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Tratamiento para la Migraña, Doctor Luis Carlos Moreno

Do You Suffer From Chronic Migraines?

Now There May Be a Surgical Treatment for Your Migraine

​by Doctor Luis Carlos Moreno

Migraine is a primary type of headache that usually begins in adolescence. The general prevalence at one year is 18.2% in women and 6.5% in men. 90% of migraineurs have their first attack before the age of 40 years.  It becomes a disabling problem in many patients with social and economic implications due to the many days of disabilities that can occur, even losing their jobs due to long absences.  Migraine is more common and frequent than asthma and diabetes combined. You have to distinguish when it comes to a migraine or any other type of headache

Migraine  It is characterized by presenting a prodromal phase that may or may not have auras before the headache phase itself begins, and ends with a resolution phase that patients perceive with varied symptoms.

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Tratamiento para la Migraña, Doctor Luis Carlos Moreno

The symptoms of the prodromal phase can be anorexia or lack of appetite, mood swings, lethargy and / or euphoria. The prodromal phase can last 1 to 2 days.  When it presents with auras (25% of cases), which are very characteristic symptoms that precede the pain phase itself and that can last an hour, the symptoms that can occur more frequently are visual symptoms such as seeing cucullos or lights , sensory, language disturbances and  motor symptoms such as cramps or stiffness or heaviness of the muscles.  There are migraines without auras  which are the most common.  


Then follows the headache phase that can be unilateral (more frequent), bilateral, usually severe, throbbing, with intolerance to light, sounds and / or hypersensitivity to odors. It can be associated with nausea or vomiting and   it increases with movements or efforts.  This phase of pain lasts between 4 hours and 72 hours (3 days).  


Rarely does a migraine last more than 3 days, and when this occurs, another pathology or a headache due to overuse of medications must be ruled out, which is caused by the abuse of analgesic medications. Then comes the resolution or postdromic phase where the patient may manifest irritability, a heavy head, fatigue and anorexia among other symptoms.

There are very specific criteria to be able to classify a headache as a migraine.  This is the migraine without aura or common, which  It is the most frequent, and for it to be classified as a common migraine, you must have at least 5 headache attacks that are associated with   2 or more of these  characteristics:   duration of 4 to 72 hours, whether unilateral, throbbing, moderate or severe pain, aggravated by physical activity;  and have  during pain at least one of these symptoms:  nausea or vomiting, photophobia or phonophobia.

Tratamiento para la Migraña, Doctor Luis Carlos Moreno

For classic migraine or migraine with aura, which is more common, you must have at least 2 attacks that meet the following criteria:  one or more of the following symptoms of reversible auras:  visual, sensory, language, motor or retina, and that  has two or more of the following characteristics: 1 or more aura symptoms that gradually spread over 5 or more minutes, aura symptoms that last 5 to 60 minutes, more than one aura symptom is unilateral, and the symptoms of aura are followed by headache.


The other category is chronic migraine which are migraine type headaches that are caused by  15 days or more per month or for more than 3 months attacks.  This chronic migraine is one that may be possible to treat surgically.


In many cases of migraine, the trigger that triggers the migraine can be of muscular origin, that is, there are muscles that compress  vessels or nerves and which are the ones that trigger the migraine process. One way to diagnose whether the trigger for a migraine is muscle compression is to treat the point where the migraine starts with botulinum toxin. If this test is positive, that is, by applying the botulinum toxin the symptoms are improved or the migraine disappears, surgical treatment can treat the migraine in that patient.  It is important to locate the point where the pain is triggered. Some start in the forehead, others in the temporal area, others in the nape. These pain start points are what determine the trigger for chronic migraine attacks.

Surgical treatment consists of releasing the muscular areas where the compression of the nerves or vessels occurs, and by releasing the compression, the triggering effect of the migraine is eliminated.  Surgical treatments in patients with chronic migraine, many of which are refractory to treatment, in the literature report improvements in some cases of up to 100% of attacks. The decision of surgery for these patients is only made after having been treated by their neurologist and presenting attacks that are very difficult to control with conventional treatments. 

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