MIGRAINE

THE MIGRAINE

Migraine is a very common pathology worldwide, including in Portugal. According to the 2018 Health Portrait, in Portugal, migraine represents the second cause of morbidity in women and the fifth in men. It is more frequent in women (usually in adolescence, reaching its peak in the 3rd decade, then decreasing with advancing age). The onset of migraine after the age of 50 is uncommon.

SIGNS AND SYMPTOMS

Migraine is a neurological disease manifest by episodes of severe and disabling headache.


Clinical Manifestations

There are two main subtypes: migraine without aura (most frequent) and migraine with aura.


Migraine without Aura

Headache episodes lasting between 4 and 72 hours

Usually, unilateral headache

Moderate to severe pain

Possibly with a throbbing sensation

Possibly aggravated during routine physical activity

Possibly associated with nausea/vomiting

Possibly associated with photophobia (intolerance to light)

Possibly associated with phonophobia (intolerance to noise)


Migraine with Aura

In this subtype, in addition to headache episodes with the features mentioned above, patients present transient neurological signs/symptoms referred to as aura.


These neurological manifestations typically precede or accompany the headache episode and last less than 60 minutes.

The most frequent aura are visual phenomena, which can be manifest in different ways but in most cases tend to be luminous flashes, dark mosaic-shaped spots or shiny zigzag images. In other cases, the aura could be sensitive - changes in lateral sensitivity or on one side of the body, such as numbness or tingling; and it may affect language or muscle strength.


Unlike episodic migraine, chronic migraine is characterized by more than 15 days per month with headache, and at least 8 of these episodes must have the features mentioned above. Chronic migraine can be associated with secondary headache, associated for example with the abuse of analgesic medication.

DIAGNOSIS AND TREATMENT

  • DIAGNOSIS
    The diagnosis of migraine is clinical, requiring detailed clinical history and neurological examination. There is often a family history.

    NON-PHARMACOLOGICAL TREATMENT
    The therapeutic approach is important to ensure non-pharmacological measures, such as regular exercise, weight control and sleep regulation.

    Identifying potential trigger factors is crucial so that they can be avoided when possible. These factors vary from one patient to the next, and there may be more than one in each case and fluctuate over time.

    Potential migraine trigger factors:
    Excessive stress
  • Sleep deprivation or excessive hours of sleep
  • Fasting
  • Alcohol consumption
  • Climate change
  • Hormonal changes
  • Certain foods: sweeteners, aged cheeses, nitrates, monosodium glutamate, caffeine, among others


PHARMACOLOGICAL TREATMENT
We offer pharmacological treatment for acute migraine episodes and prophylactic treatment that aim to prevent and reduce the intensity and frequency of episodes. There are specific drugs for migraine and the most appropriate type of medication must be adapted to each patient.