2 English reference migraine migraine [2 1 century bilingual dictionary of science and technology]
Migraine [Terminology Committee of Traditional Chinese Medicine]. Terminology of Traditional Chinese Medicine (2004)]
3 Migraine migraine is the name of the disease, also known as migraine and migraine wind [1]. Headache on one side often persists and can occur regularly, often accompanied by symptoms such as nausea, vomiting and eye pain [2]. "Shi Lan's Secret Collection of Headache": "The first half of the cold pain, first take the hand Shaoyang and Yangming, and then take the foot Shaoyang and Yangming, is also a migraine."
Migraine is paroxysmal intracranial and extracranial vascular dysfunction, characterized by recurrent headache [3]. Which belongs to the category of headache in traditional Chinese medicine. The etiology is not clear at present, which may be related to heredity or allergy [3].
3. 1 Diagnostic points of migraine ① Headache is paroxysmal, showing pulsatile pain or distending pain on one side, both sides or the whole head, which generally does not exceed 24 hours, and some cases can last for several days [3].
② It is more common in women and is induced by fatigue, emotional factors and menstrual cramps [3].
③ Seizures are often accompanied by obvious autonomic symptoms (such as pallor, cold sweat, nausea, vomiting and defecation). I often feel sleepy after vomiting, and the symptoms disappear after waking up [3].
④ Diseases such as glaucoma, vertebrobasilar insufficiency, epileptic headache and intracranial aneurysm were excluded [3].
3.2 Treatment of migraine 3.2. 1 Acupuncture treatment takes points such as Sunlight Tougu, Head and Tail, Fengchi, Taichong, Hegu and Zulinqi [3]. Acupuncture at the temple, 0.5 ~ 1.0 inch straight, twisting to get angry, withdrawing the needle to the subcutaneous, and then penetrating the valley along the skin to transmit the feeling of acid swelling to the ipsilateral temple; Acupuncture at fengchi should be directed towards the lateral canthus of the same eye, and the needle penetration should be 0.8 ~ 1.0 inch, so that the acupuncture sensation can also be transmitted to the temporal forehead of the same side; The rest of the acupoints were acupunctured according to the conventional method, with purging method or flat reinforcing purging method [3].
3.2.2 Prescription treatment of "benefiting the forest and causing pulse pain": "Migraine patients will feel pain on one side, but feel pain on the left side, which belongs to qi, and this qi is better than wind, so it is advisable to take the lead in smoothing the qi, such as Fangfeng Tongsheng Powder; Pain in the right hand belongs to phlegm, and this wind is better than phlegm. What is important is to reduce phlegm and reduce fire, such as Fritillaria, Chen Erjia Qin, Gardenia, Chamomile and so on. "
3.2.3 Massage Therapy The following methods are effective for migraine patients with nausea, vomiting, photophobia and phonophobia [4]:
① Press thenar with both hands and rub the sun on both sides 1 min.
② thenar pushes back to the valley 100 times.
(3) Press the index finger and abdomen for 5 times, with slightly stronger force.
4 Western medicine migraine is a disease characterized by unilateral or bilateral headache with unknown etiology, often accompanied by nausea and vomiting, sensitive to light fire, and a few typical symptoms can appear before the attack, lasting for 4-72 hours [5]. Headache is a common clinical symptom, which usually refers to the pain confined to the upper part of the skull, including the eyebrow arch, the upper edge of the helix and the connecting line above the occipital protuberance. According to the different clinical manifestations, migraine can be divided into many types: common type, typical type, basilar artery type, ophthalmoplegia type, hemiplegia type, migraine allelopathy and so on.
Migraine is a periodic disease with familial predisposition. It is characterized by paroxysmal unilateral pulsating headache, accompanied by nausea, vomiting and shyness, and recurs after a period of rest. Relieve headache in quiet and dark environment or after sleep. Before or during the onset of headache, it may be accompanied by neurological and mental dysfunction. Migraine is a common type of headache and a paroxysmal neurovascular dysfunction, which can occur at any age. The first onset is usually between 10-30 years old, with more women than men, and more than 50% cases have a family genetic history; The treatment of the disease focuses on prevention, and good results can often be achieved by applying preventive drugs and overcoming bad living habits.
4. 1 classification of diseases nervous system diseases >: paroxysmal diseases >: headache and migraine.
4.2 The cause of migraine The cause of migraine is still unclear, and about 50% of patients have a family history. Female patients often have migraine attacks before menstrual cramps, and the attacks decrease after pregnancy, suggesting that the onset may be related to endocrine or water retention. Mental stress, overwork, sudden climate change, strong light, scorching sun, hypoglycemia, using vasodilators or reserpine, eating high tyramine food and alcoholic beverages can all induce migraine attacks.
How various inducements can cause migraine attacks can generally be said according to the origin of blood vessels and nerves. Wolff and others explained the clinical manifestations of migraine with the theory of vascular origin. Typical migraine first has intracranial artery contraction, local cerebral blood flow reduction, which causes premonitory symptoms such as vision change, abnormal sensation or hemiparalysis, and then the intracranial and extracranial arteries dilate, resulting in headache.
The observation of migraine patients by different methods failed to find a constant relationship between intracranial vascular changes and headache. Goltman found intracranial vasodilation during migraine attack in 1 patient undergoing craniotomy. Thier et al. found in the cerebral angiography of 1 typical migraine attack that the diameters of all arteries were relatively small, while Olson et al. did not change in the cerebral angiography of 1 1 typical migraine attack. Lauritzen et al. observed with 133XeSPECT that 12 patients with common migraine attacks had normal rCBF, and10/patients with typical migraine attacks had an average decrease of 17% in the hemisphere corresponding to the aura symptoms for 4-6 hours. No increased rCBF was seen in the brain region. During the intermission, no abnormality was found in the two types of migraine, and only 1 case found a small hypoperfusion area in the insula. Andersen et al. observed rCBF after migraine attack with 133 x SPECT. When the rCBF of the posterior hemisphere related to aura decreased by 65438 09% compared with that of the contralateral hemisphere, 3 cases were normal, 2 cases only had reduced local perfusion, and 7 cases of typical migraine patients had headache. When the headache was mild or the headache pulse disappeared, it turned to high perfusion, and the rCBF increased by 65438 09% compared with the contralateral one. Two cases of high perfusion lasted for 20 years. Olsen et al. induced typical migraine by carotid injection 133Xe. Using a 254-probe γ camera, it was found that the CBF in the brain could be reduced by 20 ml/(100g min), and the local hypoperfusion could last for several hours after the halo disappeared. Olesen et al. measured the rCBF of typical migraine patients during the whole attack, and observed that there was hypoperfusion in the occipital region before the attack, and the rCBF decreased by 25-30% on average and gradually spread to the forehead, which lasted for 4-6 hours during the whole headache period. Kobari et al. used 133Xe enhanced CT to measure regional cerebral blood flow (1CBF). 10 cases were all normal in remission. 6 cases of generalized migraine and 6 cases of typical migraine occurred 30 minutes to 8 hours after onset. When the premonition disappeared and the headache was positive, the bilateral 1CBF generally increased, which was 25% ~ 35% higher than that in remission. There is no difference between these two types of migraine. Qin Zhen et al. performed transcranial Doppler examination on 10 patients with common migraine, and found that most patients had abnormal increase of bilateral or single basilar artery velocity during headache remission. Three patients with migraine showed abnormal increase of cerebral blood flow velocity and broadband murmur after five attacks. Thier et al. also found the same results in TCD examination of 1 typical migraine and 1 migraine. Qin Zhen and others performed 99mTcSPECT examination on 2 patients with generalized migraine, and found hypoperfusion in the posterior cortex of parietal lobe and temporal lobe respectively.
Therefore, when migraine attacks, a considerable number of patients can see that the cerebral blood flow is less, more or less, or decreases first and then increases, the cerebral blood flow velocity increases abnormally, and the cerebral vessels dilate or the caliber shrinks. However, there is no constant relationship between these changes and headache type, aura or headache attack. Some changes are followed by the head, and some changes are followed by the head. The abnormal findings reported by the same author can not be found in all patients of the same kind, and some patients still have local hypoperfusion area or increased cerebral blood flow velocity during headache interval. In short, the relationship between migraine and cerebrovascular dysfunction needs to be further clarified.
There will be a series of biochemical changes when migraine attacks. During the premonitory period, the plasma 5- hydroxytryptamine (5HT) content may temporarily increase. 5- hydroxyindoleacetic acid (5HIAA), a metabolite of 5-HT in urine, can be significantly increased during the onset of headache. This indicates that 5HT in plasma is rapidly degraded and excreted from urine. 5HT has biphasic effect on smooth muscle, and the decrease of plasma 5HT causes the contraction of arterioles and the expansion of larger arteries. Arteriole contraction leads to cerebral ischemia, which produces aura or other symptoms of nervous system damage; Dilation of aorta leads to headache. A part of 5HT leaks into extracellular fluid around blood vessels, which together with neuropeptides such as histamine, bradykinin and bradykinin reduces the pain threshold of blood vessel wall, leading to "aseptic inflammation" of arteries. Clinical symptoms of migraine caused by vasodilation combined with aseptic inflammation. 5HT is mainly stored in platelets. When platelet aggregation increases or there is a 5HT releasing factor, the 5HT content of platelets suddenly drops and clinical symptoms appear. Some drugs (such as reserpine) can release and excrete 5HT, which can induce migraine. 5HT blockers (such as dimethoxine and pizotifen) are used to prevent migraine attacks. The decrease of monoamine oxidase (MAO) activity during headache attack may be related to the consumption of a large amount of MAO during 5HT degradation.
Many experiments have confirmed that the platelets of migraine patients are easier to aggregate than those of normal people. Platelet aggregation can release 5HT, ADP, histamine, epinephrine, norepinephrine, arachidonic acid (AA) and thromboxane A2(TXA2), which can further promote platelet aggregation. This interaction produces a large number of catecholamine, AA and TXA2, which has the functions of strongly contracting blood vessels and reducing cerebral blood flow. Prostaglandin E 1 can cause headaches in people without migraine. Estrogen can increase the synthesis of prostaglandin, and some women who take high estrogen contraceptives can induce migraine attacks.
But why do extensive vascular regulation mechanism obstacles and many biochemical changes that affect the whole body only cause headaches? Why are most headaches unilateral? Sometimes it alternates left and right?
Neurogenesis theory holds that migraine originates from the central nervous system, and endocrine changes and vasomotor disorders are secondary phenomena, that is, the discovery of migraine blood vessels is secondary to the "release" of the central nervous system. The complex symptoms of migraine are the result of cerebral cortex dysfunction, which may be caused by the decrease of hypothalamic/diencephalon excitation threshold.
Neurons containing 5HT norepinephrine innervate some cranial vessels, and their cell bodies are located in locus coeruleus and raphe nucleus of brain stem respectively. Mental stress, anxiety, fatigue or other factors lead to the excitation of brain stem neurons and the increase of transmitter release, which leads to the changes of cerebrovascular movement, cerebral ischemia and "aseptic inflammation" of blood vessels, and the nociceptors of trigeminal nerve endings in blood vessels are introduced into the brain to produce pain. In addition, trigeminal nerve endings can release vasoactive substances (vasodilators and pathogenic peptides, substance P) to the intracranial and extracranial vessels of Jiao Da University.
4.3 Clinical Stage of Migraine Migraine can be divided into four stages clinically:
4.3. 1 Preheadache (premonitory period or intracranial artery contraction period) There are premonitions before the onset of headache, and there are many hallucinations (such as seeing a flash or a color) or various forms of blind spots. Other rare conditions include dizziness, aphasia, insanity, paresthesia, facial or limb weakness, etc. The duration is about 10 ~ 30 minutes or several hours, which is related to cerebral ischemia.
4.3.2 Pulsating headache caused by extracranial artery dilatation during headache period is often accompanied by autonomic nervous symptoms such as nausea, vomiting, pallor and shyness.
4.3.3 Late headache, edema around extracranial artery, hardening and softening of artery, and persistent headache.
4.3.4 In the later stage of headache, the headache lasts for 2-3 hours before going to sleep, and disappears after waking up; Some patients have persistent vascular headache and neck muscle contraction headache, so the headache can last for several days.
4.4 Clinical Classification of Migraine Migraine is clinically divided into three types:
4.4. 1 Typical migraine has congenital genetic factors and obvious characteristic aura, and has the above four typical periods;
4.4.2 Common migraine is not hereditary, because its vascular response is light, and the aura is not obvious or does not exist. Headache doesn't happen suddenly, but gets worse gradually, lasting for a long time (several hours to several days), and the headache side is often accompanied by nasal congestion, runny nose, tears, conjunctival congestion, shame, etc.
4.4.3 Compound migraine accompanied by transient or persistent nervous system signs or mental symptoms, such as ophthalmoplegia and hemiplegic migraine;
4.4.4 The equivalent migraine attack is replaced by some periodic physical disorders, such as abdominal pain, autonomic nervous symptoms, dizziness, mental disorders, etc. Can appear alternately with typical migraine attacks.
4.5 The clinical manifestations are summarized as follows according to the international headache classification and diagnostic criteria formulated by the International Headache Society 1988, combined with the clinical practice in China.
4.5. 1 migraine without aura (generalized migraine) migraine without aura (generalized migraine) is the most common. Occasional moderate to severe pulsating headache with nausea, vomiting or photophobia. Physical activity can aggravate headaches. At the beginning of the attack, it is only mild to moderate dull pain or discomfort, and it reaches severe pulsating pain or jumping pain after several minutes to several hours. About 2/3 of them are unilateral headaches or bilateral headaches, and sometimes the pain will radiate to the upper neck and shoulders. Headache lasts for 4 ~ 72 hours and usually relieves after sleep. There are obvious normal intervals between seizures. If 90% of the attacks are closely related to menstrual cycle, it is called menstrual migraine. Except for all kinds of organic diseases inside and outside the brain, the diagnosis can only be made after the above attacks occur at least five times.
4.5.2 aura migraine (typical migraine) aura migraine (typical migraine) can be divided into aura and headache:
4.5.2. 1 The most common visual symptoms in the aura period are photophobia, flashes and sparks in front of eyes, or complicated hallucinations, followed by visual field defect, scotoma, hemianopia or temporary blindness. A few patients may have hemiplegia, mild hemiplegia or speech disorder. The gas field usually lasts for 5 ~ 20 minutes.
4.5.2.2's headache often appears when the aura begins to fade. Most of the pain starts from one side of the orbit, the back of the orbit or the frontotemporal region, and gradually increases and spreads to half of the head and even the whole head and neck. Headache is pulsating, jumping or drilling-like, and the degree is gradually aggravated, and it develops into persistent severe pain. Usually accompanied by nausea, vomiting, photophobia and fear of sound. Some patients with facial flushing, sweating profusely, conjunctival congestion; Some patients are pale, listless and have poor appetite. An attack can last 1 ~ 3 days. Usually the headache is obviously relieved after sleep, but it lasts for several days after the attack. Everything was fine at halftime.
Subtypes of typical migraine in 4.5.2.3 Typical migraine can be divided into several subtypes:
4.5.2.3.1Migraine with typical aura Migraine with typical aura includes ocular migraine, hemiplegic migraine and aphasia migraine. At least the above two typical attacks have occurred, and the diagnosis can only be made after excluding organic diseases.
4.5.2.3.2 Migraine with prolonged aura (complex migraine) Migraine with prolonged aura (complex migraine) Typical migraine with prolonged aura symptoms. During the headache attack, the aura still exists, lasting more than 1 hour, but less than 1 week. Neuroimaging examination can not find intracranial structural lesions.
4.5.2.3.3 Basal migraine (formerly known as basal migraine) has premonitory symptoms clearly originating from brain stem or bilateral occipital lobes, such as blindness, visual symptoms accompanied by temporal and nasal visual fields, dysarthria, dizziness, tinnitus, hearing loss, diplopia, * * ataxia, bilateral sensory abnormality, bilateral paraplegia or psychosis. Most of them disappeared within a few minutes to 1 hour, and then bilateral occipital lobe pulsating headache appeared. Everything is normal during the intermission.
4.5.2.3.4 Headache-free migraine aura (migraine equipotential attack) appears in various aura symptoms of migraine attack, but sometimes headache does not follow. When the patient is older, the headache can disappear completely, and there are still paroxysmal premonitory symptoms, but few people have premonitory symptoms without headache. The first onset after the age of 40 requires in-depth examination, except for thromboembolic TIA.
4.5.3 Eye muscle paralysis migraine is rare. The onset age is mostly under 30 years old. Have a history of headache attacks fixed on one side. After severe headache (orbital or retroorbital pain), ipsilateral ophthalmoplegia occurs, and ptosis of the upper face is the most common. Paralysis lasts for a few days or weeks and then recovers. At first, paralysis completely recovered, but after several attacks, part of the eye muscle paralysis could be left behind and could not be recovered. Neuroimaging does not rule out intracranial organic lesions.
4.5.4 Benign Paroxysmal Vertigo in Childhood Benign Paroxysmal Vertigo (migraine Allelopathy) has a family history of migraine but the child himself has no headache. It is characterized by repeated and short-term vertigo attacks, paroxysmal imbalance and anxiety, accompanied by nystagmus or vomiting. The nervous system and EEG are normal. Everything is normal during the intermission. Some children will turn into migraines as adults.
4.5.5 A migraine attack lasting more than 72 hours (during which there may be a remission period shorter than 4 hours) is called migraine status quo.
4.6 Diagnosis of migraine It is not difficult to diagnose long-term recurrent headache history, normal interval, normal physical examination and family history of migraine. Children with focal neurological signs should be excluded from organic diseases. Ophthalmoplegia can be caused by aneurysm, arteriovenous malformation can also be accompanied by migraine, so CT scan or cerebral angiography should be done to make a definite diagnosis. Complex migraine is often caused by organic diseases, so neuroimaging examination should be done. Visual field defect or other visual symptoms may appear in the early stage of occipital lobe or temporal lobe tumor, but with the progress of the disease, intracranial pressure may eventually increase. Temporooccipital headache in the elderly needs to be excluded from temporal arteritis. Superficial temporal artery or occipital artery thickens like a rope, and the pulse is obviously weakened or disappeared. Arterial biopsy showed characteristic multinucleated giant cell infiltration.
4.6. 1 diagnosis point 1. Recurrent, unilateral or bilateral, moderate or severe, pulsating headache, usually lasting 4 ~ 72 hours, may be accompanied by nausea and vomiting. Light, sound or daily activities can aggravate headaches, while quiet environment and rest can relieve headaches [5]. Some patients have premonitions of vision, feeling and action before the attack [5].
2. According to migraine attack type, family history and nervous system examination, clinical diagnosis can usually be made [5].
3. Brain CT, CTA, MRI, MRA and other examinations can exclude cerebrovascular diseases, intracranial aneurysms, space-occupying lesions and other intracranial organic diseases [5].
4.6.2 Diagnostic criteria This diagnosis can be based on the latest migraine diagnostic criteria of International Headache Association (2004) [5]:
4.6.2. 1 Diagnostic criteria of migraine without aura 1. At least 5 episodes meet the characteristics of 2 ~ 4 [5].
2. Headache attack (untreated or ineffective) lasts for 4 ~ 72 hours [5].
3. Have at least the following two headache characteristics [5]:
(1) unilateral;
(2) pulsation;
(3) Moderate or severe headache; Daily activities (such as walking or going up stairs) can aggravate headaches, or they will actively avoid such activities when they have headaches.
4. Headache accompanied by at least the following 1 item [5]:
(1) Nausea and/or vomiting;
(2) Fear of light and sound.
5. It cannot be attributed to other diseases.
The diagnostic standard of typical migraine with aura in 4.6.2.2 is 1. At least 2 episodes with 2 ~ 4 features [5].
2. The premonitory symptoms are at least 1 below, but there is no motor weakness [5]:
(1) completely reversible visual symptoms, including positive manifestations (such as flashing, bright spots or bright lines) and/or negative manifestations (such as visual field defect);
(2) completely reversible sensory abnormalities, including positive manifestations (such as tingling) and/or negative manifestations (such as numbness);
(3) Completely reversible speech dysfunction.
3. Meet at least the following two items [5]:
(1) Weather symptoms and/or unilateral sensory symptoms;
(2) At least 1 premonitory symptoms gradually develop for ≥5 minutes, and/or different premonitory symptoms appear successively for ≥5 minutes;
(3) Each aura lasts for 5-60 minutes.
4. Headache and aura symptoms appear at the same time or within 60 minutes after aura appears. Headache meets the second and fourth items in the diagnostic criteria of migraine without aura [5].
5. It cannot be attributed to other diseases [5].
4.7 Diseases that need to be differentiated from migraine need to be differentiated from tension headache, cluster headache, intracranial aneurysm, trigeminal neuralgia, TolosaHunt syndrome and other diseases that can cause headaches [5].
4.8 Treatment plan for migraine The purpose of treatment is not only to relieve the symptoms of acute headache, but also to prevent or reduce the recurrence of headache as much as possible. Various inducing factors should be avoided. Drug therapy, psychotherapy, acupuncture and qigong are effective for some patients.
4.8. 1 generally treat the law of life and avoid inducing factors such as food containing tyramine and direct sunlight. [5].
4.8.2 Treatment of acute attack The author of acute migraine should rest in a quiet and dark room.
The treatment should be guided by the previous reaction to drugs, the severity and age of the attack, with analgesic and sedative drugs as the main ones [5].
4.8.2. 1 The earlier the medication is used for mild migraine, the better the effect will be until the headache is completely relieved [5]. Mild people can take general analgesics and sedatives (such as aspirin and ibuprofen). ), and most of them can be alleviated. Headaches with nausea and vomiting can be treated with metoclopramide.
Nonspecific painkillers can be used:
Aspirin 50 ~ 100 mg, daily 1 time [5].
Diazepam 2.5 ~ 5 mg, 2 ~ 3 times a day [5].
Non-steroidal anti-inflammatory drugs, such as acetaminophen, once 300mg, can be used repeatedly 1 time, with an interval of 4-6 hours and no more than 2 g within 24 hours; Ibuprofen 400 ~ 800 mg, every 6 hours 1 time [5].
4.8.2.2 can take orally nonsteroidal anti-inflammatory drugs or ergot 5T 1 receptor non-selective agonists such as ergotamine caffeine, 1 ~ 2 tablets once [5]. If it doesn't work, take 1 ~ 2 tablets every 0.5 ~ 1 hour, with no more than 6 tablets per day and no more than 1 0 tablets per week [5].
Ergotamine is effective for some patients. It is an activator of 5HT receptor and has a direct vasoconstrictive effect. It mainly excites 5HT 1A receptor, but it also has effects on dopamine and adrenaline receptor, so it has great side effects. Ergotamine caffeine tablets are commonly used (each tablet contains caffeine 100mg, ergotamine 1mg). Take 1 ~ 2 tablets immediately when premonition or dull pain occurs. In order to avoid ergot poisoning, the single dose should not exceed 4 tablets, and the total weekly dose should not exceed 8 tablets. Or ergotamine tartrate 0.25 ~ 0.5 mg can be used for subcutaneous or intramuscular injection.
Note: Excessive use of ergot may cause nausea, vomiting, abdominal pain, myalgia, peripheral vasospasm, ischemia and other side effects. Severe cardiovascular, liver and kidney diseases and pregnant women are prohibited. It is also not suitable for hemiplegia, ophthalmoplegia and basal migraine.
Ergotamine caffeine can induce labor, which is prohibited for pregnant women; The elderly should use it with caution [5].
As ergotamine coffee belongs to the second-class drug managed by the state, it is necessary to strictly abide by the provisions of the "Administrative Measures" of the state, make prescriptions, supply and manage this kind of drug according to regulations, and prevent abuse [5].
Ergotamine caffeine is effective immediately after migraine attack, and should not be taken after migraine attack. Over-frequency application can cause drug overdose and headache. In order to avoid this situation, it is recommended to take medicine for no more than 2 ~ 3 days per week [5].
Sumatriptan is an activator of 5HT 1D receptor, which has a highly selective effect on cerebral vessels. Adults take 100mg orally, and the headache begins to relieve after 30 minutes, and the curative effect is the best after 4 hours. Subcutaneous injection of 6mg (adult dose) takes effect quickly. If symptoms recur, another 6mg can be injected within 24 hours. Side effects are mild, including transient general fever, dry mouth, head pressure and joint pain. Occasionally have chest tightness, chest pain or palpitations.
State migraine and severe migraine can be treated by oral or intramuscular injection of chlorpromazine (1mg/kg) or intravenous drip of ACTH50 units (placed in 500ml glucose water), or oral prednisone 10mg, 1, three times a day. For patients with long duration of attack, attention should be paid to proper rehydration to correct the disorder of water and electrolyte.
4.8.2.3's accompanying symptoms include nausea and vomiting, which need to be injected with metoclopramide 10mg and other antiemetic drugs. Or perphenazine and chlorpromazine [5].
People who are agitated can be given diazepam to ensure sleep, 1 once a day 10 mg, and then reduced to 5mg once a day as needed, 3-4 times a day [5]. Other drugs such as lorazepam 0.5 ~ 1 mg, 2 ~ 3 times a day; Zopiclone 7.5mg, every night/kloc-0 times, before going to bed [5].
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4.8.3 Prevention and treatment of frequent attacks of moderate and severe migraine, especially for patients with more than 65,438+0 attacks per week, which seriously affects their daily life and work, can be prevented by threatened headache attacks or early rehabilitation drugs [5]. Propranolol 10 ~ 60 mg twice a day; Flunarizine 5 ~ 10 mg before going to bed; Verapamil 40 ~ 380 mg, three times a day; Sodium valproate 200 ~ 400 mg, 2 ~ 3 times a day; Amitriptyline 25 ~ 75 mg, daily 1 time, taken before going to bed [5].
Those who have headaches for 2 ~ 3 times a month should consider long-term preventive drug treatment. This medicine needs to be taken every day, and it will take effect at least 2 weeks after taking it. If it works, continue to take it for 6 months, and then gradually reduce the dosage and stop taking it.
1. Propranolol? It is a beta adrenergic receptor blocker. About 50% ~ 70% patients are effective, and the number of attacks in 1/3 patients can be reduced by more than half. Propranolol 10 ~ 60 mg twice a day [5]. The side effects are small, and the gradual increase can reduce the adverse reactions such as nausea, ataxia and painful spasms of limbs.
2.5ht antagonists also have antihistamine, anticholinergic and bradykinin effects. The usual dose is 0.5mg/kloc-0 once a day, and gradually increase to 3 times a day. After 4 ~ 6 months of continuous treatment, 80% of patients' headache improved or stopped. Side effects include drowsiness and fatigue. Long-term use will increase appetite and make you fat.
3.methysergide) 5HT antagonist, which mainly antagonizes 5HT2 receptor. It should be taken from a small dose (0.5 ~ 1mg/ day) and gradually increased to 1 ~ 2 mg within one week, twice a day. Can cause nausea, vomiting, dizziness, drowsiness and other side effects, long-term use can appear retroperitoneal tissue, pulmonary pleural fibrosis. Take it continuously for 6 months, and stop taking it 1 month. Try it only on the most stubborn patients.
4. Calcium channel blockers? The usual dosage of nimodipine and flunarizine is 20 ~ 40 mg, three times a day. The medicine has few side effects, and may cause dizziness, head swelling, nausea, vomiting, insomnia or skin allergy.
Flunarizine 5 ~ 10 mg before going to bed [5].
5. Sodium valproate? 100 ~ 400 mg, 3 times a day.
6. Amitriptyline is a tricyclic antidepressant, which can prevent the reuptake of 5HT. It is mostly used to treat depression and chronic pain, and is effective for migraine with tension headache. The usual dose is 75 ~150mg/day.
7. Clonidine can inhibit the vascular motor center and has antihypertensive effect. The effect of preventing migraine is weak, but a small amount of application has no side effects. The usual dosage is 0.078 mg ~ 0. 1.5 mg, 2 ~ 3 times a day.
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