MIGRAIN WITH AURA

Particular variety of headache in the pathophysiological mechanism involving hereditary factors, circulatory and neuro-hormonal, it is not yet fully understood. A variety of stimuli may somehow act as predisposing factors and / or aggravating the crisis, among them: bright light, noise, emotional stress, alcohol, menstruation, chocolate, sausages, pickled foods.

Recommended Therapy
Symptomatic therapy: ergotamine tartrate, NSAIDs, triptans (sumatriptan, not always successfully). Preventive therapy (indicated if there are at least five seizures per month): propranolol and other beta-blockers, flunarizine and other calcium channel blockers, amitriptyline, serotonin, DOPA-agonists (lisuride, but there are still few data on the subject), methysergide, cyproheptadine and Pizotifen (the latter three drugs are used less and less).


WHAT IS AURA?

The aura is the distinctive feature of this type of headache. And 'that phase for a period of 5 to 60 minutes (on average 20-30 minutes) before the migraine attack is completely reversible, and in more than 80% of cases are represented by visual disturbances. These visual disturbances may be positive (flashing lights, shimmering images, stars, zig-zag lines or horseshoe) or negative, the rarest (deficit of view in one quadrant of the visual field that quadrantopsia, in severe cases loss of field of view). The migraine aura may be accompanied or followed by other neurological symptoms such as pins and needles sensation or feeling of numbness more frequently in the mouth, tongue and fingers on the side opposite the one where you locate the pain. It can also manifest a disorder of the word with difficulty in expressing themselves.

After the aura begins the painful crisis, immediately or after a few minutes. In some cases, after the aura will not take the painful crisis, in these cases we speak of "typical aura without headache." The painful phase it is shorter than migraine without aura, less than 4 hours in one quarter of the subjects. It is unilateral in 55% of cases and is in the middle button of the subjects. The intensity is lower than migraine without aura. The frequency of attacks is very irregular, being able to alternate periods of remission very long years, in times of crisis closer to each other, even after 24-48 hours. On average, attacks, the majority of patients, are less than 1 month.

In principle, are different and even less obvious. For example, the menstrual hormonal factors seem little influence on the occurrence of migraines, but there is an increase in pregnancy and a worsening of the crisis by taking oral contraceptives. Other triggers called to account, but some are not the usual psychological stress, intense physical exertion and even mild head trauma. Given the great variability of seizure frequency, we must adopt a logical therapeutic differently depending on the number of crises. It 'clear that the crisis in subjects with a few years (the majority) therapy is to wipe out the attack, and when crises are very often considering a preventive aim.

Among the drugs for migraine attacks are NSAIDs, namely analgesics, even those highly publicized by the media, often abused by the patient, and that triptans are often very painful to resolve quickly the attack. That is to say little or nothing about these drugs act on the aura, but tend only to suppress the painful attack. Even if triptans are administered during the aura does not affect the subsequent pain but should be administered at the beginning of the painful phase. Over the years, from time to time, other drugs have been proposed for the attack is painful for both the aura but studies have shown an effectiveness superior to placebo or no medication for a few in Italy or in the marketing still other cases they are assigned only to special and rare forms of migraine.

The drug prevention, as mentioned, are indicated in those subjects (which are the minority) who have frequent attacks. Among these drugs the most active in reducing the frequency of seizures are metoprolol, flunarizine and the last one is studying the lamotrigine would appear to be effective both on attachment painful aura. In this sense, we are also studying other antiepileptics like sodium valproate, gabapentin and topiramate.