic).

For example:
- Unilateralism alternate (sometimes left, sometimes right) is very typical, but there are those in which the headache is always on the same side, there are even cases of bilateral location;
- Vomiting are typical, but are absent in half of the crises.

What is a Migraine with Aura?

It is a migraine that includes transient neurological symptoms, whose origin is attributable to certain areas of the brain. The other symptoms are similar to those of migraine without aura
The most common auras are lush and transient disturbances of vision, manifested by loss of vision from one side of the visual field (not the one eye), blurred images, perception of points of light, geometric figures or Zig bright-zags.
Other auras may result in tingling or numbness on one side of the face or a hand. There are people who have difficulty speaking or even temporary paralysis of the limbs, usually only one side of the body.
These changes last for about 10 to 30 minutes prior to the pain.
It is an unusual type of migraine, only about 15% of all people with migraine have aura.

What is the prevalence of migraine?

It is accepted that 8 to 15% of citizens of Western countries suffer from migraine. Migraine is more frequent than asthma or diabetes, for example. The fact that reaching people in more productive ages of life, entails enormous economic cost, social and family.

A migraine is a woman's disease?

Not really. In fact there are some features of migraine associated with very female reproductive cycle: increased prevalence after the first period; predilection for frequent temporal menstrual period, worsening the occasional pill or hormone therapy, attenuation or disappearance during pregnancy or menopause.
Boys and girls are affected equally. From adolescence, migraine is more common in females. Overall, migraine is 2 to 3 times more prevalent in females. In migraine without aura have 5 women to 1 man. In migraine with aura have 3 women to 2 men.
What is the age of onset of migraine?
Usually between 15 and 40 years, but may appear in infancy or soon after menarche (first menstruation). If you see the first time after 45 years we should exclude other causes.

Therefore, children may also have Migraine?

Yes, the pain tends to be bilateral, less intense and of shorter duration. The photophobia or phonophobia may be inferred from the behavior of small children, unable to describe the symptoms. Vomiting and dark circles can be exuberant. The disruption of sleep times and meals are common precipitating factors.
The treatment of migraine attacks in children is easier than in adults, sleep usually gives good results.

In children the location  headache in the occipital is not normal, the child needs to be observed by a specialist. Very young children, with headaches, with morning vomiting or other unusual symptoms must be checked by a doctor!

There are daily Migraines?
No. migraine applicant appears so many times throughout life, but always with completely free intervals.
If one becomes a migraine headache every day, there is probably a long-term use of painkillers or other drugs. Drug abuse can become a headache in chronic daily headache, is a situation that requires the support of a specialist.
Many people who complain of daily headaches actually have a headache or tension headache then combined (migraine and tension headache).

There are end-of-week Migraines ?
There are people in that migraine occurs preferentially at the weekend. These crises may be precipitated by deprivation, excessive or abnormal sleep schedule, the failure of breakfast or coffee in the morning usually. Decompression of the end-of-week (rapid closure stress socio-professional), the abuse of alcohol or drugs may also play a role. It is advised that these people consider the radical changes in lifestyle during the weekend.

What causes migraine? Why only some people have it?
Migraine is caused by mechanisms very complex and very well studied.
We can say that is due to a combination of processes in the brain: excitation / depression of cells, dilation of the arteries and release of chemicals. People with migraine are more sensitive to certain stimuli (environmental or your own body) that can trigger these complicated brain processes.
It is thought that there will be some genetic susceptibility to migraine is inherited the same types of migraine with aura.

What can trigger a migraine?
Some people can identify precipitating factors for their attacks. The most common are: cheese, chocolate, strawberries, seafood, wines, sauces, artificial, changes in sleep, stress, menstruation, fasting, exercise or even a minor trauma (play the ball head).
Other people can not identify any precipitant.
The triggers are not the cause, only cause seizures in susceptible persons.

Coffee causes Migraine?
People who drink coffee regularly may have headaches if they break the habit. Many people get better with coffee during migraine attacks, but some may worsen.
The contraceptive pill causes Migraine? In this case, the pill should be suspended?
Some women notice a worsening of migraine with the pill. In this case the situation should be presented to the doctor. Some women notice an improvement and others reporting no change.
The pill is not recommended for women smokers with migraine with aura, given the increased risk for vascular diseases.
Vision problems can cause migraine?
No. Unlike some popular beliefs, the migraine has nothing to do with vision problems. Neither hypertension, sinus problems or problems in the cervical spine can cause migraines.
But the liver can?
No, definitely. Nausea (feeling sick) and vomiting of migraine attacks originate brain. They appear in people with liver and gallbladder perfect. The digestive symptoms are a consequence of migraine (and not its cause).
What tests should people with migraine do?
The diagnosis of migraine is made by clinical history (interview and observation). The results of laboratory tests are normal.
In rare cases, and the strangest of migraine, there are doubts, the doctor may use imaging studies (CT or MRI) to exclude other diseases. The EEG is not useful.

A migraine can be cured?
Not curable, but treatable. There are drugs and behaviors that can reduce the frequency, duration or intensity of seizures. Patients should receive a registration calendar of events and crises associated. This will help to define a treatment strategy.
What treatments exist for migraine?
The treatments are of 2 types:
Symptomatic treatment (for acute)
The patient should lie down in a quiet and dark. You can also apply pressure or cold spot of pain. The drugs recommended for migraine are: simple analgesics, anti-inflammatory drugs and triptans (serotonin agonists). Doctors have criteria for choosing the best solution for each patient.

Prophylactic treatment

People with migraine should build calendars crisis to identify precipitating factors and enhance the impact of the crisis in quality of life.
The first step of prevention may be the avoidance of precipitating factors, if possible.
In some people, in some periods of life, to turn to prescription drugs every day to reduce crises (frequency, time or intensity). There are no drugs specifically developed for the prophylaxis of migraine. However, there are drugs designed for other purposes that have demonstrated their effectiveness (some antihypertensives, some antidepressants, some drugs). Doctors have criteria for choosing the product more suited to each patient.
Doctors study and treat people with headaches or migraines?
The headache can be treated by the family doctor. In difficult situations, patients should be referred to specialists. At the outset, neurologists or neuro more easily distinguish the primary and secondary headache, and have more experience in their treatment. Patients with headaches that translate relevant mental health problems should be treated by psychiatrists. Only exceptionally is a need for other medical specialties.

What is a Type Tension Headache?
A tension headache is the most frequent primary headache. It is characterized by a mild to moderate pain, such as a weight, pressure, tightness or chaff. It is often perceived as a heavy helmet or a band oppressive. It can be accompanied by nausea and phonophobia (intolerance to noise). Sometimes there is a contraction of the muscles of the neck and shoulders. It can last hours or days and in some cases is virtually continuous.
It is distinguished from migraine because, in most cases of tension headache:
- Is bilateral,
- The intensity is lighter;
- Is throbbing;
- Not exacerbate the physical effort;
- Not accompanied by vomiting;
- The noise is less tolerated than light.
A tension headache is divided into:
- Episodic infrequent (less than 1 day per month)
- Frequent episodic (1 to 15 days per month)
- Chronic (more than 15 days per month).

What is cluster headache?
Cluster headache (classically known as sinusitis) is a rare type of eye pain and hyperpigmentation. Patients describe it as a painful experience more violent than ever.
Appears only on one side of the forehead, and may be accompanied by tearing, decreased upper eyelid, red eye, small pupil and runny nose (nose drop).
It affects almost exclusively males, appearing for the first time in young adults.
Lasts just over half an hour. Be repeated several times a day for 4 to 8 weeks (save); can disappear for months or years.
Do you have any preference for certain hours of the day (especially the early morning hours), the spring and autumn.
Patients are very restless and agitated during the crisis, contrary to what happens to sufferers of migraine.
One of the most curious of Cluster Headache is the improvement of crisis with the inhalation of oxygen.