Migraine in pregnancy
Introduction
Introduction to pregnancy combined with migraine Migraine is a common group of headaches characterized by paroxysmal neurovascular dysfunction characterized by recurrent lateral or bilateral headaches. Headache is one of the most common neurological complaints among pregnant women. Studies have shown that 70% of women with migraine have dramatic relief during pregnancy, especially migraine associated with the menstrual cycle. About 15% of migraine headaches during pregnancy are the first episodes, and most occur in the first 3 months of pregnancy, when hormone levels are already on the rise. About 60% of patients have a family history but no consistent genetic form. basic knowledge The proportion of illness: the incidence rate of pregnant women is about 5% Susceptible population: pregnant women Mode of infection: non-infectious Complications: eclampsia
Cause
Pregnancy combined with migraine cause
(1) Causes of the disease
The etiology of migraine is still unclear. There are two main causes of the theory, but they cannot be explained satisfactorily. Now I will briefly introduce them.
1. Vascular source theory The study of cerebral blood flow shows that in the aura of attack, some local cerebral blood flow is significantly reduced, which is consistent with intracranial vasoconstriction, visual changes or paresthesia due to ischemia; cerebral blood flow is significant during headache attack Increase, this is secondary to vasoconstriction, long-term ischemia of the brain tissue, hypoxia, local lactic acid accumulation caused by vasodilation.
2. The study of biochemistry by source theory shows that:
(1) Fluctuations in serotonin levels have an effect on vasoconstriction and relaxation of blood vessels.
(2) serotonin and bradykinin in extracellular fluid, neuropeptides such as histamine and vasomotor tachykinin lead to aseptic inflammation of the arteries, the combination of the two causes pre-onset aura symptoms and migraine attack.
(two) pathogenesis
The pathogenesis of migraine is still unclear. The mechanisms of various causes of morbidity can be summarized as two categories: angiogenic theory and neurogenic theory.
Neurogenic theory believes that the origin of migraine lesions in the central nervous system, endocrine changes and vasomotor disorders is a follow-up phenomenon, that is, the vascular manifestations of migraine are secondary to the release of the nerve center, migraine The complex symptoms presented are the result of cerebral cortical dysfunction, which may be a threshold threshold of the brain that originates at the level of the hypothalamus-diencephalon. Migraine patients have a genetic predisposition to lower the threshold of morbidity; Under the influence of predisposing factors, the threshold of the brain can be further reduced, and a migraine attack is finally formed through a series of changes.
The cerebrovascular blood vessels are mainly innervated by norepinephrine and serotonin (5-HT). The cell bodies of these neurons are located in the blue spot and interstitial nucleus of the brainstem, and the brain 5-HT receptors are mainly concentrated in the suture. The nucleus, which is mainly 5-HT1A receptor, also has 5-HT1D receptor. After administration to dihydroergotamine, the drug has the highest concentration in the interspinous nucleus, so this place is also an important part of the drug action. Stress, anxiety, excessive fatigue or other environmental factors can cause brainstem neurons to excite, norepinephrine, 5-HT and other transmitter release activities, leading to changes in cranial vasomotor changes, cerebral ischemia and blood vessels "Aseptic inflammation", in experimental animals, the use of electrical stimulation of neurons near the interstitial nucleus can also cause migraine-like headaches.
Closely related to the incidence of migraine is the receptor of 5-HT1. The role of subtype 5-HT1D is very important. It is mainly distributed in the choroid plexus of the brain, which can regulate cerebral blood flow. Clinical studies have found that anti-migraine drugs The effects are mainly related to 5-HT1D and 5-HT1B receptors, ergotamine is the strongest 5-HT1A receptor agonist, while sumatriptan is mainly a 5-HT1D receptor agonist, which has a higher specificity. Sex.
Experiments have shown that dura mater small blood vessels are highly sensitive to various stimuli and are an important source of headache. There are many fibers of trigeminal nerves distributed around the meningeal vessels (trigeminal-vascular fibers), and various pathological changes stimulate the damage of trigeminal nerve endings. Sensory, abnormal signals are transmitted to the brainstem, thalamus and cerebral cortex through the central branch of the trigeminal nerve, causing pain and nausea, vomiting, sweating and other symptoms.
Migraine does not affect pregnancy and childbirth. Migraine can be aggravated during the first 3 months of pregnancy, but it usually improves or stops during the 6 months after pregnancy. 60% to 80% of women have migraine that can be completely stopped. There is recurrence after childbirth, which may be related to high estrogen levels during pregnancy. Female patients often have aggravated seizures when taking contraceptives. The frequency of migraine attacks in pregnant women has little effect on the fetus, but the incidence of migraine in their children Significantly increased, the statistics of the three groups of patients showed that 76 out of 265 (28.7%) with no migraine in their parents had migraine; 564 (45.1%) of the 1,250 of the parents who had migraine had the same disease; 285 (74.7%) of the 383 parents who suffered from migraine suffered from the same disease. Therefore, from the perspective of eugenics, patients with migraine should choose to marry and should avoid family history with the same disease or family. marry.
Prevention
Pregnancy combined with migraine prevention
1. Take a proper rest and avoid strenuous exercise. But when the condition is stable, pay attention to proper exercise.
2. Increase disease resistance, avoid cold, and pay attention to actively prevent colds.
3. Pay attention to regularly check the color ultrasound during pregnancy, pay attention to maintain the law of life.
4. Diet control: The diet is mainly light. It is advisable to eat more fruits, vegetables and high-quality high-protein foods. It is forbidden to spicy, fat and sweet, as well as mildew products, preserved foods, and avoid alcohol.
Complication
Pregnancy with migraine complications Complications
At present, there are some common pathological basis between migraine and eclampsia. Patients with migraine quality are prone to eclampsia. The worsening of migraine during pregnancy marks the occurrence of complications in pregnancy.
Symptom
Pregnancy with migraine symptoms Common symptoms Sensory disorder pale nausea eyelid pain frontal pain hallucinogenic traction headache
1. Common migraine is the most common type of migraine. There is no clear aura. The headache usually begins from the ankle, eyelids, and then spreads to the hemisphere. It is often accompanied by nausea and vomiting. Lasts for a few days.
2. Typical migraine is only seen in 10% of migraine patients, usually in adolescence, with a family history, typical aura symptoms before headache, flashing illusion, usually some flashing dark spots or "There is a Venus in front of you." The headache begins to manifest as a dull pain on the side, a dull pain in the back or frontal area, occasionally on the top or occiput. When the headache is enhanced, it has a pulsating nature, in an enhanced way to the top, and then continues. For a severely fixed pain, the patient is pale, accompanied by nausea and vomiting. The headache usually lasts for a whole day and is often terminated by sleep.
3. Complex migraine may be associated with neurological symptoms such as paresthesia, sensation, tingling, burning sensation, palsy or even aphasia or similar stroke-like temporary paralysis, generally recovering completely, in the onset The patient in the gap period is completely normal.
Examine
Pregnancy combined with migraine examination
In the course of pregnancy, migraine still continues to attack or the first episode of pregnancy, non-vasomotor dysfunction should be considered, local may have some more serious cause, such as abnormal vascular development or slow-growing tumors, should be done head CT or MRI examination to confirm the diagnosis.
Diagnosis
Diagnosis and diagnosis of pregnancy combined with migraine
diagnosis
For common types of migraine, there is no difficulty in diagnosis. It is based on a long history of repeated attacks, family history and physical examination. If the trial of ergotamine is effective, the diagnosis is more clear.
Differential diagnosis
The following diseases need to be identified:
Cluster headache
Also known as histamine headache or Horton neuralgia, it is another mechanism of vascular neuropathic headache. The headache is extremely rapid. It reaches a peak in 20 minutes. It can be completely relieved within 1-2 hours. Strong pain can be limited to one side of the ankle. Conjunctival congestion, tearing, nasal congestion, sometimes photophobia and nausea, often wake up at night, 1 to 3 episodes within 24 hours, usually one or more episodes in one week or several weeks (namely "cluster" ), after an asymptomatic period of several days or years, men are about 4 times more than women, generally anti-migraine drugs are often ineffective, early oxygen inhalation, indomethacin (indomethacin) or corticosteroid treatment can be alleviated .
2. Other vascular headaches
Hypertensive patients sometimes have a frontal pulsating headache in the morning, pulsating headaches, measuring and controlling blood pressure can help diagnose, cerebral arteriosclerosis may occur ischemic headache, generally not severe, no nausea, vomiting, patients are older There are signs of arteriosclerosis, giant cell arteritis is seen in the elderly, the headache is non-onset, the superficial temporal artery often has varicose veins, pain, and blood sedimentation.
3. Intracranial space occupying and vascular lesions
Any patient with headache must undergo detailed neurological examination to rule out space-occupying lesions and further examination if necessary, such as cerebral angiography, CT, MRI, etc.
In addition, it must be differentiated from epilepsy, neurosis, and tension headache.
