Migraine is a complex, hereditarily influenced disease characterised by episodes of moderate to severe unilateral headaches, frequently accompanied by nausea, light sensitivity, and other symptoms. The name migraine comes from the Greek word “hemikrania,” which was subsequently translated into Latin as “hemigranea.” This word’s French equivalent is “migraine.” In many cases, it leads to disability and job loss. Attacks from migraines are complex brain processes that can last anywhere from a few hours to many days. 75 percent of migraine cases lack any recognisable aura. This exercise reviews the pathophysiology and aetiology of migraine and highlights the role of the interprofessional team in the diagnosis and treatment of migraine patients.
Identify the causes of migraine headaches and medical emergencies.
Review the correct migraine diagnosis.
Describe the available options for managing migraine headaches.
In order to improve communication and care coordination and improve migraine treatment and outcomes, provide examples of interprofessional team practises.
Introduction
Periods of moderate to severe headache, usually unilateral, and frequent nausea, as well as increased sensitivity to light and sound, are hallmarks of the complex condition known as migraine. The name migraine comes from the Greek word “hemikrania,” which was subsequently translated into Latin as “hemigranea.” This word’s French equivalent is “migraine.” [1] Migraine is frequently a factor in disability and job loss. Attacks from migraines are complex brain processes that can last anywhere from a few hours to many days. 75 percent of migraine cases lack any recognisable aura.
There are various migraine subtypes, according to the headache classification committee of the International Headache Society.
[2] The subtypes are as follows:
A migraine without an aura is a long-lasting, unilateral headache attack that lasts 4 to 72 hours, is frequently accompanied by nausea, light sensitivity, and sound sensitivity, and is typically pulsating in nature, of moderate to severe intensity, and made worse by activity (photophobia and phonophobia).
Attacks of migraine with aura that are recurrent and entirely reversible frequently involve one or more of the unilateral symptoms of vision, hearing, speech, motor function, brainstem, and retina. Other migraine symptoms including headaches are commonly present as well.
A chronic migraine is a headache that lasts longer than three months and has at least eight days where symptoms of a migraine are present.
headache repercussions
Status migrainosus is a severe migraine attack that persists for more than 72 hours.
Persistent aura without infarction is the term used to describe an aura that lasts longer than a week without neuroimaging evidence of myocardial infarction.
The term “migrainous infarction” refers to one or more of the aura symptoms during a normal migraine attack that are connected to brain ischemia on neuroimaging.
A migraine aura-triggered seizure is a seizure that is brought on by a migraine assault with an aura.
A symptomatic migraine attack that fits one of the following descriptions but not another type of headache is thought to be likely to be a migraine.
Administration / Treatment
Abortive or Prolonged Care
Acute treatment aims to stop a headache from getting worse. Rapid treatment is required, along with a Sumatriptan 50 mg. Oral drugs may not work effectively for those who have stomach stasis brought on by migraines. As a result, some people may need parenteral treatment, especially if they have nausea or vomiting. [45] [46] [47] The following are your tiered therapeutic options:
NSAIDs (nonsteroidal anti-inflammatory drugs) include aspirin (900–1000 mg), diclofenac (65 mg), ibuprofen (400–600 mg), and naproxen (275–825 mg) (1000 mg).
[48] In mild to severe episodes, nausea and vomiting are frequently absent. If an NSAID is unsuccessful, it is advisable to switch to a different class of drug.
Sumatriptan 100 mg (administered as a subcutaneous injection of 6 mg, a nasal spray of 20–40 mg over 24 hours, a nasal powder of 10–30 mg over 24 hours, or orally 50–100 mg once); zolmitriptan 10 mg per 24 hours (nasal 2.5–5 mg as a single dose and oral 2.5 mg as a single dose); for attacks that are mild to severe, with or without naproxen. Contrary to NSAIDs, patients who do not respond well to one triptan may respond to another, allowing for customised therapy.
To avoid pharmaceutical abuse, triptans should only be taken for 10 days or less in a month.
Due to the activation of the 5-HT(1B) and 5-HT(1D) receptors on coronary arteries and brain vessels, it is advised against usage in individuals with ischemic stroke, ischemic heart disease, poorly controlled hypertension, angina, pregnancy, hemiplegic, or basilar migraine. Lasmiditan, a selective serotonin 1F receptor agonist that doesn’t produce vasoconstriction, is the medication that works effectively for these patients with cardiovascular issues.
It is important to monitor the patient’s therapy if they use selective serotonin reuptake inhibitors or selective serotonin-norepinephrine reuptake inhibitors due to the likelihood of serotonin syndrome.
Triptans and nonsteroidal anti-inflammatory drugs (NSAIDs) seem to complement each other’s effects better than each drug class alone. One pill containing 85 mg of sumatriptan succinate and 500 mg of naproxen sodium may be suggested as the initial course of treatment. [49]
Antiemetics include methoclopramide, chlorpromazine, and prochlorperazine.
They are often used as an additional treatment to NSAIDs or triptans to decrease nausea and vomiting, especially in the emergency room. Diphenhydramine can also be used to prevent dystonic responses (mostly metoclopramide).
Ubrogepant and rimegepant, both of which come in doses of 75 mg, are antagonists of the peptides connected to the calcitonin gene. Patients who have coronary artery disease or who don’t respond to conventional medication may want to give it some thought. [50] For the short-term treatment of adult migraines, the US Food and Drug Administration (FDA) approved lasmiditan oral tablets in October 2019. It is a selective agonist of the serotonin 1F receptor. When taken at a starting dose of 50 or 100 mg, lasmiditan is most helpful for patients who cannot use triptans owing to cardiovascular risks.
The dose may be increased to 100 or 200 mg depending on the situation, but no more than one dose should be taken in a 24-hour period. However, dizziness is a major side effect. For this reason, patients must wait at least eight hours after each dose of lasmiditan before taking part in potentially hazardous activities or driving a car. [51] Ergots: Ergotamine and dihydroergotamine are recommended for use during acute attacks and are useful as bridge therapy for status migrainosus and drug overuse headache. They can be administered intravenously, intramuscularly, subcutaneously, and orally. The benefits of ergotamine have not yet been clearly demonstrated, and it can also have very negative side effects such peripheral ischemia, cerebrovascular disease, and cardiovascular issues.