pain that affects generally half of the skull and that usually appears in form of crises accompanied generally by fotofobia, nauseas or vomits.
Although one is
, it can get to incapacitate in the daily activities. It is
very frequent pathology, according to the last statistics, affects
5% of the population. The typical profile of the migrañoso patient is the following one: young woman (2 of
3) who lives in
great city and who suffers of 1 to 4 crises per month.
Schematically, migraña appears under three clinical aspects: migraña
, migraña oftálmica and migraña accompanied.
the migrañosa crisis goes generally preceded of certain announcing signs that they appear the eve before or hours. The patient learns to recognize these pródromos that, often, are to him own: modification of humor, the dream, the appetite, etc. The crisis usually begins at dawn or when awaking, although it can begin to any hour of the day. In most of the cases, migraña is located at level te'mporo - frontal, pronouncing
at the beginning of unilateral form. The pain is intermittent and rhythmic with the pulse, becoming serious
before the presence of noise, light (fotofobia) and with the head movements.
In treatment absence, the duration of the crisis can oscillate between several hours and two days.
ten cases present / display nauseas accompanied by an nourishing intolerancia (solid and
) and by sensations of
. Remarkable and asintomático
fact is that the migrañosos feel well between the crises. All the clinical and paraclínicos examinations are absolutely
typical variety of migraña. Essentially, the pródromos are constituted by the following
• sparkling Esotoma:
shining point that appears in the eyes and moves with the glance extending of progressive form.
luminous and overwhelming spots, sometimes multicolors or in zigzag form.
upheavals have been described. One is
forms that cause that the subject sees like through opaque crystals or of dirty
, as well as
hallucinations. these oftálmicos symptoms stop generally once they appear the painful accesses, whose signs are similar to those of migraña
. The oftamológicos and neurological examinations are totally
. When finalizing the crisis, all the
signs disappears without leaving sequels.
Migraña accompanied or migraña classic.
Migraña accompanied is characterized by the appearance of neurological upheavals in the prodrómica phase. Migraña oftálmica is
form of migraña accompanied, totally individualized and with essentially
The neurological signs are
and polimorfos. By frequency order, they are the following ones:
• sensitive Manifestations:
The patient feels
creeps in the hand that is extended towards the
and, mainly, towards the face, concretely, in the
zone of the lips and the
• Upheavals of the
, the perception of the corporal scheme, hummings in the ears or olfactory deformations.
The phenomena that accompany these signs do not have why to be individualized. He is not
patient who presents / displays first fosfenos soon and, for example, parestésicos upheavals. All these manifestations disappear once the
The migrañosos subject to numerous and are varied circumstances able to precipitate the crisis: one is the leading factors. Its identification is very interesting, since it provides information with respect to the fisiopatología of migraña and, most important, aid to avoid those factors, by means of the treatment.
We will consider leading the factors more frequently described.
mple, escotoma or fosfenos of migraña oftálmica and upheavals sensitive - motors of migraña accompanied. The reaccional vasodilatación affects the extracerebral arteries (territory of the external carotid) This vasodilatación restrains the pródromos (consecutive to the hypoxia)
, due to the excitation of the sensitive completions vasculares, gives rise to the appearance of the pain.
creciones of noradrenaline and adrenalin.
The migrañosos make frequent references to digestive nourishing factors. Certain number of foods is implied, specially those that contain tiramina (strong cheeses, white wine) or feniletilamina (chocolate) In addition, others like the
, the eggs, the cooked fats, some meats exist and fish, the
. In general, the patient very knows or the products that can originate the crisis to him, so that it voluntarily restricts them or it suppresses of his feeding.
Some migrañosos mention stimulating sensorial factors: alive light, noise, strong scent (like the one of the fresh painting) The tobacco also is mentioned like leading factor,
it is difficult to value if its
is in the sensorial excitation of the cigarette or in the farmacológico mechanism related to the nicotine.
favorecedor factor of the appearance of migraña takes place. One is
factor of endocrino
that provides to migraña the own cyclical character of feminine sex. It is spoken of migraña catamenial, originated by the abrupt diminution of estradiol at the end of the cycle. These crises appear of
form in the puberty, disappearing in the
. The migrañosas indicate
clear improvement during the
in which the hormone level is more stable.
Next, we will mention some other factors that favor the appearance of these crises:
• the climate:
periods of snow, storms, violent wind, excessive heat.
: this factor could take part by the increase of plasmática histamina that takes place in the migrañoso patient.
• the inheritance:
it is evident that
familiar character in the migrañosa pathology exists, which comes to support the hereditary theory of migraña. This hereditary factor would be
favorecedor factor by the reduction that takes place in the "threshold of outbreak" of the
As we will see later, all the factors that can determine, directly or indirectly, the appearance of vasomotoras disturbances can cause
Migraña must to the succession of two phenomena vasculares in the
followed initial vasoconstricción of
reaccional vasodilatación. It is the classic scheme of "the
storm" described by
. G. Wolfe in 1950.
The initial vasoconstricción affects the intracraneales arteries (territory of the internal carotid) causing one isquemia
that originates the appearance of the announcing signs of the crisis: fotofobia of migraña simple, escotoma or fosfenos of migraña oftálmica and upheavals sensitive - motors of migraña accompanied. The reaccional vasodilatación affects the extracerebral arteries (territory of the external carotid) This vasodilatación restrains the pródromos (consecutive to the hypoxia)
, due to the excitation of the sensitive completions vasculares, gives rise to the appearance of the pain.
Today, everybody admits like simple model "the
storm". Nevertheless, different hypotheses in which exist concerns to the exact
• primitive neurological
• Intervention of some neuromediadores.
In fact, it is very difficult that these factors are separated. It seems to be that migraña is the resultant of its interaction.
It seems to be that the vasomotores phenomena of the
arteries closely are related to an anomaly in the
of neuronal membranes. This disfunción of membranes is translated in an intracellular
accumulation. The interchanges through calcic ion membranes that take place throughout the
channels, are favored in case of isquemia or hypoxia.
certain extent, the initial vasoconstricción of migraña appears when an injurious
accumulation takes place in pathological circumstances.
Totally it is demonstrated that, in prodrómico
, migraña goes accompanied of
hemostasis of plaquetas: hyperadhesiveness and hiperagregabilidad. At the moment of the crisis, plaquetas carries out
desgranulación and liberation of serotonin. This instability of the plaquetaria membrane would be from
imbalance between the antiagregantes and vasodilator effects of the endoteliales prostaciclinas and the opposite effects (agregantes and vasoconstrictores) of the plaquetario tromboxano.
One knows that the set of phenomena discovered in migraña depends on the neuromediadores. With the present knowledge, it is possible to be affirmed that several neuromediadores are implied. We will deal them with more detail, considering that most of the antimigrañosos treatments takes part on their activities.
The serotonin is the most important neuromediador in the génesis of the migrañosa crisis. In first stage, plaquetas
serotonin (under the action of
plasmático factor recently identified: the Serotonin Releasing Factor) with
transitory increase of its sanguineous level that causes an
vasoconstricción. Later, the plasmática serotonin, quickly metabolizada, descends and happens to tinkles it in form of metabolitos (acid 5 - hidroxi - indol - acetic) At level of the blood vessels, the diminution of serotoninemia causes
reaccional expansion and
reduction of the threshold of sensitivity of the receivers vasculares of the pain. One is the second phase of migraña, with appearance of the painful picture. The relation between serotonin and migraña is explained by the reduction of the intraplaquetaria serotonin level before the beginning of the crisis (precritical phase) since, on the contrary, its plasmático level diminishes in the tip of the painful phase, increasing the elimination of its main metabolito, the 5 - hidroxil - indol - acetic acid (5
Noradrenaline acts on the receivers to originating the phenomena of vasoconstricción and increase of the plaquetaria agregabilidad. It
been stated that, during the crisis, most of the migrañosos presents / displays
greater excreción of metabolitos of noradrenaline and adrenalin: the vainillilmandélico acid (VMA) These observations seem logics if it considers that the psychological factors (
, emotion, rage. leading of the migrañosa crisis increase the liberation of catecholamines.
With complete certainty, other neuromediadores implied in the migrañosa
• the cininas, that take part in sinergia with serotonin and the prostaglandins.
peptide, person in
of the vasodilatación phenomena and transmission of the painful messages.
• the endorfinas, specially the endorfina b, that takes part in the defense of the organism against the pain.
These molecules, considered opioideas endogenous, are synthesized in
single region of the brain: the bent center of the hypothalamus. They cause an inhibition of the transmission of the nociceptivos messages at level to medular through the serotoninérgicas routes (the endorfina b is 73 times more powerful than morphine) During the migrañosa crisis, the pain appears as
reduction of the plasmática endorfina b.
The migrañoso pain would be originated by
reaccional vasodilatación that causes the stimulation of the receivers of the pain. So that the alternancia of these phenomena takes place, it is necessary that some concrete circumstances take place (leading factors, neuronal
) and that
greater individual sensitivity to the different mediators exists who participate in the migrañosa
Considering the plurifactorial character of migraña and the uncertainties that subsist around their fisiopatología,
unique treatment does not exist. Throughout history, different therapeutic methods with more or less success have seted out. One of them is specially famous: in the middle of
strong crisis of migraña,
great blow in the head with the purpose of calming the pain to him. This peculiar remedy, besides to be able to alleviate to him,
the cause of the birth of Shovels Athenian. As we see, they were very far from therapeutic
With regard to the humans, two types of treatment exist:
• the treatment of the migrañosa crisis.
• the bottom treatment.
1. Treatment of the crisis.
The objective of this treatment is to reduce to the duration and the severity of the crisis. One is due to act quickly and in depth. The treatment must take place as soon as appear the announcing signs. Of entrance, the dosages must be elevated. The main used medicines are antiinflammatory the nonesteroideos ones, the antálgicos and the alkaloids of cornezuelo of the rye.
In the acute crisis, the
, nevertheless, in the bottom treatment, as we see later, it is of an exceptional effectiveness, often, unsuspected.
2. Treatment of bottom.
The bottom treatment is determined based on the frequency of the crises (superior to two per month) and of their intensity. One is habitual
preventive treatment that must regularly be carried out and. Associate must go to
life way that avoids the leading factors.
Numerous treatments exist that act on the vasculo - humoral mechanism cause of the crisis.
Based on its way of action, they can be classified in three categories:
• Stabilizing of the
Alkaloids of cornezuelo of rye. The most known between all they are dihidroergota -
mine, the dihidroergocriptina and the dihidroergotoxina.
which they prevent the intracellular
accumulation, produced in case.
hypoxia, by means of
blockade of the calcic channels.
• Inhibiting of the plaquetaria aggregation.
Among them are the derivatives of the salicílico acetil acid whose property consists of correcting the registered plaquetarias hyperadhesiveness and agregabilidad in the migrañosos subjects.
• Substances that interfere with the neuromediadores.
Antiserotoninérgicos, being the main representative the metisergida one.
Antihistamine, little used like antimigrañosos.
b - bloqueantes. Their habitual indications belong rather to the field of the cardiology,
being inhidores of the caratecolaminas, its use extends to the cases of
In case of migrañosos patients in whom the psychological factor can represent the main leading factor, another category can be established: ansiolíticos and antidepressants, of which we will not speak at the moment.
presents / displays
great interest in the treatment of bottom of migraña. In this pathology, we can have some very active plants with sedative and espasmolíticos effects that allow to lessen the pain the crisis.
The matricana is the most representative plant for the treatment of migraña. Of possible form, we will associate it to other chosen medicinal plants based on the leading factor.
Plants adapted for this