A headache localized in the same place and recurring several times a month can 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 areas, oppressive sensations often affect the state of the organs of vision. Pain with migraine is almost always one-sided, not migratory. In some cases, pain begins in the occipital region, but later advances to the forehead.
In addition to a headache, patients with migraine suffer from photosensitivity, a painful reaction to noise, and a loud sound. Often, against the background of 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
Unlike headache, which occurs with other diseases, migraine has one specific symptom. This is a 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 the attack in patients are visual and speech disorders (for example, loss of visual field, flickering, “flies” in the eyes, temporary inability to pronounce words, individual syllables), weakness in the limbs, worsening sense of taste and smell, perception of size surrounding objects.
As soon as an attack of migraine pain begins, the aura disappears. There are cases when, after the appearance of the aura of an attack, it did not follow, but they are more correctly considered a rare exception.
Suspected Migraine Screening
Diagnosis occurs after research procedures. The first step in the diagnosis of migraine is to study the patient's complaints and the formation of a neurological history. Additional research procedures for suspecting 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.
A detailed examination practically makes it 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. The presence of evidence of tension and pain in the pericranial muscles. As the seizures become more frequent, pain sensations intensify.
When examining patients, a neurologist draws attention to another important criterion in the diagnosis of migraine - these are symptoms of vegetative-vascular dystonia, which include increased sweating of the palms and the bluish color of the fingers. Convulsive syndrome, which occurs against the background of excessive neuromuscular excitability, can signal dystonia.
What diseases can be confused
The main pathology, which proceeds in a similar way, is a headache of tension. This is not an independent disease, but rather a syndrome that occurs against the background of some neurological, cardiovascular disorders.
Unlike migraine, tension headache is less intense, and during the attack there is no painful pulsation. With this pathology, patients feel as if something is squeezing their head very strongly. Localization with tension headache is widespread. Symptoms such as nausea or photosensitivity do not accompany this disease.
The reason for the development of a headache of tension, in contrast to hereditary migraine, which can have many provoking factors, is a person's prolonged stay in an uncomfortable position for the neck or head, a stressful situation.
Differential diagnosis of basilar and vestibular migraines
Neurologists distinguish between two types of the most severe types of this disease. The first is basilar migraine, which occurs with dizziness in combination with impaired consciousness, psychomotor abnormalities, including causeless mood swings. The second type of disease is vestibular: its attacks are manifested exclusively by dizziness and temporary hearing loss, without a headache.
Vestibular migraine is most difficult to diagnose due to the absence of pain. Photophobia, an acute reaction to noise, an increase in symptoms during physical activity, and polyuria also indicate a migraine nature of dizziness. Unlike basilar migraine, with the vestibular type of the disease, patients have minor oculomotor abnormalities. While for the basilar form the inherent excitability of the vestibular apparatus is a tendency to motion sickness.
Specialist consultations
During the examination of the patient, the doctor will direct the patient for examination to narrow-profile doctors to exclude diseases that manifest headaches similar to migraines. If you suspect this disease, consultations are required:
- optometrist - with the aim of studying the condition of the fundus, determining visual acuity and excluding inflammatory and infectious processes;
- dentist - to assess the condition of the oral cavity, detect foci of purulent infection that could cause throbbing headache;
- otolaryngologist - the exception of diseases of the inner and middle ear, sinusitis, Meniere's disease;
- Vertebrologist - a study of the dorsal and cervical spine in order to confirm or exclude hernial formations and pinch nerves.
Consultations with the above specialists will allow you to find out the exact cause of the occurrence of headache attacks, and to exclude migraine or to determine the very provoking ailment.
Electroencephalography
This is the most affordable and painless method for the differential diagnosis of migraine. Vestibular forms of the disease affect the state of the brain structures, the main vessels and arteries that feed the brain at different periods of activity. In addition, due to encephalography, an inflammatory process or pathological disorders can be detected.
Tomography (computed and magnetic resonance)
In order to exclude possible neurological diagnoses, vascular aneurysms or oncological neoplasms, the attending physician will prescribe the patient a brain examination using computed tomography or magnetic resonance imaging. This type of study allows us to determine that the cause of migraine was abnormal processes affecting only one part of the head or several zones. At the same time, not so long ago, scientists put forward the version that migraine does not move further than the area in which the pain is localized.
Thanks to tomography, it is possible to determine the factors for the development of neurological diseases that provoke the appearance of pains that are 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 or aneurysm. This can be determined by computer diagnosis 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 detect a decrease in blood circulation intensity and a sharp spasm of the vessels before a migraine attack.
Benefits of MRI
The choice in favor of a particular diagnostic procedure should be made by the attending physician on the basis of the anamnesis, well-being of the patient and the general picture of the disease. If a specialist decides on the need for a study, he should clarify the parameters of MRI diagnostics of migraine, including the use of a contrast medium.
Magnetic resonance imaging determines the type of migraine that has arisen against the background of structural changes in the 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);
- head injuries;
- complaints of pain of unknown origin in one of the cerebral hemispheres;
- high risk of cerebral infarction.
When is a CT scan more appropriate?
Magnetic resonance imaging does not always detect neoplasms during diagnosis. Migraine in women or men may actually turn out to be a brain tumor, which computer tomography can recognize without a doubt. It should be noted 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 eliminate the accompanying 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 medium, which may contain various substances. Most often, iodine and gadolinium, which is injected into the peripheral vessels, are used. A few minutes later, as soon as the contrast is distributed over all arteries and intracranial vessels, they begin to x-ray the study area. Angiography results are converted to 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 tears in their walls, gaps, and the degree of elasticity. Unlike x-ray angiography, MRI angiography is a more expensive method of examination and does not require the use of contrast.
How to diagnose a child
There are no specific features for diagnosing migraine in children. Parents should pay attention to any complaints of the child if they are associated with a headache and symptoms such as nausea, vomiting, and hearing and vision impairment. When repeating several episodes of migraine, the baby must be shown to a neurologist.
The doctor will conduct a visual examination and conduct a survey. The specialist will need information about what the child ate or did before the attack of the disease occurred, what events preceded this. Parents are encouraged to keep a diary and note in it all the changes and potential causes of migraine attacks.
Most often, a pediatric neuropathologist diagnoses a child according to complaints and examination results. Moreover, an experienced specialist without additional studies will be able to make an assumption about the type of disease. Of the additional diagnostic procedures, children are prescribed electroencephalography, dopplerography, or brain MRI to assess the condition of the main vessels. Children under 14 years of age are not recommended for procedures such as radiography and CT, as they negatively affect the growing body.
Migraine Treatment
Many are confident that without waiting for the results of the diagnosis, it is impossible to proceed with the treatment of migraine. This is actually not the case. The principle of treatment for 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 simple one-component NSAIDs for the treatment of migraine, it is worth noting drugs based on:
- acetylsalicylic acid;
- ibuprofen;
- acetaminophen;
- naproxen;
- nimesulide;
- ketorolac;
- xefocama;
- diclofenac;
- lornoxicam.
If, after prolonged use, these drugs cease to be effective, they are replaced by more complex analgesics, which include 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 better relieve seizures in migraines, but you can’t take them regularly, since most of the components in the composition cause drug dependence.