Simple (ordinary) migraine- the most common form. Its main manifestations are paroxysmal headaches localized in the frontal-temporo-orbital region, usually in one half of the head (hemicrania), in some cases spreading to the entire head. A paroxysm of pain can occur at any time, but more often at night or immediately after waking up. Over the course of several hours, the pain increases and can be either throbbing, bursting, or dull, boring. The duration of the attack is from several hours to 1-2 days. After the end, and sometimes during the attack, nausea and vomiting appear. Light, sounds, smells, sudden movements of the head increase the severity of pain. The temporal artery may tense and pulsate, painful on palpation; the sclera is injected, the soft tissues of the face swell.
The harbinger of paroxysm in most patients with a simple form of migraine (from several hours, days before the attack) is a change in mood - hypochondria, euphoria, irritability, poor appetite, etc. After the end of the attack, drowsiness occurs, which brings relief. Most often, paroxysms of pain during simple migraine are repeated after a certain time. It has been noted that sometimes migraines do not occur during periods of stress, but a few days later, during relaxation (“Sunday migraine”).
Ophthalmic migraine
Unlike simple ophthalmic migraine a visual aura appears (atrial fibrillation, loss of visual fields, deformation of visual perception, simple visual hallucinations, etc.). The visual aura precedes the pain syndrome, which gradually increases, accompanied by nausea and vomiting. The duration of the pain syndrome is on average 6-8 hours. Autonomic disorders in this form of migraine are less pronounced than in simple ones. The intensity of headaches in both forms is practically the same.
Sometimes patients have a combination of simple and ophthalmic forms of migraine.
Associated migraine
Associated migraine is manifested by attacks of severe headache and the occurrence of various focal neurological disorders (motor, sensory, vestibular, etc.) caused by dyscirculation (vasospasm, vasodilation) of the corresponding vascular pools.
Associated forms of migraine include:
- ophthalmoplegic, when, against the background of severe headache, at the end of it or after a paroxysm, oculomotor disorders appear (unilateral ptosis, diplopia, convergent or divergent strabismus). More often it is observed in young people (up to 20-25 years of age), who have a history of other types of migraine - simple and classic (in differential diagnosis, arterial and arteriovenous aneurysms should be kept in mind);
- vegetative - against the background of a regular migraine attack, vegetative-vascular (usually sympatho-adrenal) crises appear;
- syncopal migraine - during the period of headache paroxysm, short-term fainting occurs (usually against the background of increased blood pressure).
Menstrual migraine
Menstrual migraine (clinically occurs in the same way as the simple form) occurs two to three days before or during menstruation. In most patients, careful history taking can reveal a simple form of migraine.
Facial migraine
Facial migraine is paroxysmal, periodically recurring paroxysms of throbbing pain in the lower half of the face, spreading to the orbit, temple, and half of the face. The duration of the attack is up to 3 days. Hereditary burden, onset of the disease (young age), provoking factors, appearance and behavior of the patient, improvement in the condition from the use of anti-migraine drugs allow us to consider facial migraine as one of the forms of migraine.
V.B. Shalkevich
"Simple, ophthalmic, associated, menstrual, facial forms of migraine" and other articles from the section
The most common type of migraine paroxysms, the distinctive feature of which is the absence of an aura and any transient neurological disorders. Simple migraine is characterized by attacks of intense headache, often unilateral, accompanied by nausea, repeated vomiting, sound and photophobia. Diagnosis is based on clinical criteria. It is imperative to exclude other cerebral diseases, the symptom of which may be similar cephalalgia. Treatment of simple migraine is carried out with serotonin receptor agonists, NSAIDs, dihydroergotamines, non-narcotic and narcotic analgesics, antiemetics, sedatives and tranquilizers.
ICD-10
G43.0 Migraine without aura [simple migraine]
General information
Simple migraine accounts for up to 80% of all attacks migraine. Unlike migraine with aura and associated migraine, it does not have transient visual, motor or sensory disturbances preceding or accompanying the headache. The first attacks of simple migraine usually occur between the ages of 17 and 35. In old age, migraine attacks lose their duration and intensity. Women suffer from migraines 3-4 times more often than men; their attacks are often associated with periods of the menstrual cycle. Simple migraine occurs in the vast majority of migraine cases in children. In this case, the familial nature of the disease is often traced. In addition, some authors indicate that in 80% of men with migraine, their mothers also suffered from migraine paroxysms.
Causes of simple migraine
It is known that a simple migraine attack can be triggered by a stressful situation, physical fatigue, mental overload, lack of sleep, hypothermia, changes in weather, strong smell, noise, flickering light, drinking alcohol, eating disorders, eating certain foods (for example, nuts, citrus fruits, chocolate, soy sauce, cheese, celery, Coca-Cola, etc.). In women, simple migraine can be caused by hormonal changes - ovulation and menstruation, taking hormonal contraceptives. Trigger factors for migraine are to a certain extent individual; over time, each patient knows his own set of similar triggers from experience.
Simple migraine, like other types of migraine paroxysms, is associated with such character traits as ambition and ambition, increased excitability. Patients are mostly strong-willed and strong people, but at the same time they are intolerant of the mistakes of others, which is why they are often irritated and dissatisfied.
The pathogenetic mechanisms of the development of migraine attacks are still the subject of study in clinical biochemistry and neurology. During an attack, changes are noted in the content of a number of substances - serotonin, histamine, catecholamines, prostaglandins, bradykinin. Today, the main role is played by serotonin. Studies have shown that at the onset of a migraine attack, there is a sharp release of serotonin from platelets, which is accompanied by constriction of cerebral vessels. Serotonin levels then decrease significantly. The effectiveness of serotonin metabolism regulators against migraine also emphasizes the importance of this neurotransmitter.
Other studies suggest a trigeminovascular mechanism for the development of simple migraine. The initial stimulation is the stimulation of the neurons of the trigeminal nerve nucleus located in the medulla oblongata, which provokes the release of neurotransmitters. The latter irritate trigeminal receptors and potentiate aseptic inflammation of the carotid artery wall. This explains the pain of the artery on palpation and swelling of the surrounding tissues.
Symptoms of simple migraine
Simple migraine is characterized by the sudden onset of cephalalgia without a preceding aura. In some cases, headaches are heralded by prodromal phenomena - decreased mood, drowsiness, decreased performance, nausea, yawning. Since cephalgia often extends to only half of the head, it is called hemicrania. Hemicrania is most often observed on the right side of the head. In some cases, cephalgia affects the second half of the head and is diffuse. The pain is accompanied by nausea of varying intensity and repeated vomiting. Any movement increases the intensity of cephalgia. Increased sensitivity to sounds and light stimuli forces patients to isolate themselves from the outside world during a migraine attack (lock themselves in a room, curtain the windows, hide under a blanket, etc.).
A simple migraine can last from 4 hours to 2-3 days. Sometimes a migraine attack is accompanied by frequent urination, diarrhea, dizziness, nasal congestion, vegetative disorders (palpitations, sweating, a feeling of hot flashes, chills, a feeling of lack of air). The end of the paroxysm in half of the cases occurs with the patient's transition to a state of sleep. After a migraine attack, some fatigue and weakness may be observed; in some cases, on the contrary, increased physical and intellectual activity is noted.
Simple migraine in children is often diffuse or localized bitemporally and bifrontally. The attack usually does not last more than 1 day. The intensity of cephalalgia in children is often less than in adults. Nausea and repeated vomiting come to the fore. Cases have been described in which a migraine attack in a child was accompanied by fever and abdominal pain and was mistakenly interpreted as an intestinal infection.
Diagnosis of simple migraine
Simple migraine is diagnosed neurologist according to the following clinical criteria: a history of at least 5 migraine-like paroxysms, the duration of each of which is no shorter than 4 hours and no more than 3 days; cephalgia is characterized by at least 2 of the listed signs - it has medium and high intensity, pulsating, one-sided, becomes more intense with physical activity; there is at least 1 of the following accompanying symptoms - sound and photophobia, nausea and vomiting.
An important point is the differential diagnosis of migraine from serious cerebral diseases, such as, meningitis , arachnoiditis , brain cyst , encephalitis , cerebral aneurysm etc. Particular vigilance is required in case of rapid development of a migraine attack, previously unobserved excessive intensity of cephalalgia or its unusual nature, the presence of rigidity of the muscles of the back of the head, an attack of loss of consciousness, convulsions, or limitation of visual fields. To exclude organic cerebral pathology, a comprehensive neurological examination is performed: electroencephalography , echoencephalography , REG , Doppler ultrasound of head vessels, inspection ophthalmologist with fundus examination and perimetry. According to indications it is prescribed MRI of the brain And MRI of cerebral vessels.
Treatment of simple migraine
Standard analgesics are ineffective in relieving migraine paroxysm. As a rule, dihydroergotamines (ergotamine, dihydroergotamine) or selective serotonin agonists - triptans (sumatriptan, rizatriptan, naratriptan, zolmitriptan, eletriptan) are used. With the gradual development of paroxysm, it is enough to take one of these drugs orally. However, due to reduced gastrointestinal motility, this method of administration may be ineffective. In such cases, the use of ergotamine in rectal suppositories, dihydroergotamine intramuscularly or intravenously, sumatriptan subcutaneously is recommended. The use of triptans is associated with frequent relapses of cephalalgia, since these drugs have a short half-life (only 2 hours). When cephalalgia recurs, it is often necessary to take the medication again, combining triptans with non-steroidal anti-inflammatory drugs (ibuprofen, nimesulide, diclofenac).
In some cases, simple migraine is relieved by endonasal administration of lidocaine, taking naproxen, and intramuscular administration of magnesium. Repeated vomiting is an indication for the use of antiemetics (metoclopramide, domperidone, ondansetron). With high intensity of cephalalgia and no improvement from the use of the above pharmaceuticals, they resort to the use of narcotic analgesics (tramadol, trimeperidine, codeine, fentanyl, nalbuphine). However, their use is possible no more than 2 times a week.
Unfortunately, at present, simple migraine does not have effective pharmacotherapy during the interictal period, which would significantly reduce the likelihood of a migraine attack. Neurologists use monoamine oxidase inhibitors, beta-blockers, tranquilizers, anticonvulsants, oxytriptan (a precursor to serotonin), etc. Some domestic studies have shown the effectiveness of long-term use of small doses of aspirin.
Since drug treatment is ineffective, great attention should be paid to the patient’s lifestyle and the exclusion of factors that provoke a migraine attack. This is a task that only the sickest person can solve. In addition to normalizing the daily routine and nutrition, this should include serious psychological work aimed at reducing demands on others and developing a more friendly attitude towards people. Consultations can play a supporting role in this. psychologist, special trainings, psychotherapy.
Forecast
A simple migraine in itself is not a disease threatening the life or health of the patient. However, migraine attacks reduce the performance of patients, making it impossible for them to perform their work duties during the attack. In addition, some patients (for example, rescuers, doctors, workers in noisy workshops, cooks, etc.) are forced to change their profession because it is associated with migraine triggers. Unfortunately, according to statistics, only in 10% of cases doctors manage to achieve cessation of migraine paroxysms. On the other hand, there are numerous cases where patients themselves, by changing their lives, achieved recovery.
MIGRAINE- a disease whose dominant manifestation is repeated attacks of intense headaches. Hereditary predisposition plays an important role in the pathogenesis of migraine. For a long time, a migraine attack was associated with changes in vascular tone: narrowing of the intracerebral arteries and dilation of the arteries of the dura mater. It has now been established that these changes are secondary and may not be directly related to the symptoms of the disease. The leading role in the genesis of pain is played by the activation of neurons of the trigeminal nerve nucleus, and as a result, biologically active substances are released at their endings in the vascular wall, causing focal neurogenic inflammation and swelling of the vessels and the adjacent area of the dura mater. And the activation of serotonergic neurons in the raphe nuclei plays an important role in the initiation of the attack and the genesis of the aura. Migraine is more common in women aged 25 - 55 years.
Clinically, there are 2 main forms: migraine without aura (simple migraine) and migraine with aura (classical migraine). In more than half of patients, a migraine attack is preceded by prodromal phenomena that begin several hours or days before the onset of the headache (depressed mood or euphoria, irritability or lethargy, drowsiness, sometimes sensitivity to light and sound, thirst, frequent urination, constipation, diarrhea). In a typical case, it is unilateral (hence the name - migraine, which comes from the term “hemicrania”), but in at least 40% of cases it is bilateral. The pain is usually very intense, pulsating in nature, localized in the frontotemporal region, and intensifies with physical activity. The attack most often begins in the morning. The pain gradually increases (over 30 minutes - 2 hours), after which it stabilizes and then slowly passes. The total duration of the attack averages about a day (with fluctuations from 4 to 72 hours). Almost always accompanied by other symptoms: anorexia, nausea, and less often vomiting. During an attack, there is increased sensitivity to light and sounds, so patients tend to find a dark, quiet room. In many patients, the cessation of an attack is facilitated by sleep or. After an attack, you often feel tired, irritable, and depressed, but some, on the contrary, note unusual freshness and euphoria.
Aura is the hallmark of classic migraine, accounting for about 20% of migraine cases. It is characterized by focal neurological symptoms that precede or accompany the headache. The aura usually develops within 5-20 minutes and lasts 10-30 (no more than 60) minutes. usually occurs no later than 60 minutes after the end of the aura. A typical aura is distinguished (visual, sensory, motor or aphasic). Most often, a visual aura is observed, manifested by flashes of light, moving flickering dots and luminous zigzags, sometimes reminiscent of the outlines of the bastions of a fortress, in the place of which a scotoma remains - a blind spot. Visual phenomena most often begin in the central region and gradually spread outward. An aura can be paresthesia and numbness in the hand, perioral area and half of the tongue, hemiparesis,.
Provoking factors include menstruation, stress (or, rather, its resolution), fatigue, sleep disturbance, weather changes, prolonged exposure to the sun, noise, and exposure to perfume. In some patients, the provoking factor is the ingestion of certain foods: chocolate, nuts, creams, yogurt, chicken liver, avocado, citrus fruits, bananas, canned (especially pickled) foods, pork, tea, coffee, sausages, alcohol (especially red wine) , pizza, cheese.
If focal symptoms persist after the headache ends, they speak of complicated migraine. Currently, two separate conditions are distinguished: migraine with a prolonged aura lasting from 1 hour to 1 week, and migraine infarction, in which focal symptoms persist for more than 1 week. In middle and old age, migraine attacks may manifest themselves only as an aura without headache (migraine equivalents).
Diagnosis is based solely on the history, revealing the characteristic features of headache and associated symptoms, prodromal symptoms, positive family history, pain relief after sleep, exacerbation due to menstruation, typical precipitating factors. The recurrence of attacks is a characteristic feature of migraine, so after the first attacks you should be careful - migraine-like pain may be a manifestation of the brain, sinusitis or glaucoma.
Treatment. During an attack, the patient should be placed in a quiet, darkened room, and a warm or cold compress should be applied, slightly squeezing the head. Some patients are helped by simple analgesics: 2 tablets of aspirin or paracetamol, taken when the first signs of an attack appear. Additionally, antiemetics are used to improve the absorption of analgesics - metoclopramide (Cerucal) 5-10 mg orally, domperidone (Motilium) 5-10 mg orally, pipolfen 25-50 mg, meterazine 5-10 mg. In case of vomiting, these drugs are administered rectally (in the form of suppositories) or parenterally.
If simple analgesics are ineffective, they resort to non-steroidal anti-inflammatory drugs (NSAIDs) or combination drugs containing barbiturates. enhances the effect of analgesics, improving their absorption, but with frequent attacks, when the daily dose of caffeine at least several times a week exceeds 300 - 500 mg (3 - 4 cups of coffee), it can worsen the condition, causing rebound or withdrawal headaches. The addition of codeine and barbiturates (drugs, pentalgin, solpadeine) increases effectiveness, but also increases side effects and creates the possibility of abuse. For migraine, various NSAIDs are effective, but ibuprofen (200 mg), (250 mg), (75 mg), (10 mg) is most often prescribed (usually take 2 tablets with the same dose repeated after 1 hour). NSAIDs can also be administered parenterally: aspirin (aspizol) 1000 mg intravenously, diclofenac (Voltaren) 75 mg and (toradol) 30 - 60 mg intramuscularly. In cases where these drugs are ineffective, ergotamine tartrate is used, usually in combination with caffeine, which improves its absorption (drugs caffeamine, cofergot, etc.). Usually start with 2 tablets (1 tablet contains 1 mg of ergotamine and 100 mg of caffeine), if necessary, the same dose is repeated after 1 hour. When using rectal suppositories, smaller doses are needed, since absorption occurs more completely. Start with 1/4 of a suppository (1 suppository contains 2 mg of ergotamine and 100 mg of caffeine); if ineffective, 1/2 of a suppository is administered after 1 hour. The maximum daily dose of ergotamine is 4 mg (it can be used no more than 1-2 times a week). Since it provokes nausea and vomiting, before taking it it is often necessary to administer an antiemetic (metoclopramide, aminazine or pipolfen). also causes abdominal pain, paresthesia in the distal extremities, and cramps. The drug is contraindicated in pregnancy, uncontrolled arterial hypertension, stenotic lesions of coronary, cerebral or peripheral vessels, sepsis, liver and kidney diseases. Effectively relieves migraine attacks and, which is administered parenterally (0.25-0.5 mg). The drug is also available in the form of an aerosol for nasal administration (dihydroergot). Sumatriptan (imigran), which is administered subcutaneously in a dose of 6 mg (the drug is available as an autoinjector) or 100 mg orally, is highly effective. If the effect is partial, the drug can be re-administered after 1 hour. The drug is contraindicated in coronary heart disease, basimirtic and hemiplegic migraine, and uncontrolled arterial hypertension. After administration, pain at the injection site, paresthesia in the distal extremities, hot flashes, and chest discomfort are possible. To relieve attacks, opioid drugs (Tramal), butorphanol (Stadol), 10-20 mg intramuscularly, must also be used in combination with antiemetics. For migraine status, in addition to the above medications, parenteral fluid administration is mandatory (especially with persistent vomiting), and the use of corticosteroids (dexamethasone 8-12 mg intravenously or intramuscularly, if necessary, again after 3 hours).
Preventive treatment consists primarily of eliminating provoking factors, including dietary ones. Equally important are regular meals, adequate sleep, reduced consumption of caffeine and alcohol, and dosed physical activity. The patient needs to be taught various relaxation techniques. Pharmacological treatment is indicated for frequent or severe attacks. The most commonly used drugs are beta blockers, calcium antagonists, NSAIDs (naproxen), and antidepressants (amitriptyline). If first-line drugs are ineffective, antiserotonin drugs (methysergide, cyproheptadine (peritol), sodium valproate) are used. In some cases, papaverine or high doses are effective.
Migraine is a neurological disease that manifests itself as intense headache predominantly on one side. The disease is accompanied by autonomic disorders or so-called aura. Typically, an aura is manifested by visual disturbances, nausea and vomiting, and photophobia.
An attack of hemicrania can be caused by various factors: depression, fatigue, strong smells or sounds, changes in atmospheric pressure. Some food products, such as smoked meats, red wine, chocolate, and cheese, can act as a provocateur.
Many people know how migraine manifests itself, but not everyone understands the pathogenesis of the disease. Most scientists are unanimous in the opinion that the main site of pain development is the blood vessels of the brain.
Therefore, it is obvious that the aura accompanying painful attacks is a consequence of vascular spasm and the development of cerebral ischemia. Cases of manifestations of focal neurological symptoms (dizziness, loss of consciousness, tremors of the extremities) may indicate the development of serious pathologies that require immediate treatment.
Causes of neurological symptoms
Vertebral artery syndrome and cervical osteochondrosis
Migraine with focal neurological symptoms can be caused by VA (vertebral artery) syndrome. The vertebral arteries (right and left) are located along the spinal column and pass through the canals formed by the transverse processes of the cervical vertebrae. At the base of the brain stem, the vessels merge into an artery, which branches out and supplies the cerebral hemispheres with blood.
The cause of pathological processes can be cervical osteochondrosis. Degenerative changes in the vertebrae and their spinous processes lead to compression of the spinal nerves, arteries and veins that supply blood to the brain. The neurological manifestation of osteochondrosis is the occurrence of vertebrobasilar insufficiency, manifested by the following symptoms:
- Nausea and vomiting;
- Decreased vision and hearing;
- Dizziness;
- Impaired coordination of movements;
- Loss of consciousness;
- Temporary amnesia;
- Partial or complete paresis of the limbs.
The patient may experience intense pain, starting in the area of the occipital part of the head and the seventh vertebra, spreading to the parietal region, to the forehead, temple, ear and eyes. When you turn your head, you may feel a strong crunching and burning sensation in the neck area - the so-called cervical migraine.
Neurological headaches are usually caused by excessive compression of the occipital and facial nerves and have an intense shooting character. Painful sensations spread along the location of the nerves and are characterized by duration and constancy, lack of proper effect from the prescribed treatment.
Seizures can significantly limit performance and disrupt the usual rhythm of life. There are several types of migraine with focal neurological symptoms: facial, pharyngeal, hemiplegic.
Pharyngeal migraine
Much less often, specialists diagnose pharyngeal migraine. Pharyngeal migraine occurs as a result of damage to the sympathetic weave of the vertebral artery and is accompanied by sensations of a foreign body in the throat and a violation of the swallowing reflex.
In other cases, paresthesia (numbness, loss of sensitivity, tingling, crawling) and one-sided painful sensations involving the pharynx, hard palate, and tongue may occur. Chills, increased sweating, and spots in the eyes are also observed.
Any turn of the neck or change in head position leads to an increase in pain attacks. If you can find the optimal position of the head, the headache may weaken and disappear completely.
Facial migraine
Facial migraine is diagnosed as trigeminal neuralgia and is accompanied by neurotic reactions: strong excitement or vice versa, emotional numbness, aggression, hysterical state.
Shooting pain radiates to the area of the lower jaw or neck, sometimes to the area around the eyes. The attacks are difficult to stop and can recur several times a week, accompanied by accompanying pain in a certain part of the head.
Facial migraine with focal neurological symptoms can recur systematically. Cold wind or just communication is enough to cause unpleasant sensations.
A characteristic symptom of the disease is the presence of so-called trigger points, careless touching of which can trigger the onset of an attack. In the area of the carotid artery, pulsation increases, swelling and redness are visualized, and touching it is painful.
Hemiplegic migraine
To establish a diagnosis, the doctor conducts a thorough medical history and prescribes a set of examinations to exclude other causes of attacks. Treatment of hemiplegic migraine consists of a complex of drugs and measures used for other types of the disease, and depends on the severity of the condition and the individual data of the patient.
Hemiplegic migraine can be divided into two forms: a disease without complications and a disease complicated by neurological manifestations with paresis of one half of the body. The disease can be considered as a hereditary autoimmune disease.
This is a rare, severe form of hemicrania, characterized by attacks of headache with central paresis, temporary impairment of speech and sensitivity.
Paresis is manifested by difficulty in motor activity of the fingers, followed by spread to the corresponding side of the body and an increase in throbbing headache.
Such disorders can only in very rare cases reach the level of paralysis.
Unlike classic migraine, accompanied by aura, the first symptoms of hemiplegic hemicrania are paresthesia and headache, which are subsequently joined by reversible neurological symptoms: dizziness, double vision, short-term amnesia, fever, speech disorders.
In some cases, symptoms may be complicated by epileptic seizures.
Treatment, diagnosis
Migraine with focal neurological symptoms is difficult to treat and requires an integrated approach. The choice of methods and drugs depends on the origin of the migraine.
Diagnosis is based on collecting anamnesis and identifying characteristic complaints. In addition to collecting anamnesis, the specialist must conduct additional high-tech studies:
- X-ray of the cervical or lumbar spine.
- Dopplerography of the vessels supplying the brain.
- MRI of the spine.
- Blood test for cholesterol and lipids.
Neurologists treat hemicrania with focal neurological symptoms. If measures are started on time, then pain attacks can be quickly stopped or significantly minimized.
As a rule, treatment includes the use of ointments with active anti-inflammatory and analgesic components, medications that promote the regeneration of cartilage tissue, as well as:
- Medicines that improve blood circulation, such as cinnarizine;
- Anti-inflammatory and painkillers: nurofen, diclofenac, indomethacin nimesulide;
- B vitamins;
- Antispasmodics;
- Neuroprotectors to protect the brain from hypoxia;
- Triptan drugs: Sumatriptan, Sumamigren, Imigran spray;
- Antidepressants - Cymbalta, Velafax;
- Anticonvulsants.
Prevention
To correct the disease, consultation with a neurologist and comprehensive treatment are necessary. It is necessary to understand that therapeutic measures are intended only to relieve pain and relieve inflammation.
In order for the disease to bother you, you need to avoid stress as little as possible, lead a healthy lifestyle: play sports, take walks in the fresh air, eat a balanced diet.
Non-drug methods will help control the situation. Manual therapy, acupuncture massage, yoga classes are excellent disease prevention. It is very important to know the first manifestations of an attack and be able to stop them in time.
If the correct treatment is selected, then manifestations of migraine with focal neurological symptoms have a favorable prognosis - a decrease in the number of attacks and their intensity.
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