Do you know about - Is My ill a Migraine?
Pre Occupational Therapy! Again, for I know. Ready to share new things that are useful. You and your friends.One of the occupational hazards of being a physician, moreover, one who is trained in internal treatment and neurology, is the supper table. This is the traditional "non-doctor place" where we physicians are hit-up by guests for medical advice. I am often asked by family, and friends, "What is a throbbing head headache, and are my headaches migraines?" This is sometimes difficult to reply when brought up as supper conversation. Why? Because many things can cause headaches, from brain tumors to lack of sleep, any condition can present with severe to mild headaches. Besides, this branch gets so deep, unless you're postured for a long conversation, you don't dare get started, because it gets long, and many questions come up. So, this is the seminar which usually ensues, and it always gets interesting.
What I said. It is not outcome that the actual about Pre Occupational Therapy. You read this article for information about anyone wish to know is Pre Occupational Therapy.How is Is My ill a Migraine?
Barring serious conditions such as brain tumors, severe head and neck pathology, trauma, eye and vision disorders, serious metabolic conditions and infectious diseases, this narrative is meant to discuss non-pathogenically and non traumatic induced headaches, moreover, the difference between muscle tension headaches and migraines.
Generally, the lay man thinks of a throbbing head as a very severe headache. So, when they get a "bad" headache, they usually refer to it as a "migraine", but this is not the case at all. There are many types of benign headaches which are severe sufficient to ruin one's day or even their week. The classification of headaches, and more importantly, migraines, has been written and rewritten by doctors for centuries. It wasn't until the 20th century that the specialty of neurology was born and a way to evaluate headaches scientifically was put into place. Interestingly, even during the 20th century, the classification of the distinct types of migraines has changed substantially. For the sake of this article, we will differentiate between 2 common benign headaches, those which are muscle tension induced and those which we in treatment refer to as throbbing head type. Keep in mind that there is no Syn. Clearness in these classifications, and that most headaches are mixed.
We live in a fast paced society. We run colse to dehydrated, drinking coffee, stare at Lcd screens either tiny or large, and on top of that, process more information in a day than our great grandparents did in their lifetime. That's right! No wonder we run colse to stressed out. Most of us manifest our stress physically, so we either get upset stomachs, aching necks, or we get headaches, and for some, all three. In America, particularly, two types of headaches are commonly seen in this regard, muscle tension types, and vascular throbbing head types. Here's "the quick and dirty" on both.
Muscle tension headaches tend to come on as the day progresses, while the stressors one is dealing with are ongoing and building. So by the end of the day, your ill progressively worsens, your neck and scalp muscles growth their tone and now you have a full blown "knocker" at the end of the day. Migraines on the other hand are vascular in nature, are brought on by chemical changes reacting to stress loads and dietary triggers. You commonly awaken with the ill as they come on after the stress is gone. You guessed it, the following day, after the stressful event or events are over, you're in pain. It is the first-rate euphoric phase of "the normal alarm reaction to stress". So you wake up with a "banger" which is hugely painful and stays with you all day. This is also why a migrainer (pronounced, "mi-gren-urr") tends to have his ill on Saturday mornings, or say, the day after that big speech he had been preparation for weeks.
Muscle tension headaches, also known as "tension" headaches or "contraction" headaches are direct results of increased tone and muscular irritation in the back, shoulders, neck, and scalp. As a result, they usually reply to anti-inflammatory drugs like ibuprofen or aspirin; massage; muscle relaxants; or just laying down for a while. Migraines are more brittle. Since they involve vascular changes in the coverings of the brain, anti-inflammatory drugs and muscle freedom are usually ineffective treatments; moreover, they can even make a ill worse. Increased blood vessel caliber is commonly the qoute and needs to be controlled and re-set. This is why caffeine, decongestants, and other vasoconstricting agents help.
A test I have many patients, as well as friends and house try, is the "Beer Test". It's not one hundred percent, but if you want to know if that ill you've had all day is a throbbing head or tension headache, when you get home, drink a beer. If the ill goes away, it's a tension headache, if it gets worse, it's a migraine.
So, tension headaches are a direct follow of stress insult, like man turning up the volume on your neck muscles throughout the day. This type of ill is obviously exacerbated by posture, compensatory changes after an injury, arthritis, lasting musculoskeletal conditions, and of course stress load, and the amount of rest a man gets.
Migrainers suffer as they do because the ill waits, then sneaks up on them when they're resting. The other foremost thing to remember is that in all these ill types, corporal examination, metabolic workups, and imaging, are always negative for "lesion" or organic pathology. What I'm saying is that, "migraine", is a pathology of exclusion.
Let's discuss this phenomenon we call migraines. "Migraine" is a very old term derived from the Greek, meaning "semi-cranium" or "half skull". Yes, commonly a throbbing head ill is usually, but not always, unilateral, affecting one side of the head. The qoute is they come in so many distinct manifestations that it has been difficult to classify them, even in modern medicine. Some versions have been published since the early 1920s, however, after World War Ii, neurologists in America started to find some consistencies which allowed at least for neurologists, an quality to observe, diagnose, and treat with a suitable of care. It also allowed doctors to chronicle the type of ill a inpatient was experiencing.
This so-called classification remained in place for nearly sixty years, but in 1995, The National ill Foundation along with The American Academy of Neurology, published straight forward guidelines that have allowed all physicians to more truly navigate the presentation of ill patients, pathology them accurately, and treat them appropriately and effectively. The older "traditional classification" which is still used by many older doctors, uses perfect descriptors and relies on 5 major presentations, and thus, the inpatient is labeled as such. They are: Classical Migraine; common Migraine; complex Migraine; Mixed Headache; and throbbing head Equivalent (also known as Retinal Migraine). I don't need to remind you that there are many variations on each one of these.
Classical Migraines are the brittle ones you hear about, and the type that causes a great many to present to the urgency group of their local hospital. Here's a typical presentation. usually a woman, as 75% of migrainers are women, she awoke with a one sided throbbing ill that wouldn't reply to any medication. It started with a optical aura of sparkles in the upper left optical field (what we in treatment call a stratified optical scotoma). She can't stand to have any light in the room, noises make the pain worse, and she's nauseous and vomiting, in addition, just sharp colse to makes it much worse. The inpatient commonly requires narcotic pain supervision and neurovascular operate with a triptan drug (see below). It is this sufferer, who guarnatee statistical experts and the U.S. group of Labor have stated, "costs our nation nearly 95 billion dollars in lost man hours a year! That's not along with the tab to her condition guarnatee company, or if she's on Medicaid, your tax dollars. Wow!
Common Migraines, are much less intense and disabling, they still throb, are usually one sided, the inpatient can have nausea, but commonly no vomiting. The lights and sounds are still bothersome but not as overwhelming. Most apparent in their history, is no aura or scotoma. These are self limited, usually responding to aspirin, Tylenol and caffeine in combination, and of course, rest.
Complex Migraines can be terrifying. Also referred to as Hemiplegic Migraines, they will commonly have features of either a classical or common type, but in addition, present with neurologic deficit. Many are mistaken for Cerebral Vascular Accidents (stroke), or Transient Ischemic Attack, and wish hospital observation and treatment. Ancillary studies are usually negative, and the event resolves spontaneously. Obviously, this inpatient requires an exhaustive assessment before being given this diagnosis.
Mixed Type is just that. usually a common throbbing head with muscle tension overlay or muscle tension ill with throbbing head overlay. Again, aspirin, Tylenol, and caffeine are helpful; also mild muscle relaxants are effective. usually if one component is treated, the other falls away.
Migraine Equivalent types are very interesting. commonly seen in college aged "type A" personalities, their hallmark is the scintillating optical scotoma, but there is no pain. That's right! There is no headache. These patients are obviously afraid they have something serious when they first see their doctors, but after a negative work up and reassurance they do fine. Also sharp is the phenomenon of "dissipation with this migraine. The scotoma starts commonly as a "dot", moderately enlarges, becomes a crescent with a large optical field cut known as a first-rate quadrantanopsia, (say that 3 times, real fast), sweeps laterally, then vanishes. These types of migraines usually determine as a condition by the time the private reaches their thirties.
The newer guidelines have made pathology more precise and streamlined for therapy using two sets: "Migraine with Aura", and "Migraine without Aura". Both have their definite subsets, criteria, and recommended therapies. Understand that The National ill Foundation also endorses guidelines for other types of headaches that are not classified as "migraine".
What we truly know about migraines now, started in the 1980s, subsequently producing new knowledge and new therapies. When sumatriptan hit the treatment cabinet as throbbing head weaponry in 1991, much changed in the arrival to headaches, along with throbbing head classing. Since its introduction, our comprehension of the throbbing head condition and the migrainer's display of symptoms has been revolutionary, and produced a paradigm shift in treatment. We now know that the "migraine" is truly a cascade of events.
We always knew that there was an basic driver and that migraines were vascular, hence, the pre-triptan therapies, which were designed to do two things, lyse an acute ill with narcotics and get the inpatient to sleep so as to break the vascular pain cycle and throbbing. The other, was to arrival chronically, preventing the throbbing head from evolving. We assumed that they were vascular from the starting of throbbing head study history and therapies, because they commonly throb and reply in kind to vasoconstricting agents. Subsequent study revealed that they occurred in 2 phases. First the blood vessels of the brain would constrict during stress or dietary trigger attack. Then, rather than come back to their traditional caliber, the vessels would overshoot, engorge, finally causing the painful phase.
So, our therapies in the 1980s and 1990s were designed to keep the constricting phase from manifesting, and therefore there would be no overshoot and no pain. This is why to this day we continue to see migrainers treated with blood pressure lowering medications like verapamil and propranolol, which prevent tightening of vessels. In increasing to these agents, antidepressants with lasting neurovascular down-gain performance like amitriptyline are added which help operate lasting pain. For many patients these drugs work. That's why they are still used in many migrainers who suffer severe and ongoing disabling attacks.
Sumatriptan lead to more compounds in the "triptan class", and a host of "me too drugs" which are the mainstay of therapy today. Why? Because the study which produced these drugs revealed that deep inside the brain of a migrainer is a "migraine motor". It is tied to an area in the midbrain called the Trigeminal Nucleus Caudalis. When stimulated by neurotransmitters from stress loads, lack of sleep, too much sleep, medications, or food triggers, it sends pain signals along the Trigeminal Nerve (The Fifth Cranial Nerve), and the vascular bed which surrounds it.
The two Trigeminal Nerves (left and right) are sensory nerves innervating the scalp, forehead, face and periosteal bone of the skull. When the throbbing head motor is stimulated, blood vessels are irritated, inflamed, and dilate, causing severe painful migraines. This should not be confused with its very predominant cousin, Trigeminal Neuralgia which is also very painful and responds to similar medical treatments. Sumatriptan counters this directly. It is structurally similar to serotonin (5Ht), and is a 5-Ht_agonist. The definite receptor subtypes it activates are present on the cranial arteries and veins. Acting as an agonist at these receptors, sumatriptan reduces the vascular inflammation and dilatation related with throbbing head at its source. Even in a disabling attack, sumatriptan injection can lyse the pain of throbbing head within minutes, without the side effects and sedation of narcotics and anti-emetics.
So now we know more about migraines and tension headaches. We know what causes them, how they are different, and how we can treat them. But you've probably been asking yourselves, what are these food triggers and how do they stimulate the "migraine motor"? throbbing head triggers are all over the web. A good place to start for a suitable list is at The National ill Foundation website: http//www.headaches.org.
The real mechanism of throbbing head motor stimulation is not fully understood, but may involve the neurotransmitter levels of dopamine, serotonin, and nor-epinephrine, in addition, the hormones 2-hydroxy-estradiol, progesterone, and thyroxin, as well as IgG antibodies from distinct food antigens. However, the triggers are well known and they themselves give us a clue.
Certainly there are known direct vasodilator foods such as Monosodium Glutamate (Msg), caffeine, kava based, and ephedra based herbs, and chocolate. Of course Msg is in all of our salted snacks and most of our "prepared" foods in the freezer section. Not surprisingly, many of my throbbing head patients when asked to keep a food diary, find they consumed large amounts of Msg the night before an attack, usually a potato chip, Doritos, or Frito binge. Citrus such as orange juice; wine, particularly the reds; hard aged cheeses; meats cured in nitrates; pickles; peanuts; and mint, to name only a few, are well known culprits.
The non-food triggers are classic: too much or not sufficient sleep; the computer screen you're finding at right now; stressful life styles; drugs of all kinds; and lastly, restorative hormones such as progesterone, yeah, your birth operate pills. This is one of the reasons why women are more prone to migraine.
Because headaches are so prevalent, they can become a huge topic in conversation with any doctor. Perhaps one needs to write a book on the branch to produce a concise literary treatment which the lasting ill sufferer can utilize. Or should I say, "Another book". That's right. There have been many, written by doctors and non-doctors alike. Hopefully this narrative will help you select the right one. In the mean time, watch those foods, try some way to lower your stress, don't forget to drink plenty of water, and if you are a true migrainer, or a lasting ill sufferer, you should see your doctor right away and don't forget to check out The National ill Foundation.
Dr. Counce
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