migraine 편두통

Migraine is a chronic disorder characterized by moderate to severe headaches, and nausea. Although some believe it to be a neurological disorder, there is no evidence to confirm this theory.^[1] Migraines are about three times more common in women than in men.^[2] The word derives from the Greek ἡμικρανία (hemikrania), "pain on one side of the head",^[3] from ἡμι- (hemi-), "half", and κρανίον (kranion), "skull".^[4]

A typical migraine headache is unilateral (affecting one half of the head) and pulsating in nature and lasting from two to 72 hours; symptoms include nausea, vomiting, photophobia (increased sensitivity to light) and phonophobia (increased sensitivity to sound); the symptoms are generally aggravated by routine activity.^[5][6] Approximately one-third of people who suffer from migraine headaches perceive an aura—transient visual, sensory, language, or motor disturbances signaling the migraine will soon occur.^[7][5]

Initial treatment is with analgesics for the headache, an antiemetic for the nausea, and the avoidance of triggers. The cause of migraine headache is unknown; the most supported theory is that it is related to hyperexcitability of the cerebral cortex and/or abnormal control of pain neurons in the trigeminal nucleus of the brainstem.^[8]

Studies of twins indicate a 60- to 65-percent genetic influence upon their propensity to develop migraine headaches.^[9][10] Moreover, fluctuating hormone levels indicate a migraine relation: 75 percent of adult patients are women, although migraine affects approximately equal numbers of prepubescent boys and girls. Propensity to migraine headache sometimes disappears during pregnancy, but in some women, migraines may become more frequent.^[11]

Cause

The underlying cause of migraines is unknown.^[22] There are, however, many biological events that have been clinically associated with migraine.

Triggers

Migraines may be induced by triggers, with some reporting it as an influence in a minority of cases^[12] and others the majority.^[23] Many things have been labeled as triggers, however the strength and significance of these relationships are uncertain.^[23][24] Common triggers quoted are stress, hunger, and fatigue (these equally contribute to tension headaches).^[23] A 2003 review concluded there was no scientific evidence for an effect of tyramine on migraine.^[25] A 2005 literature review on dietary triggers found the available scientific studies, mostly relying on subjective assessments, were not rigorous enough to prove or disprove any particular triggers.^[26] This is in line with other reviews. A 2009 review of potential triggers in the indoor and outdoor environment concluded the overall evidence was of poor quality, but nevertheless suggested people with migraines take some preventative measures related to indoor air quality and lighting.^[27] While monosodium glutamate (MSG) is frequently reported as a dietary trigger^[28] evidence does not consistently support this.^[29] Migraines are more likely to occur around menstruation.^[30] Other hormonal influences, such as menarche, oral contraceptive use, pregnancy, perimenopause, and menopause, also play a role.^[31]

Prevention

Main article: Prevention of migraines

Preventive treatments of migraines can be an important part of migraine management and include: medications, migraine surgery, nutritional supplements, lifestyle alterations, such as increased exercise, and avoidance of migraine triggers. The goals of preventive therapy are to reduce the frequency, painfulness, and/or duration of migraines, and to increase the effectiveness of abortive therapy.^[44] Another reason to pursue these goals is to avoid medication overuse headache (MOH), otherwise known as rebound headache. This is a common problem and can result in chronic daily headache.^[45][46] Many of the preventive treatments are quite effective. Even with a placebo, one-quarter of patients find their migraine frequency is reduced by half or more, and actual treatments often far exceed this figure.^[47]

Medication

Preventive migraine drugs are considered effective if they reduce the frequency or severity of migraine attacks by at least 50%.^[48] The most effective preventitative medications include: beta-blockers, flunarizine, valproic acid, topiramate and amitriptyline while there is less evidence for venlafaxine, gabapentin, naproxen, butterbur root, vitamin B2 and magnesium.^[49]

Surgery

Migraine surgery which involves decompression of certain nerves around the head and neck may be an option in certain people who do not improve with medications.^[50]

Alternative therapies

Acupuncture is effective in the treatment of migraines.^[51] The use of "true" acupuncture is not more efficient than sham acupuncture, however, both "true" and sham acupuncture appear to be more effective than routine care, with fewer adverse effects than prophylactic drug treatment.^[52] Chiropractic manipulation, physiotherapy, massage and relaxation might be as effective as propranolol or topiramate in the prevention of migraine headaches; however, the research had some problems with methodology.^[53] There is some tentative evidence of benefit for: magnesium, coenzyme Q(10), riboflavin, vitamin B(12),^[54] fever-few, and butterbur.^[55]

Medical devices

Medical devices, such as biofeedback and neurostimulators, have some advantages in the migraine treatment, mainly when common antimigraine medication is contraindicated or in case of medication over use. Biofeedback helps people to be conscious of some physiologic parameters to control them and try to relax and may be efficient for migraine treatment.^[56][57] Neurostimulation uses implantable neurostimulators similar to pacemakers for the treatment of intractable chronic migraines^[58][59] with encouraging results for severe cases.

 

건강샘에서

		편두통이란?

편두통은 가장 흔한 혈관성 두통의 형태로 여자가 남자보다 3배정도 많고, 인구의 20-30%가 편두통을 앓은 경험이 있으며, 이들 중 60-70%에서 가족력이 있다고 합니다. 흔히 완벽, 내성적, 잠재적 적개심, 신경증적 성격일 때 많이 나타납니다.

		편두통은 왜 생기나요?

이러한 편두통의 발생 기전은 아직 확실히 알려져 있지 않으나 주로 머리 속의 내, 외 동맥이 가끔씩 불안정하게 운동하면서 혈관이 수축 및 확장하여 발생하는 것으로 생각됩니다. 유발 요인으로는 정신적인 스트레스, 생리 전, 기상 변화, 폐경, 발효된 음식물이나 공복 시 또는 혈관을 확장시키는 약 등이 있습니다.

		편두통의 증상은?

전형적인 편두통은 전구증상으로 갑자기 눈 앞에 번쩍거리는 느낌이 있고, 눈이 피로해지고, 시야가 흐려지고, 한쪽 또는 양쪽 팔다리에 감각의 이상 등 국소 신경 증상이 나타납니다. 그러나 대부분의 경우 분명한 전구 증상을 알기는 힘들고, 뇌동맥이 확장하게 되면 편두통을 느끼게 됩니다.  편두통은 발작적으로 짧게 그리고 맥박이 뛰는 것과 함께 통증을 느끼게 되고, 흔히 오심이나 구토, 광선 공포, 전신무력, 시야 흐림, 이상 감각, 현훈(어지러움) 등의 증상들이 동반될 수 있습니다. 통증은 대개 24-48시간 동안 지속되며, 몇 주 또는 몇 달 간격으로 발생하는 주기성을 가지는 경우도 있습니다.

		편두통은 어떻게 치료하나요?

편두통은 개개인에 따라 증상 지속 시간도 다르고 빈도도 다양하기 때문에 예방 제제나 급성 발작 조절 제제의 선택에 신중을 기해야 합니다. 자신이 편두통 환자라고 진단을 받으면 두통 일기를 쓰면서 발작의 빈도 및 일상 생활에 미치는 영향 등을 조사하는 것이 좋습니다.  만약 편두통 발작이 1개월에 1-2회 이하이고 일상 생활에 지장을 초래하지 않는 정도라면, 발작 급성기의 치료만을 하면서 상태를 관찰하지만, 편두통 발작이 1개월에 3-4회 이상이거나, 발작 횟수가 1개월에 1-2회이더라도 일상 생활에 지장을 줄 정도라면 예방적 약물 요법을 실시합니다.  -약물요법  증상이 온다고 느낄 때 바로 약을 먹는 것이 중요합니다. 유발할 수 있는 상황에 대해서도 미리 인지하고 있어야 합니다. 만일 피할 수 없는 상황이라면 최소한 그 전에 처방 된 약이라도 먹을 수 있는 준비를 해 두는 것이 좋습니다. 투약은 각자의 상황에 맞추어 이루어져야 하며 반드시 의사의 처방에 의한 약만을 복용하며 지시사항도 잘 따라야만 합니다. Flunarizine, Sumatriptan, 카펠고트(ergotamine, caffeine), 미가펜과 같은 약물이 처방됩니다.

		생활 가이드

-금연을 하고 과다한 알코올을 삼가고, 기분 전환제, 각성제, 흥분제, 진정제를 일체 금해야 합니다. -표준체중을 유지하고 모든 활동에서 적정선을 유지하는 것이 좋습니다.  -삶의 긍정적인 면을 찾고 간직하며 자신과 타인에 대한 좋은 태도는 매우 훌륭한 방책입니다.