Contents 1 Pinyin 2 English Reference 3 Traditional Chinese Medicine·Migraine 3.1 Diagnostic Key Points of Migraine 3.2 Treatment of Migraine 3.2.1 Acupuncture Treatment 3.2.2 Prescription Treatment 3.2.3 Massage Therapy 4 Western Medicine·Migraine 4.1 Classification of diseases 4.2 Causes of migraine 4.3 Clinical stages of migraine 4.3.1 Pre-headache stage (aura stage or intracranial artery systole stage) 4.3.2 Headache stage 4.3.3 Late headache stage 4.3.4 Late stage of headache 4.4 Clinical classification of migraine 4.4.1 Typical migraine 4.4.2 Common migraine 4.4.3 Combined migraine 4.4.4 Migraine equivalence syndrome 4.5 Clinical manifestations 4.5.1 Migraine without aura (generalized migraine) 4.5.2 With Migraine with aura (classic migraine) 4.5.2.1 Aura phase 4.5.2.2 Headache phase 4.5.2.3 Subtypes of classic migraine 4.5.2.3.1 Migraine with classic aura 4.5.2.3.2 With prolonged aura Migraine (complex migraine) 4.5.2.3.3 Basal migraine (formerly known as basilar migraine) 4.5.2.3.4 Migraine aura without headache (migraine isotope) 4.5.3 Eye muscles Paralytic migraine 4.5.4 Benign paroxysmal vertigo in childhood 4.5.5 Status migraine 4.6 Diagnosis of migraine 4.6.1 Key points in diagnosis 4.6.2 Diagnostic criteria 4.6.2.1 Diagnostic criteria for migraine without aura 4.6.2.2 With typical aura Diagnostic criteria for migraine headache 4.7 Diseases that need to be differentiated from migraine 4.8 Treatment options for migraine 4.8.1 General treatment 4.8.2 Treatment of acute attacks 4.8.2.1 Mild migraine 4.8.2.2 Moderate to severe migraine 4.8.2.3 Accompanying symptoms 4.8.3 Preventive treatment 5 References attached: 1 Acupoints for treating migraine 2 Prescriptions for treating migraine 3 Chinese patent medicines for treating migraine 4 Migraine-related drugs 5 Migraine in ancient books 1 Pinyin
Migraine is the name of the disease, also known as migraine and migraine [1]. It refers to pain on one side of the head, which is often stubborn and may occur regularly. It is often accompanied by nausea, vomiting, and eye pain [2]. "Lanshi Secret Collection: Headache Gate": "For example, if the head is cold and painful, first take Shaoyang and Yangming from the hand, and then take Shaoyang and Yangming from the foot. This is also a migraine."
Migraine It is an episodic intracranial and extracranial vascular dysfunction characterized by recurrent headaches [3]. It belongs to the category of "headache" in Chinese medicine. The cause is currently unknown, but may be related to genetics or allergies [3].
3.1 Key points of diagnosis of migraine
① The headache is episodic, manifesting as pulsating pain or distending pain on one side, both sides or the whole head, usually not exceeding 24 hours. , which can last for several days in some cases [3].
② It is more common in women and is mostly caused by fatigue, emotional factors and menstrual cramps [3].
③The attack is often accompanied by obvious autonomic symptoms (such as pale complexion, cold sweat, nausea, vomiting, and urge to defecate, etc.). There is often drowsiness after vomiting, and the symptoms disappear after waking up [3].
④Exclude glaucoma, vertebrobasilar artery insufficiency, epileptic headaches, intracranial aneurysms and other diseases [3]. 3.2 Treatment of migraine 3.2.1 Acupuncture treatment
Take the Taiyang Shugu, Touwei, Fengchi, Taichong, Hegu, Zulinqi and other points [3]. Acupuncture the temple, 0.5 to 1.0 inches straight. After twisting to gain breath, withdraw the needle to the subcutaneous area, and then puncture through the skin along the trough to spread the soreness and swelling to the ipsilateral temporal area; the acupuncture pool should be directed toward the outside of the ipsilateral eye. Acupuncture is performed in the direction of the canthus, and the needle is inserted 0.8 to 1.0 cun, so that the needle sensation also spreads to the temporal and frontal areas on the ipsilateral side; the remaining points are all acupuncture according to conventional methods, using the purgative method or the flat tonic and flattening method [3].
3.2.2 Prescription treatment
"Yilin Shengmo·Headache": "Those who have migraine will have pain on one side, but the pain on the left side belongs to Qi. This Qi is better than wind, so it should be used to drive away wind. The first is to treat the Qi, such as Fangfeng Tongsheng Powder; if the pain is on the right side, it is due to phlegm, and the wind is stronger than the phlegm, so the main treatment is to clear the phlegm and reduce the fire, such as Fritillaria, Erchen plus Qin, Gardenia, and Chamomile. ” 3.2.3 Massage therapy
The following methods are effective for people with nausea, vomiting, photophobia, and phonophobia due to migraine [4]: ??
① Massage the thenar eminences of both hands with both hands. Side view of the sun for 1 minute.
② Use the thenar to push back the rate valley 100 times.
③ Use the pad of your index finger to press Taichong 5 times with slightly stronger force. 4 Western Medicine·Migraine
Migraine is a disease characterized by recurrent unilateral or bilateral headaches of unknown origin, often accompanied by nausea, vomiting, and reaction to light, fire, and sound** * Sensitive, a few typical attacks may be preceded by various visual, sensory, motor and other auras, and an attack lasts from 4 to 72 hours [5]. Headache is a common clinical symptom, which usually refers to pain limited to the upper half of the skull, including the area above the line connecting the eyebrow arch, the upper edge of the helix and the external occipital protuberance. According to different clinical manifestations, migraine can be divided into many types: common type, typical type, basilar artery type, ophthalmoplegic type, hemiplegic type, migraine isotopia, etc.
Migraine is a periodic disease that tends to occur in families. It manifests as episodic hemilateral pulsating headache, accompanied by nausea, vomiting, and blindness, and relapses after a period of rest. Headaches are relieved in a quiet, dark environment or after sleep. Nervous and mental dysfunction may occur before or during the headache. Migraine is a common type of headache and is an episodic neurovascular dysfunction that can occur at any age. The first onset of the disease usually occurs between the ages of 10 and 30, with more females than males, and more than 50% of cases have a family history of inheritance. The treatment of the disease focuses on prevention, and good results can often be obtained by applying preventive drugs and overcoming bad living habits. Effect. 4.1 Disease classification
Nervous system diseases > Episodic diseases > Headache and migraine 4.2 Causes of migraine
The cause of migraine is unclear, and about 50% of patients have a family history. Migraine attacks in female patients tend to occur before menstruation and decrease after pregnancy, suggesting that the onset may be related to endocrine or water retention. Mental stress, overwork, sudden changes in climate, strong light exposure, scorching sun exposure, hypoglycemia, application of vasodilator drugs or reserpine, and consumption of high-tyramine foods and alcoholic beverages can all induce migraine attacks.
How various triggers cause migraine attacks can be roughly based on the vascular source theory and the neurosource theory. Wolff et al used the vascular origin theory to explain the clinical manifestations of migraine. Typical migraine begins with constriction of intracranial arteries and reduction of local cerebral blood flow, causing aura symptoms such as visual changes, abnormal sensation, or hemiparesis, and then dilation of intracranial and external arteries, leading to headache.
Various companies used different methods to observe migraine patients during attacks, but failed to find a constant relationship between changes in intracranial blood vessels and headaches. Goltman saw dilation of intracranial blood vessels in a patient undergoing craniotomy during a migraine attack. Thie et al. found that the diameters of all arteries were relatively small in the cerebral angiography of 1 case of typical migraine attack, while Olson et al. found no changes in the cerebral angiography of 11 cases of typical migraine attack. Lauritzen et al. used 133XeSPECT to observe that there was no abnormality in rCBF during 12 cases of common migraine attacks. In 8 of 11 cases of typical migraine attacks, the rCBF in the hemisphere corresponding to the aura symptoms was reduced by an average of 17% compared with the corresponding area on the contralateral side. This was continuously seen during the headache period. 4 to 6 hours. No brain areas with increased rCBF were found. During inter-attack examinations, there were no abnormal findings in either type of migraine, except for one case where a small hypoperfusion area was found in the insula. Andersen et al. used 133XeSPECT to observe rCBF after the onset of migraine attack. There were no abnormalities in 3 cases, and only local perfusion was reduced in 2 cases. In 7 cases of typical migraine, headache occurred when the rCBF in the posterior hemisphere related to aura symptoms was 19% lower than the contralateral side. When the headache occurred When the headache was already very mild or the pulsatility of the headache disappeared, it turned into hyperperfusion. The rCBF increased by 19% compared with the contralateral side. In 2 cases, the hyperperfusion lasted for 24 hours. Olsen et al. used intracarotid artery injection of 133Xe to induce typical migraine. Using a 254 probe gamma camera, they found that the CBF in the back of the brain could be reduced by up to 20ml/(100g·min), and the local hypoperfusion could last until several hours after the aura symptoms disappeared. Olesen et al. measured the rCBF of typical migraine patients throughout the attack and observed that there was already hypoperfusion in the occipital region before the attack. The rCBF decreased by an average of 25 to 30% and gradually extended forward to the forehead, lasting for 4 to 4 months of the entire headache period. 6 hours. Kobari et al. used 133Xe-enhanced CT to measure local cerebral blood flow (1CBF). All 10 cases in the remission period were normal. In 6 cases of general migraine and 6 cases of typical migraine, the aura had disappeared 30 minutes to 8 hours after the onset of the attack. When having a headache, 1CBF generally increases on both sides, which can be 25% to 35% higher than that in the remission period, with the frontal, temporal cortex and thalamus being the most significant. The increase in the occipital area is not significantly different from that in the remission period. There is no difference between the two types of migraine.
Qin Zhen et al. used transcranial Doppler (TCD) to examine 10 patients with common migraine, and found that most patients showed abnormal increase in flow velocity of both sides or individual skull base large arteries during the headache remission period. Five migraine attacks in 3 cases showed abnormal increase in cerebral blood flow velocity and broadband murmur. Thie et al. also found the same findings in TCD examination of a case of typical migraine and a case of isotopic migraine. Qin Zhen et al. examined 99mTcSPECT in 2 cases of common migraine and found hypoperfusion in the posterior parietal cortex and temporal lobe respectively.
Therefore, during a migraine attack, in a considerable number of patients, cerebral blood flow may be low, increase, or first decrease and then increase, the cerebral blood flow speed increases abnormally, and the cerebral blood vessels dilate or become smaller in diameter. But there is no consistent relationship between these changes and headache type, aura, or headache onset. Some changes involve the head from the rear, while others involve the head from the front. The abnormal findings reported by the same author were not all seen in all similar patients observed. Some patients also had local hypoperfusion areas or increased cerebral blood flow velocity during the headache interval. In summary, the relationship between migraine and cerebrovascular dysfunction remains to be further elucidated.
Migraine attacks are accompanied by a series of biochemical changes. During the aura stage, the plasma serotonin (5HT) content may temporarily increase; during a headache attack, the metabolite of 5HT in the urine, 5hydroxyindoleacetic acid (5HIAA), may increase significantly. This suggests that 5HT in plasma is quickly degraded and excreted in urine. 5HT has a biphasic effect on smooth muscle, with reduced plasma 5HT causing contraction of small arteries and dilation of larger arteries. The contraction of small arteries causes ischemia of brain tissue, resulting in aura or other symptoms of neurological damage; the expansion of large arteries causes headaches. Part of 5HT leaks into the extracellular fluid around blood vessels, and together with neuropeptides such as histamine, bradykinin, and bradykinin, it reduces the pain threshold of the blood vessel wall and causes "sterile inflammation" of the arteries. Vasodilation combined with "sterile inflammation" causes the clinical symptoms of migraine. 5HT is mainly stored in platelets. When platelet aggregation increases or 5HT releasing factors are present, the 5HT content in platelets suddenly decreases and clinical onset occurs. Certain drugs (such as reserpine) have the effect of releasing and depleting 5HT, which can induce headache attacks in migraine patients; 5HT blockers (such as dimethylergosine, phenylthiazine) are used to prevent migraine attacks. The decrease in monoamine oxidase (MAO) activity during headache attacks may be related to the large amount of MAO consumed during the degradation of 5HT.
Many experiments have confirmed that the platelets of migraine patients are more likely to aggregate than those of normal people. After platelet aggregation, substances such as 5HT, ADP, histamine, epinephrine, norepinephrine, arachidonic acid (AA), and thromboxane A2 (TXA2) can be released. These substances can further promote platelet aggregation. This interaction produces a large amount of catecholamines, AA and TXA2, which can strongly constrict blood vessels and reduce cerebral blood flow. Prostaglandin E1 can cause headaches in people who have never had migraines. Estrogen can increase prostaglandin synthesis, and some women taking high-estrogen contraceptives can trigger migraine attacks.
But why does it only cause headaches due to extensive vascular regulatory mechanism disorders and many biochemical changes that affect the whole body? Why are most headache attacks lateralized? Sometimes it alternates left and right?
The neurogenic theory believes that the origin of migraine is in the central nervous system, and that endocrine changes and vasomotor disorders are secondary phenomena, that is, the vascular findings of migraine are secondary to the "nervous center" release". The various complex symptoms presented by migraine are the result of cerebral cortical dysfunction, which may be caused by a decrease in the excitation threshold of the hypothalamus/diencephalon.
Neurons containing norepinephrine 5HT innervate certain cranial blood vessels, and their cell bodies are located in the locus coeruleus and the inters suture nucleus of the brainstem. Mental stress, anxiety, fatigue or other factors lead to increased excitement and transmitter release of brainstem neurons, causing changes in cranial vascular movement, cerebral ischemia and "sterile inflammation" of blood vessels, *** damage to intravascular trigeminal nerve endings Receptors transmit pain to the brain. In addition, trigeminal nerve endings can release vasoactive substances (vasodilators and pathogenic peptides, substance P) into large intracranial and intracranial blood vessels. 4.3 Clinical stages of migraine
Migraine is clinically divided into four stages: 4.3.1 Pre-headache stage (aura stage or intracranial artery systole stage)
Headache attack There are premonitory signs, such as visual hallucinations (such as seeing flashes of light or a color) or various forms of blind spots. Other rare cases include dizziness, aphasia, confusion, abnormal sensation, facial or limb weakness, which lasts for about 10 to 30 minutes or several hours. This period is related to local ischemia of the brain. 4.3.2 Headache phase
Expansion of extracranial arteries causes pulsating headaches, often accompanied by nausea, vomiting, paleness, blindness and other autonomic symptoms. 4.3.3 Late stage of headache
There is edema around the extracranial arteries, the arteries become hard and tender, and the headache becomes persistent. 4.3.4 Late stage of headache
A period of headache lasts for 2 to 3 hours before falling asleep and disappearing after waking up; some patients have persistent vascular headache and neck muscle contraction headache. In this case, the headache can last for several hours. day.
4.4 Clinical classification of migraine
Migraine is clinically divided into three types: 4.4.1 Typical migraine
There are congenital genetic factors and obvious characteristic aura, as mentioned above. Typical four periods; 4.4.2 Common migraine
It is not hereditary, because its vascular reaction is mild, the aura is not obvious or absent, the headache does not occur suddenly but gradually worsens, and lasts for a long time (hours to days), the headache side is often accompanied by nasal congestion, runny nose, tears, conjunctival congestion, blindness, etc.; 4.4.3 Compound migraine
accompanied by transient or persistent neurological signs or Psychiatric symptoms, such as ophthalmoplegic and hemiplegic migraine; 4.4.4 Migraine equivalence syndrome
Migraine attacks are replaced by certain periodic physical disorders, such as abdominal pain, autonomic nervous system Symptoms, dizziness, mental disorders, etc., may alternate with typical migraine attacks. 4.5 Clinical manifestations
According to the international headache classification and diagnostic standards formulated by the International Headache Society in 1988, combined with my country's clinical practice, they are summarized as follows. 4.5.1 Migraine without aura (generalized migraine)
Migraine without aura (generalized migraine) is the most common. Episodic moderate to severe throbbing headache with nausea, vomiting, or photophobia. Headaches are worsened by physical activity. The attack starts with a mild to moderate dull pain or discomfort, and after a few minutes to a few hours it reaches severe throbbing or throbbing pain. About 2/3 have one-sided headaches, but they can also be bilateral headaches, and sometimes the pain radiates to the upper neck and shoulders. The headache lasts 4 to 72 hours and is usually relieved after sleep. There are well-defined normal intervals between attacks. If 90% of the attacks are closely related to the menstrual cycle, it is called menstrual migraine. The above-mentioned attacks have occurred at least 5 times, and diagnosis can only be made after excluding various intracranial and extracranial organic diseases. 4.5.2 Migraine with aura (typical migraine)
Migraine with aura (typical migraine) can be divided into two phases: aura and headache: 4.5.2.1 Aura phase
Visual symptoms in the aura stage are the most common, such as photophobia, flashes, sparks, or complex visual hallucinations, followed by visual field defects, scotomas, hemianopsia, or temporary blindness. A few patients may experience partial numbness, mild hemiplegia or speech impairment. Most auras last 5 to 20 minutes. 4.5.2.2 Headache Phase
The headache phase often occurs when the aura begins to subside. The pain usually starts in the supraorbital, postorbital or frontotemporal area on one side, gradually worsens and extends to half of the head, or even the entire head and neck. The headache is pulsating, throbbing or drilling, and gradually worsens to develop into persistent severe pain. Often accompanied by nausea, vomiting, photophobia, and phonophobia. Some patients have facial flushing, excessive sweating, and conjunctival congestion; some patients are pale, listless, and anorexic. An attack can last for 1 to 3 days. Usually the headache is significantly relieved after going to bed, but the patient feels tired and weak for several days after the attack. Everything is normal between attacks. 4.5.2.3 Subtypes of typical migraine
Typical migraine can be divided into several subtypes: 4.5.2.3.1 Migraine with typical aura
Migraine with typical aura Migraine includes ocular migraine, hemiplegic migraine, aphasic migraine, etc. The above typical attacks have occurred at least twice, and the diagnosis can only be established after excluding organic diseases. 4.5.2.3.2 Migraine with prolonged aura (complex migraine)
Migraine with prolonged aura (complex migraine) has symptoms that accompany migraine with typical aura. The aura persists during the headache attack, lasting more than 1 hour and less than 1 week. Neuroimaging examination cannot detect intracranial structural lesions. 4.5.2.3.3 Basal migraine (formerly known as basilar migraine)
Basal migraine (formerly known as basilar migraine) has aura symptoms that clearly originate from the brainstem or bilateral occipital lobes. , such as blindness, visual symptoms in both temporal and nasal fields of both eyes, dysarthria, vertigo, tinnitus, hearing loss, diplopia, ataxia, bilateral paresthesia, bilateral paresis or mental confusion. wait. It usually disappears within a few minutes to an hour, and then a pulsating headache in the bilateral occipital region is found. Everything is normal during the gap period. 4.5.2.3.4 Migraine aura without headache (migraine aura)
Migraine aura without headache (migraine aura) presents various aura symptoms seen in migraine attacks , but there are times when headaches do not ensue. As the patient ages, the headache may completely disappear while still having episodic aura symptoms, but it is rare for patients to have complete aura symptoms without headache. Those who develop the disease for the first time after the age of 40 need in-depth examination to exclude thromboembolic TIA. 4.5.3 Ophthalmoplegic migraine
Ophthalmoplegic migraine is extremely rare. The age of onset is mostly under 30 years old. There is a history of headaches fixed on one side. After a severe headache (orbital or retro-orbital pain), ophthalmoplegia on the same side occurs, with upper face drooping being the most common. The paralysis lasts for days or weeks and then resolves. The first few episodes of paralysis completely recover, but after multiple episodes, partial ophthalmoplegia may remain without recovery.
Neuroimaging cannot rule out intracranial organic lesions. 4.5.4 Benign episodic vertigo in childhood
Benign episodic vertigo in childhood (migraine attacks) has a family history of migraine but the child himself does not have headaches. It manifests as multiple, brief episodes of vertigo, as well as paroxysmal balance disorders and anxiety, accompanied by nystagmus or vomiting. Nervous system and electroencephalogram examination were normal. Everything is normal during the gap period. Some children may develop migraines as adults. 4.5.5 Status migraine
A migraine attack that lasts for more than 72 hours (with a possible remission period of less than 4 hours) is called status migraine. 4.6 Diagnosis of migraine
Diagnosis is not difficult if there is a long history of recurring headaches, everything is normal during the interval, a normal physical examination and a family history of migraine. Those with focal neurological signs need to exclude organic diseases. Ophthalmoplegia can be caused by aneurysm, and arteriovenous malformation can also be accompanied by migraine. A head CT scan or cerebral angiography should be performed for a clear diagnosis. Complex migraine is often caused by organic disease and neuroimaging examination should be performed. Occipital lobe or temporal lobe tumors may also present visual field defects or other visual symptoms in the early stages, but as the disease progresses, symptoms of increased intracranial pressure may eventually occur. Temporal arteritis should be excluded for temporo-occipital headaches in the elderly. The superficial temporal artery or occipital artery is thickened like a rope, the pulse is significantly weakened or disappears, and characteristic multinucleated giant cell infiltration is seen on artery biopsy. 4.6.1 Key points of diagnosis
1. Recurrent, unilateral or bilateral, moderate to severe, pulsating headache, usually lasting 4 to 72 hours, may be accompanied by nausea and vomiting, light, sound stimulation or daily activities can aggravate the headache, quiet environment, rest Can relieve headaches[5]. Some patients have visual, sensory, and motor auras before the attack [5].
2. A clinical diagnosis is usually made based on the type of migraine attack, family history, and neurological examination [5].
3. Brain CT, CTA, MRI, MRA and other examinations can rule out intracranial organic diseases such as cerebrovascular disease, intracranial aneurysms and space-occupying lesions [5]. 4.6.2 Diagnostic criteria
Diagnosis can be based on the latest migraine diagnostic criteria of the International Headache Society (2004) [5]: 4.6.2.1 Diagnostic criteria for migraine without aura
1. At least 5 attacks that meet characteristics 2 to 4 [5].
2. Headache attacks (untreated or ineffective with treatment) last 4 to 72 hours [5].
3. Have at least 2 of the following headache characteristics [5]:
(1) Unilateral;
(2) Pulsating;
(3) Moderate or severe headache; daily activities (such as walking or climbing stairs) that worsen the headache, or that such activities are actively avoided when the person has a headache.
4. The headache process is accompanied by at least one of the following items[5]:
(1) Nausea and/or vomiting;
(2) Photophobia and phonophobia.
5. Not attributable to other diseases. 4.6.2.2 Diagnostic criteria for migraine headache with typical aura
1. At least 2 attacks that meet characteristics 2 to 4 [5].
2. Aura has at least one of the following manifestations, but no motor weakness symptoms [5]:
(1) Completely reversible visual symptoms, including positive manifestations (such as flashes, bright spots or bright lines) and (or ) Negative manifestations (such as visual field defect);
(2) Completely reversible sensory abnormalities, including positive manifestations (such as pinprick sensation) and/or negative manifestations (such as numbness);
< p> (3) Completely reversible speech dysfunction.3. At least 2 of the following are met[5]:
(1) Visual symptoms in the same direction and/or unilateral sensory symptoms;
(2) At least 1 aura symptom gradually develops The process lasts for ≥5 minutes, and/or different aura symptoms occur one after another, and the process lasts for ≥5 minutes;
(3) Each aura symptom lasts for 5 to 60 minutes.
4. If the headache occurs at the same time as the aura symptoms or within 60 minutes after the aura occurs, the headache meets two or four of the diagnostic criteria for migraine without aura [5].
5. cannot be attributed to other diseases [5]. 4.7 Diseases that need to be differentiated from migraine
Migraine needs to be differentiated from tension headache, cluster headache, intracranial aneurysm, trigeminal neuralgia, Tolosa Hunt syndrome and other diseases that can cause headaches[5] . 4.8 Migraine treatment plan
In addition to relieving the symptoms of acute headache attacks, the purpose of treatment is to prevent or reduce the recurrence of headaches as much as possible. Various predisposing factors should be avoided. Medication, psychotherapy, acupuncture and qigong are effective for some patients. 4.8.1 General treatment
Life style, avoidance of triggering factors such as tyramine-containing foods, direct sunlight, etc.[5] 4.8.2 Treatment of acute attacks
People with acute attacks of migraine should rest indoors in a quiet and dark place.
Treatment should be guided by the response to drugs during past attacks, the severity of the attack, and age, with analgesics and sedatives being the mainstay [5]. 4.8.2.1 Mild migraine
The earlier the drug is used in patients with mild migraine, the better the effect will be until the headache is completely relieved [5]. Mild cases can take general analgesics and tranquilizers (such as aspirin, ibuprofen, etc.), and most can get relief. Those who have headaches accompanied by nausea and vomiting can use metoclopramide.
Non-specific analgesics can be used:
Aspirin 50-100 mg, once a day [5].
Diazepam 2.5 to 5 mg, 2 to 3 times a day [5].
Non-steroidal anti-inflammatory drugs such as acetaminophen, 300mg once, can be repeated once every 4 to 6 hours, no more than 2g within 24 hours; ibuprofen 400~800mg, 1 dose every 6 hours times[5]. 4.8.2.2 Moderate to severe migraine
For moderate to severe migraine, non-steroidal anti-inflammatory drugs or ergot 5HT1 receptor non-selective agonists such as ergotamine and caffeine can be taken orally, 1 to 2 tablets at a time [5 ]. If it is ineffective, take another 1 to 2 tablets after an interval of 0.5 to 1 hour. The total dosage per day should not exceed 6 tablets and no more than 10 tablets within a week [5].
Ergotamine treatment is effective for some patients. It is an agonist of 5HT receptors and also has a direct vasoconstrictive effect. It mainly stimulates 5HT1A receptors, but also has effects on dopamine and adrenergic receptors, so the side effects are greater. Ergotamine and caffeine tablets are commonly used (each tablet contains 100 mg of caffeine and 1 mg of ergotamine). Take 1 to 2 tablets immediately when aura appears or dull pain begins. To avoid ergot poisoning, do not take more than 4 tablets in a single episode, and the total dose per week should not exceed 8 tablets. Alternatively, 0.25 to 0.5 mg of ergotamine tartrate can be used for subcutaneous or intramuscular injection.
Note: Overdosage of ergot can cause side effects such as nausea, vomiting, abdominal pain, myalgia, peripheral vasospasm, and ischemia. It is contraindicated for people with severe cardiovascular, liver, and kidney diseases and pregnant women. It is also not applicable to hemiplegic, ophthalmoplegic and basilar migraines.
Ergotamine and caffeine have an oxytocin effect and are contraindicated in pregnant women; they should be used with caution in the elderly [5].
Ergotamine caffeine is a second-category drug controlled by the country. It is necessary to strictly abide by the national management regulations of the "Measures for the Administration of Drugs" and write prescriptions, supply and management of drugs in accordance with regulations. This type of medicines should be prevented from being abused[5].
Ergotamine and caffeine are most effective when taken immediately when a migraine attacks. It should not be taken after a migraine attack. Over-frequent application may cause drug overdose headache. To avoid this, it is recommended to use the drug no more than 2 to 3 days per week [5].
Sumatriptan is a 5HT1D receptor agonist and has a highly selective effect on cerebral blood vessels. Adults take 100 mg orally. The headache will begin to relieve after 30 minutes, and the best effect will be achieved after 4 hours. A subcutaneous injection of 6 mg (adult dose) has a rapid onset of action. If symptoms recur, another 6 mg injection can be given within 24 hours. Side effects are mild, including transient general body heat, dry mouth, head pressure and joint pain. Occasionally, chest tightness, chest pain or palpitations may occur.
For status migraine and severe migraine, oral or intramuscular injection of chlorpromazine (1mg/kg) or intravenous infusion of ACTH 50 units (placed in 500ml of glucose water), or oral prednisone 10mg, 3 times a day. For patients whose attacks last for a long time, attention should be paid to appropriate rehydration and correction of water and electrolyte imbalances. 4.8.2.3 Accompanying symptoms
When nausea and vomiting occur, antiemetic drugs such as metoclopramide 10 mg, intramuscular injection, or perphenazine, chlorpromazine, etc. are required [5].
For those who are irritable, diazepam or other drugs can be given to calm and ensure sleep, 10 mg once on the first day, and then reduced to 5 mg once as needed, 3 to 4 times a day [5]. Other drugs such as lorazepam 0.5 to 1 mg, 2 to 3 times a day; Zopiclone 7.5 mg, once a night, taken before going to bed [5]. Human body surface area calculator BMI index calculation and evaluation Female safe period calculator Pregnancy date calculator Normal weight gain during pregnancy Safety classification of medication during pregnancy (FDA) Five elements and eight characters Adult blood pressure evaluation Body temperature level evaluation Diabetes diet recommendations Common clinical biochemistry units Conversion to basal metabolic rate Calculate sodium supplementation calculator Iron supplementation calculator Commonly used Latin abbreviations for prescription Quick check Common symbols for pharmacokinetics Quick check Effective plasma osmolarity calculator Ethanol intake calculator
Medical encyclopedia, calculate now! 4.8.3 Preventive treatment
For patients with frequent moderate or severe migraine attacks, especially those who have more than one attack per week that seriously affects their daily life and work, they can prevent attacks during the precursor phase of headache attacks or early rehabilitation drugs. [5]. You can choose propranolol 10 to 60 mg, twice a day; flunarizine 5 to 10 mg before bedtime; verapamil 40 to 380 mg, three times a day; sodium valproate 200 to 400 mg, 2 times a day. ~3 times; amitriptyline 25~75mg, once a day, taken before going to bed [5].
Those who suffer from headache attacks 2 to 3 times a month should consider long-term preventive drug treatment. These drugs need to be taken daily and take at least 2 weeks to take effect. If the effect is effective, continue taking it for 6 months, then gradually reduce the dosage until discontinuation.
1. Propranolol? is a beta-adrenergic receptor blocker. It is effective for about 50% to 70% of patients, and the number of attacks in 1/3 of patients can be reduced by more than half. Propranolol 10 to 60 mg, twice a day [5]. The side effects are small, and the gradual increase can reduce adverse reactions such as nausea, ataxia, and limb cramps.
2. Pizotifen, sandomigran is a 5HT antagonist that also has antihistamine, anticholinergic and antibradykinin effects. The usual dose is 0.5 mg once a day, slowly increasing to 3 times a day. After continuous treatment for 4 to 6 months, 80% of patients' headaches improved or stopped. Side effects include drowsiness and fatigue, increased appetite, and long-term use can lead to weight gain.
3. Methysergide is a 5HT antagonist, mainly antagonistic to 5HT2 receptors. It is necessary to start taking it at a small dose (0.5 to 1 mg/day) and gradually increase it to 1 to 2 mg within a week, twice a day. It can cause side effects such as nausea, vomiting, dizziness, and drowsiness. Long-term use may cause fibrosis of retroperitoneal tissue and lung pleura. You must stop taking it for 1 month after taking it continuously for 6 months. Only consider trying it in the most stubborn patients.
4. Calcium channel blockers? Nimodipine (nimodipine) and flunarizine (flunarizine, sibling). The common dose of nimodipine is 20 to 40 mg, 3 times a day. The side effects of the drug are small, but discomforts such as dizziness, head fullness, nausea, vomiting, insomnia or skin allergies may occur.
Take 5 to 10 mg of flunarizine before bedtime [5].
5. Sodium valproate? 100~400mg, 3 times a day.
6. Amitryptiline is a tricyclic antidepressant that can prevent the reuptake of 5HT. It is mostly used to fight depression and treat chronic pain, and is effective for those with migraines and tension headaches. The usual dosage is 75 to 150mg/day.
7. Clonidine can inhibit the vasomotor center and has a blood pressure lowering effect. The effect of preventing migraines is weak, but it has no side effects when used in small amounts. The usual dosage is 0.078 mg ~ 0.15 mg, 2 to 3 times a day.
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