What does an attack look like and how does it differ from a migraine?
The pain is always concentrated on one side and almost always on the same side in subsequent attacks. It progresses rapidly, reaching a maximum in 5–10 minutes, and is described as a drilling or hot rod behind the eye. A mandatory sign is vegetative manifestations on the side of pain. During an attack, a person is restless, walks, sways, and cannot lie down, while during a migraine the patient tends to go to a dark, quiet room. A migraine lasts for hours and days, a cluster attack lasts minutes and no more than three hours.
- Strictly unilateral pain around the eye or temple
- Redness and watery eyes
- Drooping of the eyelid and constriction of the pupil
- Nasal congestion or discharge from one nostril
- Facial sweating, eyelid swelling
- Motor restlessness during an attack
- Attacks at the same time of day, often at night
Why do seizures occur?
Activation of the hypothalamus, the region of the brain responsible for biological rhythms, is believed to play a key role. This explains the strict connection of attacks to the time of day and the seasonality of exacerbations. Next, the trigeminal-vegetative reflex is involved in the process, which gives a combination of pain with redness of the eye and nasal congestion. The disease is not associated with sinusitis, teeth or osteochondrosis, although people with such pain are often treated for a long time for them.
- Disturbance of rhythms in the hypothalamus
- Activation of the trigeminal-vegetative system
- Alcohol as a reliable provocateur during an exacerbation
- Smoking and nicotine
- Sleep disturbances, night shifts
- Strong odors, changes in altitude
- Seasonality - spring and autumn
Survey
The diagnosis is made by the nature of the attacks; there is no special analysis. However, at the first visit, secondary causes must be excluded: aneurysms and arterial dissection, tumors of the pituitary gland and cavernous sinus areas, inflammatory processes. Therefore, the neurologist will refer you for an MRI of the brain with a study of blood vessels, and if there is a suspicion of damage to the area of the sella turcica, for an MRI of the pituitary gland. A diary of attacks helps a lot: their time, duration, side, accompanying signs and what helped.
- Detailed interview and neurological examination
- MRI of the brain and cerebral vessels
- MRI of the pituitary gland if a mass process is suspected
- Headache Diary
- Examination by an ophthalmologist for persistent eye symptoms
- Measuring blood pressure, ECG before prescribing a number of drugs
How to relieve an attack
Conventional painkillers in tablets do not have time to act: the attack develops and ends faster than the drug is absorbed. Oxygen inhalation through a high-flow mask and triptans in fast-acting forms - spray or injection - have proven effectiveness. They are selected by a doctor, taking into account heart and vascular diseases, because triptans have contraindications. It is important to have a plan in advance and keep supplies on hand, including at night when attacks occur most often.
- Oxygen inhalation through a mask is a first-line method
- Triptans by spray or injection as prescribed by your doctor
- Tablet analgesics are ineffective for this type of pain
- Narcotic painkillers are not used
- The cupping plan is discussed with the doctor in advance
- For each attack, record the time and effect
Prevention and lifestyle
When another series of attacks begins, the doctor prescribes preventative treatment to shorten the period of exacerbation and reduce the number of attacks. Several groups of drugs are used, including calcium channel blockers and drugs that affect the nervous system; sometimes short courses of hormones and occipital nerve blocks are used. All this is prescribed only by a neurologist, taking into account concomitant diseases. From a lifestyle perspective, the main thing is to completely eliminate alcohol during an exacerbation, stop smoking and maintain a stable sleep schedule.
- Prophylactic therapy begins at the beginning of a series of attacks
- Complete abstinence from alcohol during an exacerbation
- Quitting smoking
- Stable bedtime and wake-up times
- Be careful with daytime sleep - it provokes attacks
- Avoid sudden changes in height and stuffy rooms
- Regular observation by a neurologist with correction of the scheme