Headache, localized in the same place and repeated several times a month, may be a migraine. Diagnosis of this disease requires specialized instrumental studies, since it is impossible to confirm the disease only by symptoms or external signs.
Main symptoms
One of the criteria for diagnosing migraine is the localization of pain. With this disease, it affects the temporal and frontal region, pressing sensations often affect the state of the organs of vision. Migraine pain is almost always unilateral, non-migratory. In some cases, the pain syndrome begins in the occipital region, but later moves to the forehead.
In addition to headaches, migraine patients suffer from photosensitivity, painful reaction to noise, loud sound. Often, against the background of a migraine, nausea appears with vomiting. The general condition of a person during an attack worsens so much that he becomes unable to engage in physical or mental labor.
Aura as a sign of migraine
BUnlike the headache that occurs with other diseases, migraine has one specific symptom. We are talking about migraine aura - a whole symptom complex that allows for differential diagnosis.
Migraine with aura develops rapidly, in just a few minutes. Most often, the signs preceding an attack in patients are visual and speech disturbances (for example, loss of visual field, flickering, "flies" in the eyes, temporary inability to pronounce words, individual syllables), weakness in the limbs, deterioration in the sense of taste and smell, perception of size surrounding objects.
As soon as an attack of migraine pains begins, the aura disappears. There are cases when, after the appearance of an aura, an attack did not follow, but it is more correct to consider them a rare exception.
Examination for suspected migraine
The diagnosis is made after research procedures. The first step in the diagnosis of migraine is the study of patient complaints and the formation of a neurological history. Additional research procedures for suspected this disease are carried out only if the overall clinical picture is unclear to the specialist, or the disease proceeds according to an unusual scenario.
Detailed examination makes it almost impossible to detect neurological symptoms. At the same time, myofascial syndrome is important for the diagnosis of migraine - it occurs during attacks of each type of disease type. About availabilityindicates tension and pain in the pericranial muscles. As the attacks become more frequent, the pain intensifies.
When examining patients, the neurologist draws attention to another important criterion in the diagnosis of migraine - these are the symptoms of vegetovascular dystonia, which include increased sweating of the palms and cyanotic color of the fingers on the hands. A convulsive syndrome that occurs against the background of excessive neuromuscular excitability can signal dystonia.
What diseases can be confused with
The main pathology that proceeds in a similar way is tension headache. This is not an independent disease, but rather a syndrome that occurs against the background of some neurological, cardiovascular disorders.
Unlike a migraine, a tension headache is less intense and does not throb during an attack. With this pathology, patients have a feeling as if something is squeezing the head very strongly. Localization in tension headache is ubiquitous. Symptoms such as nausea or photosensitivity are not associated with this condition.
The reason for the development of tension headache, unlike hereditary migraine, which can have many provoking factors, is a long stay of a person in an uncomfortable position for the neck or head, a stressful situation.
Differential diagnosis of basilar and vestibular migraines
Neurologists distinguish two types of the most severe types of this disease. The first is the basilarmigraine, which appears with bouts of dizziness in combination with impaired consciousness, psychomotor abnormalities, including unreasonable mood swings. The second type of disease is vestibular: its attacks are manifested exclusively by dizziness and temporary hearing loss, without headache.
Vestibular migraine is the most difficult to diagnose due to the absence of pain. The migraine nature of dizziness is also indicated by photophobia, an acute reaction to noise, an increase in symptoms during physical activity, and polyuria. Unlike basilar migraine, with the vestibular type of the disease, patients experience minor oculomotor abnormalities. While the basilar form is characterized by excitability of the vestibular apparatus, a tendency to motion sickness.
Consultations with highly specialized specialists
In the process of examining a patient, the doctor will refer the patient for examination to narrow-profile doctors to exclude diseases that manifest themselves as migraine-like headaches. If this disease is suspected, consultations are required:
- ophthalmologist - in order to study the state of the fundus, determine visual acuity and exclude inflammatory and infectious processes;
- dentist - to assess the condition of the oral cavity, detect foci of purulent infection, which could cause a throbbing headache;
- otolaryngologist – exclusion of diseases of the inner and middle ear, sinusitis, Meniere's disease;
- vertebrologist - examination of the spinal and cervical spine with the aim ofconfirmation or exclusion of hernial formations and pinched nerves.
Consultations with the above specialists will allow you to find out the exact cause of headache attacks, and exclude migraines or determine the very provoking ailment.
Electroencephalography
This is the most affordable and painless way to differentiate migraine. Vestibular forms of the disease affect the state of the brain structures, the main blood vessels and arteries that feed the brain during various periods of activity. In addition, thanks to encephalography, an inflammatory process or pathological disorders can be detected.
Tomography (CT and MRI)
To exclude possible neurological diagnoses, vascular aneurysms or oncological neoplasms, the attending physician will prescribe a brain examination for the patient using computed tomography or magnetic resonance imaging. This type of study allows you to determine that the cause of migraine was abnormal processes affecting only one part of the head or several areas. At the same time, not so long ago, scientists put forward versions that migraine does not move beyond the area in which the pain is localized.
Thanks to tomography, it is possible to determine the factors in the development of neurological diseases that provoke the appearance of pain, reminiscent of migraine in nature. In addition, the cause of pain attacks may be increased intracranial pressure that occurs against the background of a tumor oraneurysms. This can be determined by computer diagnostics of migraine in the clinic.
Treatment of ischemic disorders begins with an MRI. If you conduct an examination during an exacerbation of the disease, you can find a decrease in the intensity of blood circulation and a sharp spasm of blood vessels before a migraine attack.
Benefits of MRI
The choice in favor of a particular diagnostic procedure should be made by the attending physician based on the anamnesis, the patient's well-being and the general picture of the disease. If the specialist decides that a study is necessary, he should clarify the parameters of the MRI diagnosis of migraine, including the use of a contrast agent.
Magnetic resonance imaging determines the type of migraine that occurs against the background of structural changes in cerebral vessels. Most often, MRI is prescribed to patients in the following situations:
- postoperative period after neurosurgical intervention;
- severe cerebrovascular accidents (ischemic or hemorrhagic strokes);
- traumatic brain injury;
- complaints of pain of unknown origin, occurring in one of the hemispheres of the brain;
- high risk of cerebral infarction.
When is CT better?
Magnetic resonance imaging does not always allow to detect neoplasms in the course of diagnosis. Migraine in women or men can actually be a brain tumor, which can be recognized without a doubt by computed tomography. At the same time, it should be noted once again that the decision on the choice of procedure remains with the attending physician. In addition, MRI and CT are not mutually exclusive studies, but each of them is able to bring new data about the overall picture of the disease and exclude associated complications.
What is angiography?
Unlike previous research methods, angiography is an invasive procedure. To study the state of the vessels of the brain before the examination, the patient is injected with a contrast agent, which may contain various substances. Most often, iodine and gadolinium are used, which is injected into peripheral vessels. A few minutes later, as soon as the contrast is distributed over all arteries and intracranial vessels, X-ray of the area under study is started. Angiography results are converted into a digital image and displayed on the monitor screen.
Thanks to this technique, it is possible to give an objective assessment of the state of specific vessels, to detect ruptures in their walls, gaps, and the degree of elasticity. Unlike X-ray angiography, MRI angiography is more expensive and does not require the use of contrast.
How to diagnose a child
There is no specific diagnosis of migraine in children. Parents should pay attention to any child's complaints if they are associated with headaches and symptoms such as nausea, vomiting, hearing loss and visual impairment. When repeating several episodes of a baby's migraine, it is necessary to showneurologist.
The doctor will perform a visual examination and interview. The specialist will need information about what the child ate or did before the onset of the disease occurred, what events preceded this. Parents are encouraged to keep a diary to record any changes and potential causes of migraine attacks.
Most often, a pediatric neurologist diagnoses a child based on complaints and examination results. Moreover, an experienced specialist without additional research will be able to make an assumption about the type of disease. Of the additional diagnostic procedures, children are prescribed electroencephalography, dopplerography or MRI of the brain to assess the condition of the main vessels. For children under 14 years of age, procedures such as x-rays and CT scans are not recommended because they adversely affect the growing body.
Migraine medications
Many believe that without waiting for the results of the diagnosis, it is impossible to start treating migraine. Actually it is not. The principle of treatment of this disease is to relieve symptoms. Drug therapy for migraine involves taking anti-inflammatory and analgesic drugs of the NSAID group.
All of them effectively fight headaches, removing inflammation from the vascular walls. In fact, non-steroidal anti-inflammatory compounds eliminate the very cause of the pain syndrome. Among the simple one-component NSAIDs for the treatment of migraine, it is worth noting drugs forbasis:
- acetylsalicylic acid;
- ibuprofen;
- acetaminophen;
- naproxena;
- nimesulide;
- ketorolac;
- Xefocam;
- diclofenac;
- lornoxicam.
If, after prolonged use, these drugs have ceased to be effective, they are replaced by more complex analgesics, which contain two or more active substances (for example, codeine and phenobarbital, metamizole and paracetamol). Some of them have vasoconstrictive properties, others calm the nervous system and eliminate the excitability of the cerebral cortex. In general, such drugs are better at stopping migraine attacks, but they cannot be taken regularly, since most of the components in the composition cause drug dependence.
