What Is Migraine Surgery?

Typical migraine, also known as aura of migraine, accounts for 10% of migraine patients. It usually occurs in adolescence and has a family history.

Typical migraine, also known as aura of migraine, accounts for 10% of migraine patients. It usually occurs in adolescence and has a family history.

Chinese name

Typical migraine

Foreign name

classic migraine

Department

Neurology

Overview of typical migraines

The most significant feature of a typical migraine is the aura symptoms before the headache:

(1) Visual aura symptoms: Flash illusions can appear on both sides of the patient's field of vision, and the shape of the flash is uncertain, such as star-shaped or ring-shaped. Some patients have dark haze in front of their eyes, which is usually dark in the single eye, which is transient, or sees the vision deformed, the vision becomes larger or smaller, or the shape changes.

(2) Paresthesia: The most common are tingling and numbness in the hands and forearms. The numbness and leaning sensation in the two hands, limbs, hemilateral and around the lips diminish. It lasts a few hours, and in rare cases it can be days to weeks.

(3) Other aura symptoms: In addition to the above, the aura symptoms of migraine patients may also have motor aura, manifested as monoplegia or hemiplegia, or transient aphasia or mental symptoms.

Typical migraines can be divided into several subtypes:

(1) Migraine accompanied by typical threats: including ocular migraine, hemiplegia migraine, aphasia migraine and so on. The above-mentioned typical attacks have occurred at least 2 times before diagnosis can be established after excluding organic diseases.

(2) Migraine with protracted threat (complex migraine): The symptoms are the same as (1). Auras persist during the onset of a headache, lasting more than an hour and less than a week. Neuroimaging examination did not reveal intracranial structural lesions.

(3) Basal migraine (originally referred to as Basal artery migraine): There are aura symptoms clearly originating in the brainstem or bilateral occipital lobe, such as blindness, visual symptoms in both temporal and nasal visual fields, and dysarthria. , Dizziness, tinnitus, hearing loss, diplopia, ataxia, bilateral paresthesias, bilateral paresis, or insanity. It usually disappears within a few minutes to one hour, and then bilateral bilateral occipital pulsatile headache is found. Everything is normal during the gap period.

(4) Migraine precursors without headache (allergic migraine attacks): There are various aura symptoms seen in migraine attacks, but there is no subsequent headache. When the patient is getting older, the headache can disappear completely and there are still aura symptoms, but fewer people have completely aura symptoms and no headache. Patients who have developed the disease for the first time after the age of 40 need to be examined in depth, excluding thromboembolic TIA.

(5) Familial Hemiplegic migraine (FHM). Familial hemiplegic migraine (FHM). Familial hemiplegic migraine is an autosomal dominant inherited disorder. The clinical manifestation is a syndrome characterized by migraine as a precursor to hemiplegia. FHM has a strong genetic basis, and its genetic heterogeneity involves at least three chromosomes 19p, 1q21-23 and 1p31. 50% of FHM families have their genes linked to chromosome 19p13. FHM is caused by the CACNAIA gene suddenly. CACNAIA is the gene code of the P / Q type calcium channel d / A subunit of brain neurons, and its missense mutation causes FHM. The clinical characteristics of FHM are: its precursors are of varying degrees Hemiplegia and hemiplegia can be classified into typical migraine or protracted migraine according to the duration of the threat, and the affected side may vary from side to side, often occurring on one side, and may be accompanied by Other neurological dysfunction symptoms appear, such as visual blind spots, loss of anaesthesia, aphasia, from mental disorders to coma, fever, cerebrospinal fluid leukocytosis, and meningeal irritation. Signs and symptoms of pseudomeningitis, cerebral edema, and electroencephalography Perform slow wave activity for days or weeks. When these symptoms appear, they are often misdiagnosed as other diseases such as intracranial infection. Some families may also have symptoms of cerebellar involvement, such as nystagmus and progressive ataxia or episodic ataxia. Cerebellar atrophy can be seen on MRI. Occurs in a migraine attack. Some families may also have primary tremor and seizures. Acetazolamide has a significant effect on the onset of FHM, but is ineffective against progressive ataxia. The criteria for IHS diagnosis of FHM require at least two or more attacks, hemiplegia in the aura phase, and similar attacks in at least one generation of relatives, and the genetic pattern meets the autosomal dominant inheritance before diagnosis. Differential diagnosis needs to be considered : MELAS, CADSIL and paroxysmal ataxia type 2 (EA-2). Some families of EA-2 may also be associated with light hemiplegia and migraine attacks during the onset of ataxia. It may be difficult to identify clinical symptoms, but genetic testing It is helpful to distinguish, although FHM and EA-2 are both located at 19P13, FHM is a Missense mutation and EA-2 is a Truncating mutation. Hemiplegia precursors need to be distinguished from cerebrovascular diseases such as TIA. People with fever, pseudomeningitis, and mental retardation need to be distinguished from infectious diseases such as meningitis, meningoencephalitis, and these symptoms often cause misdiagnosis.

(6) Basal artery type migraine: This type is extremely rare and mainly occurs in adolescents or young women and is closely related to the menstrual cycle. Aura symptoms include bilateral visual disturbances such as flashing, dark spots, blurred or completely blind vision, transient dizziness, nausea, diplopia, tinnitus, numbness or paresthesia around the mouth and distal limbs, ataxia, or Have drowsiness and fall attacks. The threatening period lasts for an average of 10 to 30 minutes, followed by pulsatile headaches, which are often located in the occipital region and can be radiated to the back of the neck with nausea and vomiting. Nearly a quarter of patients may have unconsciousness during the peak period of headache attacks and headaches It lasts for several hours to one day, often remission after sleep, complete recovery, and the interval period is also normal. Occasionally, it can be seen that after multiple episodes, the basilar artery or posterior cerebral artery will be thrombotic. It is difficult to distinguish this type from vertebrobasilar ischemic disease.

(7) Migraine aura (no headache): In the past, it was called migraine allelic attack, which means that there are only recurrent attacks of neurological symptoms such as migraine aura, without headache. In the absence of a headache with the same threat, the diagnosis should be made with caution. A. Flashing dark spots: only show visual auras such as flashing dark spots, especially after migraine patients enter middle age, the headache gradually decreases, only showing visual auras from time to time, without subsequent headaches. B. Hemiplegia or numbness: It can be manifested as a short-term hemiplegic or numbness that does not occur regularly, and it does not cause headaches.