Management and Treatment of Migraine with the Available Market Preparations of Bangladesh

Abstract

Migraine is a familial disorder characterized by recurrent attacks of headache widely variable in intensity, frequency and duration. Attacks are commonly unilateral and are usually associated with anorexia, nausea and vomiting".A subtype of vascular headaches characterized by periodic unilateral pulsatile headaches which begin in childhood, adolescence, or early adult life and recur with diminishing frequency during advancing years. The two major subtypes are classic migraine (i.e., migraine with aura) and common migraine (i.e., migraine without aura). Migrainous episodes may be associated with alterations in cerebral blood flow. Migraine is most likely a heterogeneous disorder and has trigger factors and multiple physiologic causes like fatigue or emotional stress, Secondary to brain dysfunction, Specific foods or alcohol etc. Symptoms of migraines are the result of a constriction and dilation or widening of arteries in the brain. This process results in the classic symptoms of migraine, which include a severe, throbbing persistent headache that increases in intensity. The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis of mlgrame may include medical history, headache diary, migraine triggers, investigations (only to exclude secondary causes), EEG, CT Brain etc. Advances in our understanding of the pathophysiology of migraine have resulted in important breakthroughs in treatment. For example, understanding of the role of serotonin in the cerebrovascular circulation has led to the development of triptans for the acute relief of migraine headaches, and the identification of cortical spreading depression as an early central event associated with migraine has brought renewed interest m antiepileptic drugs for migraine prophylaxis. However, migraine still remains inadequately treated. Indeed, it is apparent that migraine is not a single disease but rather a syndrome that can manifest itself in a variety of pathological conditions. The consequences of this may be that treatment needs to be matched to particular patients. The management approach of migraine is to reducing the attack frequency and severity, avoiding escalation of headache medication, educating and enabling the patient to manage the disorder, improving the patient's quality of life. Clinical research needs to be devoted to identifying which sort of patients benefit best from which treatments, particularly in the field of prophylaxis. We propose four patterns of precipitating factors (adrenergic, serotoninergic, menstrual, and muscular) which may be used to structure migraine prophylaxis. Finally, little is known about long-term outcome in treated migraine. It is possible that appropriate early prophylaxis may modify the long-term course of the disease and avoid late complications.