The Treatment of Modern Western - Biblio.nhat-nam.ru

49MIGRAINE HEADACHESMigraines are a type of recurrent, paroxysmal, neurovascularheadache with or without associated visual and gastrointestinaldisturbances. Their etiology is unknown, but a geneticpredisposition is strongly suspected since a family history isobtained in more than 50% of cases. One theory favored bymany researchers is that migraines are due to vulnerability ofthe nervous system to sudden changes either internally withinthe body or in the external environment. This vulnerabilitymay be due to inheriting a more sensitive nervous systemthan most people. According to Elaine Aron, 15-20% ofpeople have such a highly sensitive nervous system. 1Biochemically, this heightened sensitivity seems to be associatedwith serotonin (5-hydroxytryptamine or 5-HT) metabolism.It seems that serotonin levels in the blood fall at theonset of a migraine headache but are normal between attacksand that urinary excretion of serotonin metabolite 5-hydroxyindoleacetic acid also increases during an attack and returnto normal afterward. 2Migraines may occur at any age but usually begin betweenthe ages of 10-30 years. They also occur more often inwomen than in men. Attacks may or may not be preceded bya prodrome. Such prodromal symptoms include a short periodof depression, irritability, restlessness, anorexia, scintillatingscotomas, visual field defects such as tunnel vision, paresthesias,and, more rarely, hemiparesis. These symptoms maydisappear shortly before the pain begins or may merge withit. Certain factors can provoke or trigger a migraine in somepeople. Among the foods which may trigger a migraine arealcohol, especially red wine, foods containing monosodiumglutamate (MSG), foods that contain tyramine, such as agedcheeses, and preserved meats with nitrates and nitrites. Otherfactors include too much or too little sleep, fluctuations infemale hormones, stress and anxiety, and environmental factors,such as weather or temperature changes, glaring orflourescent lights, computer screens, strong odors, and highaltitude.Pain is either hemilateral or generalized. When pain is onesided,it may or may not always occur on the same side.Untreated attacks may last for hours or days. Nausea, vomiting,and photophobia are common. Some migraineurs experiencea climax culminating in vomiting and diarrhea afterwhich the pain subsides. Other migraine sufferers find theirheadaches disappear only after sleeping. Attacks may occurdaily or only once in several months. In women, attacks mayoccur either before, during, or after menstruation or at ovulation.Some women’s migraines begin at puberty and end atmenopause, while other women’s migraines begin atmenopause. It is estimated that 25% of all people experiencea migraine headache at some point in their life.The Western medical diagnosis of migraines is largely basedon the patient’s personal and family history and the presentingsigns and symptoms plus an absence of any intracranialpathological changes. The Western medical management ofmigraines can be divided into nonspecific therapy with analgesicsand specific therapy with serotonin receptor agonists.It can also be divided into remedial treatment during anattack and preventive treatment between attacks. There are anumber of nonspecific analgesics available for the treatmentof the pain associated with migraine. These drugs can bebroadly subdivided into low-range, mid-range, and highrangeanalgesics depending on their strength, side effects,and potential for habituation. Low-range analgesics includesimple over-the-counter analgesics or prescription nonsteroidalanti-inflammatory drugs (NSAIDs) alone or in combinationsthat include caffeine. Examples of low-range analgesicsinclude aspirin, acetaminophen, naproxen, ketorolac,and indomethacin. Although NSAIDs have been found todiminish both the severity and duration of migraine attacks,no NSAID has been found to be more effective than another.The most common side effects of NSAIDs are gastrointestinal,ranging from mild dyspepsia to gastric bleeding.Mid-range analgesics include the sedative butalbital com-