Migraine Headache

 

1- temporal arteritis Horton:

* It should be considered in any new onset headache in a subject over 60 years

* It is typically temporal seat, superficial and deep contact with hyperesthesia

* Other symptoms: visual disturbances; fever; AEG; intermittent claudication of the jaw; rheumatica pain; temporal arteries hardened, not swinging and painful

* Inflammatory Disease: VS ++ (80-100 in the first hour) consistently.

* Temporal artery biopsy: giant cell arteritis

* Therapeutic Emergency: because risk of blindness => corticosteroids for 2 years (without waiting for the biopsy results)

Migraine

Migraine

2- Migraine:

A- CRITERIA IHC:

– At least 5 attacks meeting the criteria 2 and 4

– Crises headache for 4 to 72 hours without treatment

– Headache with at least 2 of the following characteristics: unilateral, pulsatile, moderate or severe nature, aggravation by routine physical activities such as downhill and climbing stairs

– The headaches are accompanied by at least one of the following: nausea / vomiting, photophobia and / or phonophobia

* MIGRAINE WITH AURA: the aura is the beginning of the crisis, lasts 15 to 30 minutes; it is followed by an unilateral headaches on the opposite side of the aura; will be different: visual (scintillating scotoma); sensitive (paresthesia cheiro-oral); driving will (hemiparesis) aphasic episode.

* MIGRAINE COMPLICATED: basilar migraine (dizziness, ataxia, bilateral visual disturbances); hemiplegia that persists for several days (dominant family transmission); ophthalmoplegic (third nerve palsy: III)

B- TREATMENT:

1- ACCESS migraine -> vasoconstrictor:

* Ergotamine Tartrate (Gynergène) ergot

* Dihydroergotamine

* Sumatriptan (selective serotonin agonist)

2- BOTTOM TREATMENT:

* Dihydroergotamine

* Pizotifen (Sanmigran)

* Methysergide (ergot): risk of retroperitoneal fibrosis

* Beta-blocker propranolol

* Amitriptyline (tricyclic antidepressant)

NB: the basic treatment is justified when access more than 2 / month in case of severe crises and 5 / month in case of moderate crises

3- Cluster headache face:

* Also called histamine headache Horton (cluster headache) or cluster headache

* It reaches predilection man in his thirties; Women rarely

* The pain is unilateral, never changing the side, temporomandibular orbitofrontal orbital or facial. May radiate to the gums, ears, neck and even the shoulder. Its topography does not meet the systematization of the branches of the trigeminal nerve.

* This is an unbearable pain kind of deep burns, Grind, tear

* Accompanying signs are found in 70% of cases and on the same side of pain, nostril clogged sensation, rhinorrhea, lacrimation, erythrose cheekbone, protrude from the temporal artery. Other: miosis, ptosis (HBC syndrome).

* The evolutionary pace is very particular; every access to the abrupt beginning and end lasts 20 minutes to 1 hour.The schedule is very stereotyped crises for the same patient. Often after meals and at night. One to 3 daily access will be repeated for 3-8 weeks. Then for months, a year or more.

The chronic paroxysmal hemicrania * is a variant of cluster headache; more common in women; crises are shorter (<20min) but more frequent (10-30 times / day). It has a particular sensitivity to indomethacin.

4- primitive Neuralgia V:

* Or “tick painful to face.” This is a disease of aging subject; after 50 years in ¾ of cases. It affects mostly women.

* Pain summarizes the symptoms; it is a paroxysmal pain illuminates kind of electric shock, burning, Grind, a frightful intensity.

* Pain is strictly unilateral, affecting 1 or 2 legs of the V (extremely strict topography)

* Pain can occur spontaneously or be triggered by speech, touching specific points (trigger point).

* Interval free from pain and clinical examination is normal

* Daily access from weeks to months are separated by periods of complete remission of several months to years.

* Treatment: Tegretol (carbamazepine);

thermolysis of trigeminal ganglion

NEURALGIA SECONDARY TRIGEMINAL (SYMPTOMATIC)

* The pain is continuous with less net paroxysms and a permanent painful background

* We can not find a trigger point

* The three branches of the trigeminal nerve may be affected successively or immediately

* Neurological signs objectives: hypoesthesia in the territory of V; abolition of corneal reflex

* The causes are:

– Damage of arms of the V: sinus or dental infection, facial trauma, skull base tumor.

– Injured Gasser ganglion; lesion of the sensory root (VIII neuroma, meningioma, cholesteatoma).

– Lesions bulbo-protubérantielles: multiple sclerosis; Wallenberg syndrome;

– Meningioma of the cavernous sinus; aneurysm carotid

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