What is Migraine ?

Migraine, neurological, gastrointestinal and autonomic changes associated with various forms of primary episodic (part), a headache disorder. Neurological examinations, imaging and laboratory investigations are usually normal, and they benefit more frightening to exclude other causes of clinical disease.
A) Definition of migraine attacks,
Migraine attack, headache occurring hours or days before the prodrome stage, just before the headache phase of the aura, headache phase, recovery phase in the form of headache can be divided into four sections. There is a thread must be contained as necessary for the diagnosis of migraine.
1) The leading Phenomena (Prodrome) Stage:
Phenomena seen in the previous hours or days of headaches in the vanguard. Patients mostly in cases of emotion or sudden psychological behavior, neurology, autonomic, or complain of changes in structural characteristics typical. Some patients may feel the headache in the future, but we do not fully define. These symptoms vary from patient to patient, but rather is consistent with a specific patient. Depression, cognitive dysfunction and symptoms are seen in some foods, such as state of desire. The most common symptoms are the leading display a sense of fatigue-fatigue, difficulty concentrating, neck hardness.
2) Aura Phase:

Migraine aura, prior to an attack of migraine, attack after attack but rarely seen, or a mixture of focal neurological symptoms. These symptoms usually develop within 5 to 20 minutes and usually takes less than 60 minutes. Aura within 60 minutes after the end of the headache is often to convince her husband a few hours in some cases may be delayed or not does not arise.
Most of the time between aura and headache patients themselves do not feel normal. Anxiety, somatic complaints, mood changes, speech and thought disorders, or the feeling of isolation from the environment can be seen. Auralar can occur back to back in an hour and the frequency of more than a few hours until some time may vary. These are called migraine aura status.
Crashed in the field of visual impairment among the blind spots of vision, light flashes of simple, geometric shapes, or include noktalanmalar. They are also able to move throughout the visual field, such as vibrations or fluctuations in vision are possible. The specified visual disturbances are seen with headache. Blind spots in the field of vision, sometimes both at the same time, but a rare condition görülebilse. These distortions and hallucinations may also occur outside the visual shape.
Understanding and using body parts from non-disorders, disorders of vision, speech and language disorders, the complex state of dream or a nightmare, state of trance or delirium may include such situations. The second most common form of aura of numbness starts getting uyuşmalarda, cola, and then spreads through the lips and face will affect the language, rarely will have an effect on the legs. Half of patients with migraine begins with two-sided numbness or later becomes two-sided. Auditory auralar rarely seen alone, after more than a visual aura occurs.
3) Headache Phase:
Typical migraine headache unilateral, throbbing, moderate or severe and exacerbated by physical activity. Do not need all of them together for a diagnosis of migraine. Pain may be from the beginning of bilateral or unilateral spread to the other side after the start. Çıkabilse of pain at any time day or night as the most commonly starts between 12:00 noon to 5:00 morning. Beginning the next 2 to 12 hours to reach the maximum attack turns into violence, it then passes slowly decreased. The average duration of an untreated migraine attack is 24 hours. In adults, 4 to 72 hours in children 1 to 48 hours may vary.
Although large differences in the severity of headache is the average assessment of severity from 0 to 10 from 7 to 8 between. Often seen by patients as throbbing, but this can be seen in other types of headache. Physical activity or simple movements of the head, even exacerbated.
Migraine pain is always with no other features. Although anorexia frequently in some foods (eg chocolate) may request the state. Almost all of the patients (90%) are nausea, whereas their 1 / 3 thirds vomiting occurs. However, in most patients, photophobia (light, do not be afraid), fonofobi (sensitivity to sound), osmofobi (smell discomfort), as distinct sensory sensitization occurs, the patient looks dark and quiet room.
4) Recovery Phase:
The pain gradually decreases and disappears. The patient himself may feel tired, irritable, and indifferent, decreased concentration, scalp tenderness, mood changes can be seen. However, while some patients may feel himself extremely well and renovated, while others, such as the patient may feel depressed.
B) Migraine Syndromes
1) migraine without aura (migraine Simplified):
The brain disorder characterized by diffuse or one-sided throbbing head on, it is a syndrome. The diagnosis for putting each of 4 to 72-hour long, at least two of the four pain characteristics and associated features showing at least one of the required 5 feet. This feature of the four pain; unilateralism, throbbing quality, moderate-heavy activity with an increase in violence and I include routine physical. Attacks of nausea, vomiting, photophobia (photophobia), fonofobi (the noise being disturbed), and / or anorexia can be associated with. Intervals should be reported to the recurrent attacks. All of these symptoms, I still excluded other causes of migraine.
Migraine is the term used for the status of migraine lasts longer than 3 days. Sometimes the patient is in the morning uyandırabilmekte at any time of day or night can begin. The frequency of attacks varies, may be a few times in life can be several times a week. The average migraine headache patients may or twice a month. Search of at least five attacks cause brain tumors, sinusitis, and glaucoma, and many organic disease causing headaches mimicking migraines.
2) migraine with aura (classic migraine):
One or more neurological symptoms completely resolved, the development of aura than 4 minutes long, short duration of aura and the aura after 60 minutes of time until the start of headache can be considered, such as short duration of 60 minutes at least three of the four features are required to have at least two attacks. The majority of patients with migraine with aura migraine without aura attacks may also occur. Often, the colors of the visual half-field in the geometric form, with the emergence of vibrant visual aura of light in the form of arrays. Throbbing headache, usually against the side of the visual symptoms, and patients with nausea, vomiting, photophobia, and anorexia may be fonofobi. Aura’lı such as migraine, visual field disturbances and temporary loss of neurological disorders occur in association hemisensoriyel. And always shows the same characteristics of a typical aura, migrainous headache characteristics not show from the back of a diagnosis of migraine with aura. Migraine aura, cluster headache may also occur with other types of headaches.
3) Different types of migraine:
* Basilar Type Migraine,
* Confusional Migraine,
* Ophthalmoplegic Migraine,
* Hemiplegic migraine,
* Familial hemiplegic migraine,
Subcortical Infarcts and Leukoencephalopathy with cerebral autosomal dominant arteriopathy *,
* White Substance Disorders,
* Lead pain-Aura.
C) Treatment
Effective treatment of migraine, first the right diagnosis, the patient and the patient’s disclosure of any other random event of a disease associated with it begins with the creation of a treatment plan. The most disturbing symptoms have the most appropriate form of intervention is aimed. The advantage of sometimes providing treatment comorbidities sometimes causes limitations in the treatment of migraine. Migraine with what appears the most common stroke, epilepsy, depression, mania, anxiety and panic disorders are psychological, such as.
The symptoms must be taken into consideration because the diagnosis before treatment should be absolutely sure. A specific migraine medication, a patient with migraine imitation would be useless, or even can be dangerous.
Pharmacological treatment of non-therapeutic approach of relaxation, biofeedback, and life riding on a regular basis, getting enough sleep, exercise and smoking (the smoke) substances such as smoke cessation / avoidance initiatives, such as takes place. Important though these are the main treatment consists of drugs. The selected drug, the severity and frequency of headache attacks, associated symptoms, state, and the presence of other diseases is determined by the way people respond to previous medications. Prevent headache is exacerbated and the effectiveness of treatment as early as possible to improve the treatment of headache is necessary.
1) Acute Treatment:
Treatment, according to attack and be formatted according to the person living in an attack. Out by previous treatment history and success / failure when questioned. Acute treatment of headache after it aims to turn back or stop the progression of the headache. There are various forms of acute treatment. The selected drug, the severity and frequency of headache attacks, associated symptoms, state, and the presence of other diseases is determined by the way people respond to previous medications. Excessive use of drugs or the existence of such a danger should be evaluated. Acute treatment failure is usually caused by overuse of headache drugs can be. Side effects may be most useful in considering the form of pain should be treated with drugs.
Treatment should be individualized. Headaches in patients with mild to moderate levels of analgesics, nonsteroidal anti-inflammatory (NSAID) or a compound with caffeine may be beneficial. Analgesic therapy if inadequate replacement therapy is recommended as a triptan. Majority of the patients prefer oral triptans. If necessary, take a quick answer or a way out of the oral barizse nausea and vomiting is preferred.
a) the form of simple and combination analgesics and NSAIDs:
Patients with mild to moderate to severe headaches, simple analgesics are recommended. Many people ligament pain alone or in combination with caffeine, aspirin or acetaminophen (paracetamol) as a simple analjezikle relax. NSAIDs among all the world’s most prescribed drugs when to use them is limited because of gastric side effects. Gastrointestinal discomfort from side effects of NSAIDs, pet ulcer and bleeding, abdominal pain, constipation, diarrhea, nausea, headache, paradoxical as rare, especially bozluk sensation, tendency to sleep, tinnitus and fluid retention can be specified.

b) Hypnotics Barbiturates:
There is no randomized trials about the efficacy of drugs containing butalbital. The use of these drugs can cause problems in a more pronounced or less of the drug use should be limited to situations or are ineffective. Other cases, these drugs are ineffective for migraine drugs can be very effective replacement drugs.
c) Ergotamine and dihydroergotamine (dhe):
From time to time provide for adequate analgesics where or when it comes to serious side effects or cost problem arose, ergotamine is used in the treatment of moderate-severe to severe migraine attacks. Data supporting the effectiveness of the treatment ergotaminin is not very consistent. DHE’nin has fewer side effects than ergotamine. The best evidence we have available for DHE’nin nasal shape. Dhe is useful in most patients, headache recurrence rate is low. However, to cause nausea or headache response rate lower than that of ergotamine.
Pregnant women who want to stay, those uncontrolled hypertension, spsisteki, kidney and liver failure and those with coronary, cerebral, or peripheral vascular disease, or dhe ergotamine should be avoided.
d) triptans:
The treatment of migraine headaches in both safe and effective. The first option is appropriate drugs. Be applied to patients with moderate to severe migraine attack. Analgesics adequately tested and the appropriate response may be possible to begin treatment with triptans alınamamışsa.
e) Opioids:
They do not provide sufficient relief from headache remedies other than Epioid available.

2) Preventive (prophylactic) treatment:
Whether or not you have a headache attack frequency, severity and duration to reduce the preventive (prophylactic) treatment is applied. Prior to the attack as well as be given a short or long term. The presence of a known case of a trigger or when the presence of symptoms of headache can also be given to a pioneer.
Short-term preventive treatment may be given if the patient encounter with a trigger factor. Constitute a risk of headache a few days before the event (eg, certain historical events) need treatment application. Long-term preventive treatment is applied on a daily basis to reduce the incidence of headache and usually is continued for months. Treatment during pregnancy is not expected benefit exceeds the risk of long-term preventive treatment should be avoided.
Preventive and curative treatment effects or side effects to start low-dose is formed, or until the maximum dose of the drug dose increase slowly until we reach the specialist. Testing can take from two to six months of treatment in full. The effects of treatment are usually noticeable after four weeks from the date of starting treatment. Some two weeks after the treatment in patients starting treatment with one equivalent of leaving the state streamed. Preventive treatment to ensure optimum benefit patients using excessive analgesics or ergot-derived drugs, you must have.
Migraine headaches out of treatment, may improve over time. Patients may experience relief after stopping the drug, or a part of the show state of the former dose may be needed.
3) Medications:
* Beta Blockers,
* Antidepressants,
* Calcium Channel Blockers,
* Antiepileptic Drugs,
* Serotinin Antagonists,
* Pizotifen,
* Natural Products,
* Riboflavin.
Treatment Priorities Determination: The goal of treatment, headache and other symptoms related to it or to prevent removal of the patient as possible to return back to normal functions. His selection of a drug efficacy, patient preference and the type of headache, the presence of other diseases associated with drug side effects and can be evaluated together. The best benefit-risk ratio of the drug should be preferred. Drug associations can be made in cases of treatment-resistant headache. Some drugs are used together with attention to be used on some, while others should not be used together because of severe adverse effects. Sometimes applied in cases of acute treatment in the prophylactic treatment to patients, along with other types of headaches can be applied for.

D) Status of Migraine
The headache phase (with or without treatment) 72 hours is long-lasting migraine attacks, migraine status. Severe and persistent headache and nausea that often accompanies and / or vomiting occurs. Migraine may also occur secondary to the status of an acute neurological disorder. Exclusion of organic causes of severe headache before the start of treatment is required.