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A Review Of Conventional Medicine And Acupuncture In The Treatment Of Migraine

4081 words - 17 pages

Migraine is a chronic, episodic disorder causing persistent headaches, commonly characterized by throbbing pain on one side of the head that lasts at least four hours and can continue for days (Araki, 2004). In 90 percent of attacks there is accompanying nausea and delayed gastric emptying (Barkin, Lubenow, Bruehl, et al, 2003). Sensitivity to light (photophobia) or sound (phonophobia), or visual disturbances may accompany migraine headaches and may be exacerbated by movement or physical activity (Lipton, Stewart, & Simon, 1998). The frequency of attacks can very from two to three per year to two or more per week (O'Brien, Goeree & Streiner, 2004).An estimated eight percent of ...view middle of the document...

(Pearce, 2004).A specific group of neurological symptoms called aura often precede or accompany the headache phase of a migraine. It is most commonly experienced as a visual disturbance such as multicoloured zigzag patterns that can eclipse a large part of the visual field of one eye or both, prior to the attack (Davidoff, 2001). Furthermore, some visual auras involve distortions in perception of colour such as colour bleeding or the appearance of halos or as a white spot in the visual field (Davidoff, 2001). It is believed to be related to a disseminating transient decrease in neuronal activity, with a resultant decrease in blood flow in the cerebral hemisphere, contralateral to the aural symptoms (Saper, 1997).While the most common type of aura is visual, migraine sufferers may experience a variety of neurological symptoms. Some experience tingling sensations called paresthesias or disturbances of other regions of the brain, such as language ability instead of a visual aura, either as an intermittent alternate or as their normal aura (Lipton, Stewart, Celentano, 2002). Many migraine sufferers may also encounter difficulties in speaking and forming cohesive syntax. In some cases, these symptoms may also accompany the headache; in others, a headache does not follow the aura (Rasmussen & Olesen, 2002).The precise pathophysiology of migraine has yet to be identified. However, during the past decade studies of variations in cerebral blood flow throughout an attack, and research involving the effects of prostaglandin, estrogen levels, the neurotransmitter serotonin and specific serotonin receptors have lead to changes in present understanding of the process (Weiller, May, Limmroth, et al, 2005). A breakthrough study established that brain stem activation takes place both during a migraine attack, and during pain relief achieved with Sumatriptan, a serotonin receptor agonist (Weiller, May, Limmroth, et al, 2005). Activation of other cortical sites occurs during pain, but not after pain relief; this represents the neural response to pain. Activation of brain stem structures in the absence of pain may suggest a "migraine generator" or pacemaker in the brain stem, (Weiller, May, Limmroth, et al, 2005) and that the pathogenesis of migraine may be related to an imbalance in activity between brain stem nuclei. These and other observations have given rise to the now prevailing opinion that blood vessels play only a secondary role in migraine pathophysiology. The ultimate mechanism of head pain may be trigeminal activation via the brainstem migraine generator, with release of vasoactive peptides from nerve endings, causing vasodilation and inflammation (Weiller, May, Limmroth, et al, 2005). However, whether this plays a role in migraine pathogenesis or whether it is an epiphenomenon, is uncertain. Although the exact pathophysiology of the various components of migraine are still elusive, emerging evidence suggests that serotonergic transmission plays a...

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