Migraine in Puerto Peñasco?

by Dr. Luis Rivera Solis

Headaches can be classified into three kinds: vascular, tensional, and traction or inflammatory. Correct identification is very important and can be done by questioning, and by a physical and neurological examination, which will guide the physician to proper diagnosis and treatment.

In Rocky Point the migraine (vascular headache) is very frequent. 25% of the population is affected because we live in the desert; are exposed to sun and heat; consume seafood, red meat, beer, wine, and tobacco; and are often under stress.

Migraines begin during the first 3 decades of life, and are hereditary. Migraine is recurrent, with transient nuerological disturbances like headache and frequent urination.

There are four phases to a migraine headache:

1. Normal. The extracraneal arteries are enervated (cerebral and temporal), not the parenquimatous arteries.
2. Vasoconstriction (aura). Stress plus local vasoconstriction of enervated cerebral arteries reduces the cerebral blood circulation (local isquemia); the platelet aggregation spreads serotonin; the synthesis of prostaglandines and tromboxano produces platelet aggregation with liberation of serotonin, strong vasoconstriction and perhaps other vasoactive substances. Clinical findings show migraines with aura (classic) and without aura (commmon). In the migraine with aura the symptoms correspond with the cerebral area affected by the isquemia (blood diminution), and may be sleepiness, confusion, irritability, abnormal sensations, unilateral muscular palsy, unilateral muscular weakness, disartria (difficulty in speaking), dizziness, black spots before the eyes, zigzag lines in vision, photophobia, double vision, ocular muscular palsy, or blindness in one eye.
3. Parenquimatous artery dilation. Unenervated parenquimatous blood vessels are dilated in response to local acidosis and lack of oxygen. Several biochemical and neurogenic factors force the opening of the preexisting arteriovenous bridges. Increased circulation and internal pressure open shunts in the capillaries and cause pain.
4. Vasodilation (headache). Compensatory mechanisms produce strong vasodilation with perivascular swelling in the enervated arteries, resulting in a prolonged headache. Systemic platelet aggregation diminishes the concentration of serotonin and produces vasodilation. There is painful, sterile, and prolonged perivascular swelling until the postheadache phase. Features of the headache phase are pulsing pain on one side, nausea and vomiting, chills, sweating, dizziness, diarrhea, tremor, photophobia (hypersensitivity to light), hypersensitivity to sounds, cranial hypersensitivity, dilation of blood vessels, and swelling. The patient looks sick, may have nasal obstruction, discharge, tears, or flushing of the face and ears.

The treatment is with hygienic dietetic measures like a balanced diet, 3 meals a day with a small volume of food, eating at the same times every day, and no fasting. Sufferers should avoid tea, coffee, cola drinks, alcohol, beer, chocolate, red meat, ham, hot dogs, bacon, pate, etc. No nitrites, sauces, cheese, yogurts, acid creams, nuts, animal livers, pork, vinager, or monosodium glutamates (Chinese and Japanese food). Don't smoke; avoid sun and heat, intense light, and loud sounds. Get plenty of sleep; exercise daily. If the headache continues it may be necessary to have medication: anticonvulsants, ergot compounds, beta blockers, calcium channel-blocking agents, antiseronin compounds, sumatriptan, etc. All these are effective to a variable degree, depending on the individual patient.

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