Saturday, 23 November 2013

Migraine with Aura - The Consequences


Migraine with Aura defined as condition of common migraine, involves migraine headaches that are preceded by some sort of visual disturbance of an aura such as difficulty speaking, vertigo, ringing in ears, or a number of other brainstem-related symptoms, but sometimes it may be associated with underlying hereditary or acquired cerebrovascular disorders, according to " Migraine aura pathophysiology: the role of blood vessels and microembolisation"
Dalkara T, Nozari A, Moskowitz MA.(1)
Migraine with Aura consequences
1. Coronary heart disease and stroke
Risk of mortality from coronary heart disease and stroke mortality is modestly increased in people with migraine, particularly those with aura, as study showed that mortality from cardiovascular disease shows that people with migraine with aura were at increased risk of mortality from coronary heart disease (1.28, 1.11 to 1.49) and stroke (1.40, 1.10 to 1.78). Women with migraine with aura were also at increased risk of mortality from non-cardiovascular disease (1.19, 1.06 to 1.35)(V.1)

2. Cardiovascular disease
Active migraine with aura was associated with increased risk of major CVD, myocardial infarction, ischemic stroke, and death due to ischemic CVD, as well as with coronary revascularization and angina, according to study conducted by Brigham and Women's Hospital, Harvard Medical School(V.2)

3. Chronic migraine
Chronic migraines is defined as headaches in the absence of medication overuse, occurring on ≥15 days per month for ≥3 months, of which headaches on ≥8 days must fulfill the criteria for migraine is that they continue over a long period of time. It is also known as transformed migraine, as chronic migraines can evolve (or transform) from episodic to almost daily headaches with mild symptoms (V.3)

4. Status migrainosus
Status migrainosus is defined as a condition of migraine episodes that persist for less than 3 days, but in most case, there are periods of relative relief, but these generally last no longer than four hours. With symptoms similar general migraine. Dihydroergotamine and the triptans, has found to reduce the number of headache episodes that persist after initial treatment or fail to respond to self-administered therapy(V.4)

5. Persistent aura without infarction (PAWI)
Persistent aura without infarction (PAWI) is a rare complications of migraines with neurological and ophthalmological examinations. The visual symptoms is a result of decreased left fronto-parieto-occipital and right occipital blood perfusion.(V.5)

6. Migrainous infarction
Migrainous infarction is a rare complication after usual attacks of migraine with aura. Some studies suggested that "possible" cases of migrainous infarction should undergo an extended diagnostic workup to rule out symptomatic migraine due to extra/intra-cranial vascular pathology (artery dissection/malformations, venous thrombosis) and to exclude a causal role for other conditions(V.6)

7. Migraine seizures
A migraine seizure is an epileptic seizure that follows a migraine with aura, meeting the definition for a migraine with aura, and an epileptic seizure must occur within one hour of the migraine aura. Some researchers suggested thatthe occurrence of common susceptibility loci for epilepsy and migraine on chromosomes 14q12-q23 and 12q24.2-q24.3, implicating a shared genetic etiology for these 2 diseases(C.1.5). Other suggested the hypothesis of modification in threshold of cortical hyperexcitability from migraine to epilepsy.(C.1.6.). Symptoms of the complication include some sort of visual change or loss, zigzagging lines, bright flashes, etc.(V.7)

8. Etc.
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/20170844
(V.1) http://www.ncbi.nlm.nih.gov/pubmed/22074995
(V.2) http://www.ncbi.nlm.nih.gov/pubmed/19489878
(V.3) http://www.ncbi.nlm.nih.gov/pubmed/17578537
(V.4) http://www.medscape.com/viewarticle/705597
(V.5) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1757363/
(V.6) http://www.ncbi.nlm.nih.gov/pubmed/22217520
(V.7) http://www.ncbi.nlm.nih.gov/pubmed/22367631

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