Migraine Cocktail

What Is Migraine Cocktail?

Migraine Cocktail represents a paroxysmal impairment accompanied by periods of headache, nausea, malaise, vomiting, photo or phonophobia. Migrine Cocktail attacks are extremely common in the emergency department. In most cases, such attacks are severe and recurrent.

Headache localization may be specific and indicate the involvement of the surrounding local structures (temporal arteritis, gigantocellular pain, facial pain linked to sinuzitis).

Rupture of aneurysms (an immediate pain), the cluster (the beginning of pain after 3 to 5 minutes), Migraine Cocktailand (appearance of pain after a few minutes up to several hours) are distinguished by time, reaching a maximal level of pain intensity.

The provocation of pain may be due to  environmental factors and often point to  benign causes.

Signs & Symptoms

Migraine Cocktail attacks are mostly present in patients 10 to 30 years of age, mostly female population. The exact etiopathogenetic mechanism is still not fully understood. There are certain predisposing factors such as stress, contraception, menstrual hormonal changes, certain food with substances such as tyramine or nitrates.

The additional symptoms are nausea, vomiting, and aura in the form of vision impairments and photophobia. There are present cardiovascualr disordes such as inceased cholesterol levels that may lead to atherosclerosis.

The onset of diabetes mellitus is due to the  inappropriate food ingestion. The incidence of breast and prostate cancer is higher in these individuals. Coloectal cancer is due to certain level of stress, deceased intake of water and impiared eating habits.

Diagnosis

A complete neurological examination is necessary. In case of an abrupt headache or focal neurological impairments, such patient should be further evaluated by computer resonance without contrast or magnetic resonance in order to exclude  more severe disorders such as hemorrhage.

Lumbar puncture is indicated for suspected meningitis (stiff neck, high fever).
Classic Migraine Cocktail starts onično in childhood, adolescence or youth, although the attack may occur at any age. Family history is often positive, but is more common in women.

The classic triad of symptoms constitute a visual warning (scotoma or flashes in front of the eyes), sensory or motor symptoms, unilateral throbbing pain, nausea and vomiting. Common photo and phonophobia, and dizziness. There may be a focal neurological deficit without the headache or vomiting.

The attack usually lasts 2 to 6 hours, with relief after sleep. Seizures can be caused by wine, cheese, chocolate, contraceptives, stress, exercise, or travel.

Common Migraine Cocktail  is unilateral or bilateral headaches accompanied by nausea, but no focal neurological symptoms. The pain is moderate to severe, throbbing, unilateral, worsens with activity. Is accompanied by photophobia, phonophobia and multiple attacks. It is more common in women.

Tension headache is common in all age groups. The pain is present in all the regions of the head, it is generalized. Most commonly it is described as a pressure or a tight band around the head, and can last for hours or danima. Ova headache is often associated with stress.

Cluster headache is characterized by recurrent episodes, night, unilateral, retro-orbital pain. The pain lasts for 30 to 120 minutes or tends to be repeated at the same time of night, or more times every 24 hours during 4-8 weeks.

Treatment

In the treatment Of  Migraine Cocktail there are three approaches available such as non-pharmacological, phamacological treatment of acute attacks and prophylaxis. Medicamentous treatment is most common.

The most common therapeutic approach is the administration of analgesic regimens such as aspirin or NSAIL, especially in the treatment of Migraine Cocktail attacks. ⁽³⁾ In the recent studies it has been noted that the administration of ergotamine or dihydroergotamine had decreased efficacy when compared to serotonin (5-HT)1B/D) – agonists (triptans).

The most commonly prescribed tripatans are almotriptan, eletriptan, frovatriptan, sumatriptan). Such medicaments are able to remove symptoms such as nausea, photo and phonophobia.

In case there are three or more severe Migraine Cocktail attacks present in each month, there should be prophylaxis considered in the form of beta-blockers (metoprolol, propranolol), the calcium channel blockers (flunarizine), 5-HT antagonists, amitryptiline.

Valproic acid

There are as well available certain antiepileptic drugs such as valproic acid, gabapentin and topiramate. Currently, the administration of botulinum-toxin is under the clinical research.

In the recent study, there has been an investigation in regards to the most frequently administred regimens such as prochlorperazine and metoclopramide in the migraine attack. It has been shown that prochlorperazine is more potent in comparison to other medicaments or placebo.

There are as well dopamine antagonists that are used for pain relief in migraine attacks. Dopamine antagonists, in general, appear to be equivalent for migraine pain relief to the migraine-“specific” medications sumatriptan and dihydroergotamine, although there are fewer studies involving the last two.

References

1. Alex J Sinclair.Headache management: pharmacological approaches.Pract Neurol. 2015 Dec; 15(6): 411–423.
2. Paola Sarchielli et al. Italian guidelines for primary headaches: 2012 revised version.J Headache Pain. 2012 May; 13(Suppl 2): 31–70.
3. Diener HCh.Pharmacological approaches to migraine.J Neural Transm Suppl. 2003;(64):35-63.