Migraine without aura is the most common type of migraine paroxysms, the distinctive feature of which is the absence of aura and any transient neurological disorders. Disease is characterized by attacks of intense headache, more often unilateral, accompanied by nausea, repeated vomiting, sound and photophobia. Diagnosis is based on clinical criteria. It is necessary to exclude other cerebral diseases, the symptom of which may be a similar cephalgia. Treatment is carried out by serotonin receptor agonists, NSAIDs, dihydroergotamines, non-narcotic and narcotic analgesics, antiemetics, sedatives and tranquilizers.
ICD 10
G43.0 Migraine without aura [simple migraine]
General information
Migraine without aura accounts for up to 80% of all migraine attacks. Unlike migraines with aura and associated migraines, it has no prior or concomitant headache of transient visual, motor or sensory disturbances. The first attacks of a simple migraine, as a rule, occur in the period from 17 to 35 years. In old age, migraine attacks lose their duration and intensity. Women suffer from migraines 3-4 times more often than men, their attacks are often associated with periods of the menstrual cycle. Migraine without aura is observed in the vast majority of cases of migraine in children. At the same time, the family nature of the disease is often traced. In addition, some authors indicate that 80% of men with migraines, mothers also suffered from migraine paroxysms.
Causes
It is known that a stressful situation, physical fatigue, mental overload, lack of sleep, hypothermia, changes in the weather, a sharp smell, noise, flickering light, alcohol intake, eating disorders, the use of certain foods (for example, nuts, citrus fruits, chocolate, soy sauce, cheese, celery, coca-Cola, etc.). In women, a simple migraine can be caused by hormonal shifts — ovulation and menstruation, taking hormonal contraceptives. Trigger factors of migraine are to a certain extent individual, over time, each patient knows his own set of similar triggers from experience.
Migraine without aura, like other types of migraine paroxysms, is associated with such character traits as ambition and ambition, increased excitability. Patients are mostly strong-willed and strong people, but at the same time they are intolerant of the mistakes of others, which is why they often get annoyed and show dissatisfaction.
The pathogenetic mechanisms of migraine attack development are still the subject of study in clinical biochemistry and neurology. During an attack, there are changes in the content of a number of substances — serotonin, histamine, catecholamines, prostaglandins, bradykinin. Today, the main role is assigned to serotonin. Studies have shown that at the beginning of a migraine attack, there is a sharp release of serotonin from platelets, which is accompanied by a narrowing of cerebral vessels. Then the level of serotonin decreases significantly. The effectiveness of serotonin metabolism regulators against migraine also emphasizes the importance of this neurotransmitter.
Other studies indicate a trigeminal-vascular mechanism of the development of migraine without aura. The initial is the excitation of neurons located in the medulla oblongata of the nucleus of the trigeminal nerve, which provokes the release of neurotransmitters. The latter irritate trigeminal receptors and potentiate aseptic inflammation of the carotid artery wall. This explains the painfulness of the artery during palpation and the swelling of the surrounding tissues.
Symptoms
Migraine without aura is characterized by the sudden appearance of cephalgia without a previous aura. In some cases, a headache is foreshadowed by prodromal phenomena — a decrease in mood, drowsiness, a drop in performance, nausea, yawning. Since cephalgia often extends only to half of the head, it is called hemicrania. Hemicrania is more often noted in the right half of the head. In some cases, cephalgia captures the second half of the head and is diffuse. The pain is accompanied by nausea of varying intensity and repeated vomiting. Any movement increases the intensity of cephalgia. Hypersensitivity to sounds and light stimuli, forces patients to isolate themselves from the outside world during a migraine attack (close themselves in a room, close the windows, hide under a blanket, etc.).
Migraine without aura can last from 4 hours to 2-3 days. Sometimes a migraine attack is accompanied by rapid urination, diarrhea, dizziness, nasal congestion, vegetative disorders (palpitations, sweating, a feeling of a rush of heat, chills, a feeling of lack of air). The end of the paroxysm in half of the cases occurs with the transition of the patient to a state of sleep. After a migraine attack, there may be some weakness and weakness, in some cases, on the contrary, there is increased physical and intellectual activity.
Migraine without aura in children is more often diffuse or localized bitemporally and bifrontally. The attack usually does not last more than 1 day. The intensity of cephalgia in children is often less than in adults. Nausea and repeated vomiting come to the fore. Cases are described when a migraine attack in a child was accompanied by fever and abdominal pain and was mistakenly interpreted as an intestinal infection.
Diagnostics
A simple migraine is diagnosed by a neurologist according to the following clinical criteria: the presence in the anamnesis of at least 5 migraine-like paroxysms, the duration of each of which is no shorter than 4 hours and no more than 3 days; cephalgia is characterized by at least 2 of the listed signs – has medium and high intensity, pulsating, unilateral, becomes more intense with physical there is at least 1 of the following concomitant symptoms — phobia and photophobia, nausea and vomiting.
An important point is the differential diagnosis of migraine from serious cerebral diseases, such as intracerebral tumor, meningitis, arachnoiditis, brain cyst, encephalitis, cerebral vascular aneurysm, etc. Special alertness is required with the rapid development of a migraine attack, previously not observed excessive intensity of cephalgia or its unusual nature, the presence of rigidity of the muscles of the back of the head, an attack of loss of consciousness, convulsions, limitation of visual fields. To exclude organic cerebral pathology, a comprehensive neurological examination is carried out: electroencephalography, echoencephalography, REG, ultrasound of the vessels of the head, an ophthalmologist’s examination with an examination of the fundus and perimetry. According to the indications, MRI of the brain and MRI of cerebral vessels are prescribed.
Treatment
In the relief of migraine paroxysm, standard analgesics are ineffective. As a rule, dihydroergotamines (ergotamine, dihydroergotamine) or selective serotonin agonists — triptans (sumatriptan, risatriptan, naratriptan, zolmitriptan, eletriptan) are used. With the gradual development of paroxysm, it is enough to take one of these drugs inside. However, due to reduced gastrointestinal motility, this method of administration may be ineffective. In such cases, the use of ergotamine in rectal candles, dihydroergotamine i / m or i / v, sumatriptan p / K. is recommended. The use of triptans is associated with frequent relapses of cephalgia, since these drugs have a short half-life (only 2 hours). With the resumption of cephalgia, repeated medication is often required, a combination of triptans with nonsteroidal anti-inflammatory drugs (ibuprofen, nimesulide, diclofenac).
In some cases, a simple migraine is stopped by endonasal administration of lidocaine, taking naproxen, intramuscular administration of magnesia. Repeated vomiting is an indication for the appointment of antiemetics (metoclopramide, domperidone, ondansetron). With a high intensity of cephalgia and no improvement from the use of the above-mentioned pharmaceuticals, narcotic analgesics (tramadol, trimeperidine, codeine, fentanyl, nalbufin) are resorted to. However, their use is possible no more than 2 times a week.
Unfortunately, at present, migraine without aura does not have an effective pharmacotherapy of the intercrime period, which would significantly reduce the likelihood of a migraine attack. Neurologists use monoamine oxidase inhibitors, beta-blockers, tranquilizers, anticonvulsants, oxy-triptan (serotonin precursor), etc. Some studies have shown the effectiveness of long-term administration of small doses of aspirin.
Since drug treatment is ineffective, much attention should be paid to the patient’s lifestyle, the exclusion of factors that provoke a migraine attack from it. This is a task that only the sick person can solve. In addition to normalizing the daily routine and nutrition, this should include serious psychological work aimed at reducing the demands on others and forming a more friendly attitude towards people. Psychological consultations, special trainings, and psychotherapy can play an auxiliary role in this.
Forecast
Migraine without aura in itself is not a life-threatening or health-threatening disease of the patient. However, migraine attacks reduce the efficiency of patients, making it impossible for them to perform their work duties during the attack. In addition, some patients (for example, rescuers, doctors, workers of noisy workshops, cooks, etc.) are forced to change their profession, since it is associated with triggers provoking migraines. Unfortunately, according to statistics, only in 10% of cases doctors manage to achieve the cessation of migraine paroxysms. On the other hand, there are numerous cases when patients themselves, by changing their lives, achieved recovery.