Causes and symptoms of menstrual migraine. How to Tell if You Have a Migraine Migraine Study

Ivan Drozdov 28.02.2018

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

History taking (patient interview)

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

• whether similar problems were observed in close relatives in the current and past generation;
• 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 them;
• what chronic ailments are diagnosed in the patient and is there a relationship between their treatment and;
• whether the patient had injuries (in particular, back, cervical 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 points described in it.

Criteria for diagnosing migraine

Migraine attacks occur at regular intervals, 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. There were 5 attacks of ordinary migraine or 2 attacks of classical migraine with the following symptoms:
   • the duration of a migraine attack is 4-72 hours;
   • headache is characterized by two or more signs: the pain develops on one side; the nature of the pain is an excruciating pulsation; the intensity of pain reduces normal activities; the pain is aggravated by bending, walking, monotonous physical labor;
   • the attack is aggravated by a painful reaction to light and sounds, nausea, vomiting, dizziness.
2. There are no other pathologies and 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 interconnected.

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

Physical examination for migraine

Having received general information about the patient's lifestyle and condition, the doctor proceeds to a physical examination, during which he visually examines, feels the patient and conducts a set of tactile tests.

If you suspect a migraine, the doctor performs the following manipulations:

Are you worried about something? Illness or life situation?

• measures blood pressure, pulse and respiration rate, body temperature;
• superficially examines the fundus and the condition of the pupils;
• the method of feeling and measuring determines the shape and size of the head;
• feels the temporal zone and assesses the state of the temporal artery;
• feels the area of ​​the jaw joints, cervical region, shoulder girdle and scalp to detect 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 of the skin by tingling with a sharp object (for example, a needle);
• feels the thyroid gland to determine its size and condition;
• checks coordination and degree of balance, using special tests and tests (for example, squatting or standing on one leg with eyes closed);
• evaluates the psycho-emotional state, in particular, concentration of attention, memory activity, the presence or absence of hidden disorders in the form of depression, aggression or apathy towards what is happening.

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

Consultation with specialized specialists

In the process of examining a patient, a neurologist can refer him for examination to other specialized specialists to exclude pathologies that cause headaches similar to migraine. In such cases, you may need to consult the following doctors:

• ophthalmologist - to examine the fundus, determine visual acuity, exclude inflammatory processes and infections (for example, conjunctivitis);
• dentist - to assess the condition of the teeth, the presence or absence of purulent pathologies that cause a throbbing headache similar to migraine;
• ENT doctor - to study 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 vertebral system of the spinal and cervical region, to exclude infringement of the vertebral arteries and the development of cervical migraine as a result.

An examination by the listed specialists will allow you to determine the cause of the onset of headaches and exclude migraine, or vice versa, narrow the circle of factors that provoke the development of pain and conclude that the attacks are caused by this particular ailment.

Instrumental methods for diagnosing migraine

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

The results of a comprehensive examination allow the attending neurologist to determine the etiology of pain and the causes of the accompanying symptoms, in order to eventually make or exclude the diagnosis "".

Diagnostic criteria for migraine without aura and migraine with aura (ICHD-2, 2004)

1.1. Migraine without aura.

• A. At least five seizures fulfilling criteria B-D.
• B. Duration of attacks 4-72 hours (without treatment or with ineffective treatment).
• C. Headache has at least two of the following characteristics:
  • unilateral localization;
  • pulsating character;
  • moderate to severe pain intensity;
  • the headache is aggravated by ordinary physical activity or requires its cessation (for example, walking, climbing stairs).
• D. Headache is accompanied by at least one of the following symptoms:
  • nausea and/or vomiting;
  • photophobia or phonophobia.

1.2.1. Typical aura with migraine headache.

• A. At least two seizures fulfilling criteria B-D.
• B. Aura includes at least one of the following symptoms and does not include motor weakness:
  • fully reversible visual symptoms, including positive (flickering spots or stripes) and / or negative (visual impairment);
  • fully reversible sensory symptoms, including positive (tingling sensation) and/or negative (numbness);
  • completely reversible speech disorders.
• C. At least two of the following:
  • homonymous visual disturbances and/or unilateral sensory symptoms;
  • at least one aura symptom gradually develops over 5 minutes or more and/or various aura symptoms occur sequentially over 5 minutes or more;
  • each symptom has a duration of at least 5 minutes, but not more than 60 minutes.
• D. Headache fulfilling criteria B-D for 1.1. (migraine without aura), begins during the aura or within 60 minutes after its onset.
• E. Not related to other causes (violations).

In accordance with the international classification developed by the International Headache Society, the following clinical forms of migraine are distinguished:

• I - migraine without aura (synonym used earlier - simple migraine) and
• II - migraine with aura (synonyms: classic, associated migraine).

The identification of these forms is based on the presence or absence of an aura, i.e., a complex of focal neurological symptoms that precede an attack of pain or that occur at a height of pain sensations. Depending on the type of aura in the group of migraine with aura, the following forms are distinguished:

• migraine with a typical aura (previously - the classic, ophthalmic form of migraine);
• with prolonged aura;
• familial hemiplegic migraine;
• basilar;
• migraine aura without headache;
• migraine with acute aura;
• ophthalmoplegic;
• retinal migraine;
• periodic syndromes of childhood, which may be precursors of migraine or combined with it;
• benign paroxysmal dizziness in children;
• alternating hemiplegia in children;
• migraine complications:
  • migraine status;
  • migraine stroke;
• migraine that does not meet the listed criteria.

The classification also provides the main diagnostic criteria for migraine.

Migraine without aura

• A. At least 5 migraine attacks in anamnesis, meeting the following criteria B-D.
• B. Duration of migraine attacks from 4 to 72 hours (without treatment or with unsuccessful treatment).
• B. Headache has at least two of the following:
  • unilateral localization of headache;
  • pulsating nature of the headache;
  • moderate or significant intensity of pain, reducing the activity of the patient;
  • aggravation of headache during monotonous physical work and walking.
• D. The presence of at least one of the following concomitant symptoms: nausea, vomiting, photo and/or sound phobia. It is important to keep in mind that the anamnestic data and objective examination data exclude other forms of headache. It is very important to have indications in the anamnesis to change the side of the headache, since the presence of only one-sided headache for a long time requires the search for another cause of headaches.

migraine with aura

• at least 2 attacks that meet criteria B-C;
• migraine attacks have the following characteristics:
  • complete reversibility of one or more aura symptoms;
  • none of the aura symptoms last more than 60 minutes;
  • the duration of the "light" interval between the aura and the onset of headache is less than 60 minutes.

Depending on the characteristics of the aura and the clinical manifestations of a migraine attack with aura, it is possible to determine the predominant involvement of a particular pool in the pathological process. Aura symptoms indicate a violation of microcirculation in the intracerebral territory of the cerebral arteries.

The most common aura is visual disturbances with visual field defects in the form of a flickering scotoma: sparkling balls, dots, zigzags, lightning-like flashes that begin in a strictly defined place. The intensity of photopsies increases within a few seconds or minutes. Then photopsies are replaced by scotomas or the visual field defect expands to hemianopsia - right-sided, left-sided, upper or lower, sometimes quadrant. With repeated attacks of migraine, visual disturbances are usually stereotyped. The provoking factors are bright light, its flickering, the transition from darkness to a well-lit room, flight - a loud sound, a pungent smell.

Some patients have visual illusions before a headache attack: all surrounding objects and people seem to be elongated (“Alice's syndrome” - a similar phenomenon is described in L. Carroll's book “Apis in Wonderland”) or reduced in size, sometimes with a change in the brightness of their color , as well as with difficulties in perceiving one’s body (agnosia, apraxia), a feeling of “already seen” or “never seen”, disturbances in the perception of time, nightmares, trances, etc.

"Alice's Syndrome" often occurs with migraines in childhood. The cause of visual auras is discirculation in the basin of the posterior cerebral arteries in the occipital lobe and ischemia in the adjacent territories of its blood supply (parietal and temporal lobes). The visual aura lasts 15-30 minutes, after which there is a throbbing pain in the frontal-temporal-gastric region, increasing in its intensity from half an hour to an hour and a half and accompanied by nausea, vomiting, blanching of the skin. The average duration of an attack of such a "classic" migraine is about 6 hours. A series of repeated attacks are not uncommon. This migraine worsens in the first and second trimesters of pregnancy. Less often, the aura is manifested by central or paracentral scotoma and transient blindness in one or both eyes. It is caused by a spasm in the central retinal artery system (retinal migraine). Occasionally, before a paroxysm of migraine, transient oculomotor disorders are observed on the one hand (ptosis, dilated pupil, diplopia), which are associated with impaired microcirculation in the trunk of the oculomotor nerve or with compression of this nerve in the wall of the cavernous sinus with vascular malformation. Such patients require targeted angiographic examination.

Relatively rarely, the aura manifests itself in transient paresis of the arm or hemiparesis in combination with hypesthesia on the face, arm, or the entire half of the body. Such a hemiplegic migraine is associated with impaired microcirculation in the basin of the middle cerebral artery (its cortical or deep branches). If a violation of microcirculation develops in the cortical branches of this basin in the dominant hemisphere (in the left in right-handers), then the aura manifests itself in partial or complete motor or sensory aphasia (aphatic migraine). Severe speech disorders in the form of dysarthria are possible with discirculation in the basilar artery. This may be associated with transient dizziness, nystagmus, staggering when walking (vestibular migraine) or severe cerebellar disorders (cerebellar migraine).

Also rarely, girls aged 12-15 develop a more complex aura: it begins with visual impairment (bright light in the eyes is replaced by bilateral blindness for several minutes), then dizziness, ataxia, dysarthria, tinnitus, short-term paresthesia around the mouth, in the hands , legs. A few minutes later, an attack of a sharp throbbing headache appears, mainly in the occipital region, vomiting, and even loss of consciousness (syncope) is possible. In the clinical picture of such a basilar migraine, there may be other signs of brainstem dysfunction: diplopia, dysarthria, alternating hemiparesis, etc.

Focal neurological symptoms persist from several minutes to 30 minutes. and no more than an hour. With unilateral symptoms of loss of brain function, an intense headache usually occurs in the opposite half of the skull.

In some cases, the aura manifests itself in pronounced vegetative hypothalamic disorders of the type of sympathetic-adrenal, vagoinsular and mixed paroxysms, as well as in emotional-affective disorders with a sense of fear of death, anxiety, restlessness (“panic attacks”). These variants of the aura are associated with impaired microcirculation in the hypothalamus and the limbic-hypothalamic complex.

All variants of migraine occur with different frequency - from 1-2 times a week, month or year. Occasionally there is a migraine status - a series of severe, successive attacks without a distinct light interval.

In the study of the neurological status in patients with migraine, mild signs of asymmetry in the functions of the cerebral hemispheres are often detected (in two-thirds - against the background of signs of hidden left-handedness): asymmetry of the innervation of the mimic muscles (detected with a smile), deviation of the uvula, tongue, anisoreflexia of deep and superficial reflexes, mainly vagotonic type of vegetative status (hypotension, pallor and pastosity of the skin, acrocyanosis, a tendency to constipation, etc.). Most patients with migraine have psychic features with personality accentuation in the form of ambition, anger, pedantry, aggressiveness with constant internal tension, increased sensitivity and vulnerability to stress, irritability, suspiciousness, resentment, conscientiousness, pettiness, a tendency to obsessive fears, intolerance to the mistakes of others, signs of depression. Characterized by unmotivated dysphoria.

When conducting additional studies, signs of hypertensive-hydrocephalic changes are often found on craniograms in the form of increased vascular pattern, finger-like impressions. One third have a Kimmerle anomaly. On the EEG - desynchronous and dysrhythmic manifestations. On computer and magnetic resonance tomograms, asymmetry in the structure of the ventricular system is often detected.

A special express questionnaire has been developed for the rapid diagnosis of migraine.

• Have you had any of the following headache symptoms in the last 3 months:
  • nausea or vomiting? YES______ ; NO______ ;
  • intolerance to light and sounds? YES_____ ; NO______ ;
  • Did your headache limit your ability to work, study, or daily activities for at least 1 day? YES_______ ; NO______ .

93% of patients who answered "YES" to at least two questions suffer frommigraine.

In most cases, an objective examination does not reveal organic neurological symptoms (not more than 3% of patients). At the same time, in almost all patients with migraine, the examination reveals tension and soreness in one or more pericranial muscles (the so-called myofascial syndrome). In the face area, these are the temporal and chewing muscles, in the back of the head - the muscles attached to the skull, the muscles of the back of the neck and shoulder girdle (coat hanger syndrome). Tension and painful tightness of the muscles become a constant source of discomfort and pain in the back of the head and neck, they can create prerequisites for the development of concomitant tension headaches. Often, during an objective examination of a patient with migraine, signs of autonomic dysfunction can be noted: palmar hyperhidrosis, discoloration of the fingers (Raynaud's syndrome), signs of increased neuromuscular excitability (Chvostek's symptom). As already mentioned, additional examinations for migraine are not informative and are indicated only for atypical course and suspicion of the symptomatic nature of migraine.

Characteristics of the objective status of patients during an attack and in an interictal state

Objective data during the period of the cephalgic crisis in the study of the neurological status, as already indicated, depend on the form of migraine. At the same time, some additional studies during a cephalgic attack are of interest: computed tomography (CT), rheoencephalography (REG), thermography, the state of cerebral blood flow, etc. ); REG during an attack practically reflects all its phases: vasoconstriction - vasodilation, atony of the walls of blood vessels (arteries and veins), more or less pronounced obstruction of arterial and venous blood flow. Changes are usually bilateral, but more severe on the side of pain, although the severity of these changes does not always coincide with the degree of pain.

According to CT data, with frequent severe attacks, areas of low density may appear, indicating the presence of edema of the brain tissue, transient ischemia. On the M-echo, in rare cases, there is an indication of the expansion of the ventricular system and, as a rule, the displacement of the M-echo is not determined. The results of ultrasound examination of blood flow during an attack are contradictory, especially when studying it in different pools. During an attack of pain on the affected side, in 33% of cases, the blood flow velocity increased in the common carotid, internal and external carotid arteries and decreased in the ophthalmic artery, while opposite changes were observed in 6% of patients. A number of authors note an increase in the rate of cerebral blood flow mainly in the pool of extracranial branches of the external carotid artery during the period of pain.

In the somatic status, the most common (11-14%) pathology of the gastrointestinal tract was detected: gastritis, peptic ulcer, colitis, cholecystitis. The latter was the reason to identify the syndrome of "three twins": cholecystitis, headache, arterial hypotension.

In the vast majority of patients in the interictal period, a syndrome of vegetative-vascular dystonia of varying intensity was detected: bright red persistent dermographism (more pronounced on the pain side), hyperhidrosis, vascular "necklace", tachycardia, fluctuations in blood pressure more often in the direction of its decrease or persistent arterial hypotension; tendency to allergic reactions, vestibulopathy, increased neuromuscular excitability, manifested by the symptoms of Khvostek, Trousseau-Bahnsdorff, paresthesia.

Some patients revealed microfocal neurological symptoms in the form of a difference in tendon reflexes, hemihypalgesia, in 10-14% of cases neuroendocrine manifestations of hypothalamic origin were observed (cerebral obesity, combined with menstrual disorders, hirsutism). When studying the mental sphere, bright emotional disorders were found, as well as some personality traits: increased anxiety, a tendency to subdepressive and even depressive tendencies, a high level of claims, ambition, some aggressiveness, demonstrative behavioral traits, the desire from childhood to focus on the recognition of others, in a number cases of hypochondriacal manifestations.

The vast majority of patients in the anamnesis had indications of childhood psychogeny (single-parent family, conflict relations between parents) and psychotraumatic situations preceding the onset or exacerbation of the disease. An additional study in 11-22% of cases revealed moderately pronounced hypertensive-hydrocephalic changes on the craniogram (increased vascular pattern, back of the Turkish saddle, etc.). The composition of the cerebrospinal fluid is usually within the normal range.

Changes in the EEG were not detected (although sometimes there are "flat" EEG, or the presence of dysrhythmic manifestations); echoencephalography is usually within normal limits. On REG in the interictal period, there is a decrease or increase in vascular tone, mainly carotid arteries, an increase or decrease in their pulse blood filling and dysfunction (often difficulty) of venous outflow; these changes are more pronounced on the side of the headache, although they may be absent altogether. There were no clear changes in cerebral blood flow in the interictal period, although the data on this score are contradictory (some describe a decrease, others an increase), which, apparently, is due to the phase of the study - soon or in the remote period after the attack. Most authors believe that angiospasm causes a decrease in regional cerebral blood flow for a sufficiently long period of time (a day or more).

In addition to these routine studies, in patients with migraine, the state of afferent systems is being studied, which, as you know, are systems that perceive and conduct pain sensations. For this purpose, evoked potentials (EP) of various modalities are studied: visual (VEP), auditory potentials of the brain stem (EPMS), somatosensory (SSEP), EP of the trigeminal nerve system (due to the important role of the trigeminovascular system in the pathogenesis of migraine). Analyzing the provoking factors, it can be assumed that in cases of the priority role of emotional stress, it is changes in the brain that cause a migraine attack. An indication of the role of the cold factor (cold, ice cream) suggests the primary role of the trigeminal system in initiating a migraine attack. Tyramine-dependent forms of migraine are known - where, apparently, biochemical factors play a special role. Menstrual forms of migraine indicate the role of endocrine factors. Naturally, all these and other factors are realized against the background of genetic predisposition.

Differential diagnosis of migraine

There are a number of conditions that can mimic migraine attacks.

I. In cases of severe migraines with unbearable headache, nausea, vomiting, dizziness, night attacks, it is first necessary to exclude an organic pathology of the brain:

1. tumors,
2. abscesses;
3. acute inflammatory diseases, especially those accompanied by cerebral edema, etc.

In all these cases, attention is drawn to a different nature of the headache and its course, as a rule, the absence of the factors characteristic of migraine mentioned above and the positive results of the corresponding additional studies.

II. The most important are headaches, which are based on vascular pathology of the brain. Firstly, these are cerebral aneurysms, the rupture of which (i.e., the occurrence of subarachnoid hemorrhage) is almost always accompanied by an acute headache. This is especially important to keep in mind when migraine with aura. The most significant in this regard is the ophthalmoplegic form of migraine, which is often caused by an aneurysm of the vessels of the bases of the brain. The development of the clinical picture in the future: a severe general condition, meningeal symptoms, neurological symptoms, the composition of the cerebrospinal fluid and data from additional paraclinical studies help correct diagnosis.

III. It is important to make a differential diagnosis also with the following diseases:

1. Temporal arteritis (Horton's disease). Common features with migraine: local pain in the temple area, sometimes radiating to the entire half of the head, often aching, breaking, but constant, but it can intensify paroxysmal (especially with tension, coughing, movements in the jaw). In contrast to migraine, palpation is marked by thickening and increased pulsation of the temporal artery, its pain, pupil dilation on the side of pain; decreased vision; more common in later life than migraine. Subfebrile temperature, increased ESR, leukocytosis are observed, there are signs of damage to other arteries, especially the arteries of the eye. It is regarded as local suffering of the connective tissue, local collagenosis; specific histological signs - giant cell arteritis.
2. Tolosa-Hunt syndrome (or painful ophthalmoplegia), reminiscent of migraine in nature and localization of pain. Acute pain of a burning, tearing nature, localized in the fronto-orbital region and inside the orbit, lasts for several days or weeks with periodic intensification, accompanied by damage to the oculomotor nerve (which is important to consider when comparing with the ophthalmoplegic associated form of migraine). The process also includes nerves passing through the superior orbital fissure: abducent, trochlear, ophthalmic branch of the trigeminal nerve. Pupillary disorders due to denervation hypersensitivity of the capillary muscle are detected, which is confirmed by an adrenaline-cocaine test. No other pathology was detected in additional studies. To date, the cause has not been clearly established: it is believed that this syndrome occurs due to compression of the siphon area by an aneurysm at the base of the brain. However, most authors believe that the cause is carotid intracavernous periarteritis in the region of the cavernous sinus - the upper orbital fissure, or a combination of both. In favor of regional periarteritis, low-grade fever, moderate leukocytosis and an increase in ESR, as well as the effectiveness of steroid therapy, testify.

IV. The next group is diseases caused by damage to organs located in the head and face.

1. Headaches in ocular pathology, mainly glaucoma: sharp acute pain in the eyeball, periorbitally, sometimes in the temple area, photophobia, photopsia (i.e., the same nature and localization of pain). However, there are no other signs of migraine pain, and most importantly, intraocular pressure is increased.
2. The following forms are also important:
   1. bilateral throbbing headache may accompany vasomotor rhinitis, but without typical attacks: there is a clear relationship with the occurrence of rhinitis, nasal congestion, due to certain allergic factors;
   2. with sinusitis (frontal sinusitis, sinusitis), pain, as a rule, is local in nature, although it can spread to the “whole head”, does not have a paroxysmal course, occurs daily, increases from day to day, intensifies, especially during the daytime, and lasts about an hour , does not have a pulsating character. Typical rhinological and radiological signs are revealed;
   3. with otitis, there may also be hemicrania, but of a dull or shooting nature, accompanied by symptoms characteristic of this pathology;
   4. with Kosten's syndrome, a sharp intense pain in the region of the temporomandibular joint is possible, sometimes capturing the entire half of the face; the pain does not have a pulsating, paroxysmal character, it is provoked by chewing, talking. There is a clear pain on palpation in the joint area, the cause of which is joint disease, malocclusion, poor prosthesis.

A number of authors distinguish the syndrome of vascular facial pain, or, as it is more commonly called, carotidinia. It is caused by damage to the periarterial plexus of the external carotid artery, the carotid node and can manifest itself in two forms:

1. Acute onset in young or middle age; there is a pulsating burning pain in the cheek, submandibular or temporo-zygomatic region, there is pain on palpation of the carotid artery, especially near its bifurcation, which can increase pain in the face. The pain lasts 2-3 weeks. and, as a rule, does not recur (this is a very important feature that distinguishes it from the facial form of migraine).
2. Another form of carotidinia has been described, more often in older women: attacks of throbbing, burning pain in the lower half of the face, lower jaw, lasting from several hours to 2-3 days, recurring at regular intervals - 1-2 times a week, a month, six months . At the same time, the external carotid artery is sharply tense, painful on palpation, its increased pulsation is observed. Age, nature of pain, lack of heredity, the presence of objective vascular changes during external examination and palpation make it possible to distinguish this form from true migraine. It is believed that the nature of this suffering is infectious-allergic, although there is no fever and blood changes, and there is no significant effect from hormone therapy (stopped by analgesics). The origin of this syndrome is not entirely clear. It is possible that any harm - chronic irritation, local inflammation, intoxication - may underlie carotidinia. We must not forget about the group of craniofacial neuralgia, which primarily includes trigeminal neuralgia, as well as a number of other, more rarely occurring neuralgia: occipital neuralgia (neuralgia of the large occipital nerve, suboccipital neuralgia, Arnold's neuralgia), small occipital, glossopharyngeal nerves (Weisenburg-Sicard syndrome), etc. It must be remembered that, unlike migraines, all these pains are characterized by acuteness, “lightning speed”, the presence of trigger points or “trigger” zones, certain provoking factors and the absence of typical signs of migraine pain ( mentioned above).

It is also necessary to differentiate migraine without aura from tension headache, which is one of the most common forms of headache (more than 60% according to world statistics), especially from its episodic form, lasting from several hours to 7 days (whereas in the chronic form headaches daily) from 15 or more days, a year - up to 180 days). When conducting a differential diagnosis, the following diagnostic criteria for tension-type headache are taken into account:

1. localization of pain - bilateral, diffuse with a predominance in the occipito-parietal or parieto-frontal regions;
2. the nature of the pain: monotonous, squeezing, like a "helmet", "helmet", "hoop", almost never pulsating;
3. intensity - moderate, sharply intense, usually not aggravated by physical exertion;
4. accompanying symptoms: rarely nausea, but more often loss of appetite up to anorexia, rarely photo- or phonophobia;
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The body of a woman capable of childbearing experiences serious hormonal changes every month. In some cases, the symptoms characteristic of these periods are supplemented by a headache.

Periodic menstrual migraine is diagnosed in 30% of women, and in 10% the manifestation becomes systematic. However, not all patients are predisposed to a neurological disease. Many of them do not complain of cephalalgia the rest of the time. Such a condition needs profile therapy, the scheme of which is selected individually. Ignoring the problem threatens the development of complications.

Reasons for the development of a pathological condition

Causes of menstrual migraine are conditionally divided into hormonal and non-hormonal. In 90% of cases, cephalalgia occurs as a result of hormonal instability.

Most often, she worries young girls, whose cycle is still being formed. Also at risk are people taking contraceptives or steroids, mentally and emotionally unstable women. The likelihood of hormonal disruptions increases if the patient has a history of metabolic pathologies, obesity, and vascular problems. In their case, even a physiologically normal course of menstruation can provoke negative consequences in the form of a headache.

In other situations, migraine during menstruation becomes a consequence of the influence of internal or external factors. The action of most of them can be prevented, which increases the chances of successfully combating the symptom. Much depends on the behavior of the woman herself. Persons with a tendency to headaches should pay special attention to their health.

Non-hormonal causes of migraine

Weak severity of migraine symptoms associated with the menstrual cycle is recognized doctors variant of the norm. With a vivid clinical picture or the presence of additional alarming signs, it is necessary to consult a gynecologist. Factors that cause headache attacks may be the result of an infection in the body, an inflammatory process, dangerous anatomical features.

Moments that can provoke the development of migraine during menstruation:

• increased sensitivity of the body to biochemical reactions, for example, protein breakdown;
• increased intracranial pressure due to delayed removal of fluid from the tissues;
• active contractions of the uterus and heavy bleeding, which affect the state of the vascular system;
• drops in blood pressure, the predisposition to which increases against the background of physiological processes;
• prem contraceptives not agreed with the doctor;
• smoking, drinking alcohol during menstruation;
• increased susceptibility to stress, instability of the emotional background;
• chronic fatigue, physical or intellectual exhaustion.

Menstrual migraine is characterized by a special clinical picture. The situation when the patient's condition is aggravated by fever, arrhythmia, heavy bleeding, nausea and vomiting indicates the presence of pathological processes. Such phenomena require immediate medical attention.

Symptoms of a menstrual migraine

Manifestations of pathology can occur 2-3 days before the start of menstruation, after they begin, or in the first days after menstruation stops. The set of symptoms varies, but most often it remains stable, not changing from cycle to cycle. Often the clinical picture of the disease lasts only a couple of days, after which relief comes.

Signs of a menstrual migraine:

• cephalgia of a pulsating or bursting type with localization in the forehead or temples, most often unilateral or passing;
• mood swings, tearfulness, alternating with aggression, anxiety, irritability;
• lack of appetite, negative reaction of the body to familiar foods;
• muscle weakness, fatigue;
• decreased attention and mental activity;
• violent reaction to sounds, smells, bright or flickering light;
• jumps in blood pressure, which usually do not happen;
• increased heart rate, disruption of its rhythm;
• sweating, pale skin;
• decreased quality of sleep, insomnia;
• nausea and vomiting not associated with food intake.

If an attack develops after the onset of bleeding, then it often has additional manifestations. These are aching pains in the lower abdomen, backache. The mammary glands swell, become painful. Frequent intestinal disorders in the form of bloating, unformed stools.

Treatment of menstrual migraine

It is difficult to get rid of headaches caused by critical days with the help of traditional medicine. Such approaches help only with a weak symptom. Usually therapy is required professional, complex, systematic. The selection of the optimal means should be done by a doctor. Taking medications not agreed with a specialist threatens to worsen the condition, the development of complications.

Drug treatments for migraine provoked by menstruation:

• hormones - taking drugs with estrogen in the composition is indicated with a proven deficiency of the substance. This allows you to fight seizures, prevent their development;
• painkillers - NSAIDs, combined analgesics, antispasmodics. The medicine is selected by the doctor, based on the characteristics of the case. Such products help only with mild or moderate intensity of cephalalgia. You should refrain from taking Citramon and other medicines based on acetylsalicylic acid. They thin the blood, which can increase bleeding;
• triptans, ergotamines - a narrow focus, designed to combat migraine. They not only relieve headaches, but also eliminate other manifestations of a neurological disease;
• mefenamic acid is a substance that blocks the production of prostaglandins. Due to this, the severity of all manifestations characteristic of PMS decreases;
• symptomatic therapy - according to indications, patients are prescribed antiemetics.

Medical care is often supplemented by the correction of the daily routine. Such events are also individual, selected empirically. Some women are shown bed rest for the period of exacerbation. Others find relief by doing yoga or other physical activity. Reflexology gives a good effect, but it must be carried out by high-level professionals.

Menopause and migraine

Sometimes hemicrania before menstruation begins to bother after 40-45 years. In this case, it often indicates the beginning of hormonal changes characteristic of menopause. In each case, the situation is able to develop according to an individual scenario. Some women practically do not notice the changes, the quality of life of others is noticeably reduced. Often, menstrual migraine accompanies a period of irregular periods, and with the onset of menopause, everything returns to normal.

Pharmacies offer many drugs designed to alleviate the condition of women on the threshold of the next changes in the body. Before you start taking them, you need to consult a doctor. In some cases, the use of such funds only aggravates the situation or does not provide the desired relief. In some cases, gynecologists recommend courses of hormone therapy based on individually selected medications.

Women who are prone to menstrual migraine should not just wait for the next exacerbation every month. Treatment needs to be ongoing and does not have to be based on medication.

By making a number of changes in your usual life, you can reduce the risk of developing seizures or their frequency, reduce the duration.

You will learn about the methods of treating cephalalgia before the menstrual cycle.

If you have a history of menstrual migraine, it is recommended:

• review the diet, excluding smoked meats, pickles, fried foods from it;
• observe the drinking regime, using clean water without gas;
• introduce gentle physical activity into the routine, but do not overstrain;
• carry out comprehensive prevention of stress;
• walk a lot, work and sleep in a ventilated area.

The risk of migraine exacerbation will decrease if, a couple of days before menstruation, you refuse to go to the sauna and solarium, hot baths, and being in direct sunlight. At the same time, you should diversify your drinking regimen with green tea with added sugar. Natural coffee helps some women, only you need to drink it in minimal quantities.

Critical days for 50% of women are a serious test. The situation should not be allowed to worsen due to the development of menstrual migraine. If you suspect this condition, you should not try to deal with the problem yourself. You should immediately seek help from a gynecologist. This will at least reduce the severity of discomfort, continue to lead a familiar lifestyle.

Anna Mironova

Reading time: 11 minutes

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According to experts, headache is the most common complaint among patients. Moreover, the nature of the pain can be different, as well as the causes that cause it. How can you tell a normal headache from a real migraine? What symptoms are they characterized by? .

Tension headache and migraine - differences between migraine and headache

A common headache can be caused by a cold, sinusitis, ear infections, and other illnesses. Also, a risk factor may well be a head injury, overwork, passive smoking, allergens, etc. To cope with an attack of a normal headache, pain medication is not needed. It is enough to exclude the cause of pain. A healthy lifestyle, daily routine and a competent diet will help solve the problem of even prolonged pain.

Migraine:

Symptoms of real migraine - how to understand that you have a migraine?

Until the end, unfortunately, this disease has not been studied. It affects about 11 percent of the population. The main symptom is an aura that precedes an attack - a violation of perception for 10-30 minutes:

• Flies, shroud, flashes before the eyes.
• Disturbance of the sense of balance.
• Loss of control over your muscles.
• Hearing/speech impairment.

This happens due to a sharp narrowing of the main arteries of the brain and the subsequent deficiency of blood flow to it.

Signs of a classic migraine - identify a migraine in a minute!

What can trigger a migraine attack - what causes a migraine?

What to do with frequent and severe headaches, migraines?

First of all, in the presence and repetition of the above symptoms, should consult a specialist, in order to exclude:

• Changes in the cervical spine.
• The presence of disorders in the blood supply to the brain.
• The presence of a tumor.
• Consequences of various injuries of the skull, cervical region.
• Aneurysm of cerebral vessels, etc.
• Hemorrhage in the brain.

Only a well-diagnosed and specified causes of pain will help to find a solution to this problem.

Migraine examination - which doctor will help you

If during the examination by specialists no serious abnormalities and diseases were found, then all further actions of the patient should be directed to next attack warning. That is, to prevent disease.

How to cure migraine - principles of migraine treatment

This disease can last for many years. And, given the different course and nature of pain, treatment is chosen strictly on an individual basis. What works for one person may be completely useless for another. So, key principles in treatment:

• Following the chosen method of treatment. Patience is a must.
• Elimination of all factors that can cause an attack.
• Transition to a healthy lifestyle.
• Use of prescription drugs .

Prevention plays a key role in the fight against this disease. As you know, stopping an attack with pills at the peak of pain has no effect. That's why The best option is seizure prevention.

The content of the article

migraine pathogenesis

Migraine Clinic

The course of a migraine

migraine diagnosis

Migraine treatment