Simple (common) migraine- the most common form. Its main manifestations are paroxysmal headache, localized in the frontotemporal-orbital region, more often in one half of the head (hemicrania), in some cases extending to the entire head. 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 grows, it can be either pulsating, 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 head movements increase the severity of pain. The temporal artery may tense and throb, painful on palpation; sclera injected, swelling of the soft tissues of the face.
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 sets in, which brings relief. Most often, paroxysms of pain with a simple migraine are repeated after a certain time. It is noted that sometimes migraine occurs not during a period of stress, but a few days later, during relaxation ("migraine on Sunday").
Ophthalmic migraine
In contrast to the simple one for ophthalmic migraine a visual aura appears (ciliated scotoma, 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. Vegetative disorders in this form of migraine are less pronounced than in simple migraine. The intensity of headache in both forms is practically the same.
Sometimes in patients, simple and ophthalmic forms of migraine are combined.
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 discirculation (vasospasm, vasodilation) of the corresponding vascular basins.
The associated form of migraine includes:
- ophthalmoplegic, when, against a background of severe headache, at the end of it or after paroxysm, oculomotor disorders appear (unilateral ptosis, diplopia, converging or diverging strabismus). More often it is observed in young people (up to 20-25 years old) who have a history of other types of migraine - simple and classical (in differential diagnosis, one should bear in mind arterial and arteriovenous aneurysms);
- vegetative - against the background of a normal migraine attack, vegetative-vascular (more often sympatho-adrenal) crises appear;
- syncope migraine - during the period of paroxysm of headache, a short-term fainting occurs (more often against the background of an increase in blood pressure).
Menstrual migraine
Menstrual migraine (clinically the same as the simple form) occurs two to three days before or during menstruation. In most patients, with a thorough history taking, a simple form of migraine can also be detected.
Facial migraine
Facial migraine is paroxysmal, periodically recurring paroxysms of pulsating pain in the lower half of the face, spreading to the orbit, temple, half of the face. The duration of the attack is up to 3 days. Hereditary burden, the onset of the disease (young age), provoking factors, the 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, a distinctive feature of which is the absence of an aura and any transient neurological disorders. A simple migraine is characterized by attacks of intense headache, often one-sided, accompanied by nausea, repeated vomiting, sound and photophobia. Diagnosis is based on clinical criteria. It is imperative to exclude other cerebral diseases, a symptom of which may be a 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 migraines with aura and associated migraine, it has no preceding or concomitant headache with transient visual, motor, or sensory disturbances. The first attacks of a 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 family nature of the disease is often traced. In addition, some authors indicate that 80% of men with migraine, mothers also suffered from migraine paroxysms.
Causes of a simple migraine
It is known that a stressful situation, physical overwork, mental overload, lack of sleep can provoke an attack of a simple migraine, hypothermia, changes in the weather, strong odor, noise, flickering light, alcohol intake, eating disorders, eating certain foods (for example, nuts, citrus fruits, chocolate, soy sauce, cheese, celery, Coca-Cola, etc.). In women, a simple migraine can be caused by hormonal changes - ovulation and menstruation, taking hormonal contraceptives. Trigger factors for migraine are individual to a certain extent; over time, each patient knows from experience his own set of such triggers.
Simple migraine, like other types of migraine paroxysms, is associated with character traits such as ambition and ambition, increased excitability. Most of the sick are strong-willed and strong people, but at the same time they are intolerant of the mistakes of others, which is why they often get irritated and show dissatisfaction.
The pathogenetic mechanisms of the development of migraine attacks are still the subject of clinical biochemistry and neurology... With an attack, there are changes in the content of a number of substances - serotonin, histamine, catecholamines, prostaglandins, bradykinin. Today, serotonin plays a major role. Studies have shown that at the onset of a migraine attack, there is a sharp release of serotonin from platelets, which is accompanied by a narrowing of the cerebral vessels. Then serotonin levels drop significantly. The effectiveness of regulators of serotonin metabolism against migraine also emphasizes the importance of this neurotransmitter.
Other studies indicate a trigeminal vascular mechanism for the development of simple migraine. The initial is the excitation of neurons located in the medulla oblongata of the trigeminal nerve nucleus, which provokes the release of neurotransmitters. The latter irritate trigeminal receptors and potentiate aseptic inflammation of the carotid artery wall. This explains the soreness of the artery on palpation and the swelling of the surrounding tissues.
Symptoms of a simple migraine
A simple migraine is characterized by the sudden onset of cephalalgia without a prior aura. In some cases, a headache is foreshadowed by prodromal phenomena - decreased mood, drowsiness, decreased performance, nausea, yawning. Since cephalalgia often extends to only half of the head, it is called hemicrania. Hemicrania is more often observed in the right half of the head. In some cases, cephalalgia captures the other half of the head and is diffuse in nature. The pain is accompanied by nausea of varying intensity and repeated vomiting. Any movement increases the intensity of cephalalgia. Increased sensitivity to sounds and light stimuli, forcing patients during a migraine attack to isolate themselves from the outside world (close in a room, curtain 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 increased urination, diarrhea, dizziness, nasal congestion, autonomic disorders (palpitations, sweating, hot flashes, chills, feeling of lack of air). The end of the paroxysm in half of the cases occurs with the transition of the patient to a state of sleep. After a migraine attack, there may be some weakness and weakness, in some cases, on the contrary, there is an increased physical and intellectual activity.
Simple migraine in children is more 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 are described when a migraine attack in a child was accompanied by fever and abdominal pain and was mistakenly interpreted as an intestinal infection.
Diagnosing a 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 not shorter than 4 hours and not more than 3 days; cephalalgia is characterized by at least 2 of the listed signs - it has medium and high intensity, pulsating, one-sided, becomes more intense with physical exertion; there is at least 1 of the following concomitant 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 and others. Particular vigilance is required with the rapid development of migraine attack, not previously observed excessive intensity of cephalalgia or its unusual nature, the presence of stiff neck muscles, an attack of loss of consciousness, convulsions, limitation of visual fields. To exclude organic cerebral pathology, a comprehensive neurological examination is carried out: electroencephalography , echoencephalography , REG , Doppler ultrasonography of the vessels of the head, inspection ophthalmologist with examination of the fundus and perimetry. According to the testimony is appointed MRI of the brain and MRI of cerebral vessels.
Simple migraine treatment
In the relief of migraine paroxysm, standard analgesics are ineffective. As a rule, dihydroergotamines (ergotamine, dihydroergotamine) or selective serotonin agonists - triptans (sumatriptan, risatriptan, naratriptan, zolmitriptan, eletriptan) are used. With the gradual development of paroxysm, it is enough to take one of these drugs inside. However, due to reduced gastrointestinal motility, this route of administration may be ineffective. In such cases, it is recommended to use ergotamine in rectal suppositories, dihydroergotamine i / m or i / v, sumatriptan s / c. The use of triptans is associated with frequent relapses of cephalalgia, since these drugs have a short half-life (only 2 hours). With the resumption of cephalalgia, repeated administration of the drug is often required, the combination of triptans with non-steroidal anti-inflammatory drugs (ibuprofen, nimesulide, diclofenac).
In some cases, a simple migraine is stopped by endonasal administration of lidocaine, taking naproxen, intramuscular administration of magnesia. Repeated vomiting is an indication for the appointment of antiemetics (metoclopramide, domperidone, ondansetron). With a 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 of 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 of serotonin), etc. Some domestic studies have shown the effectiveness of long-term administration of low doses of aspirin.
Since drug treatment is ineffective, much attention should be paid to the patient's lifestyle, excluding the factors that provoke a migraine attack from it. This is a task that can only be solved by the patient himself. In addition to normalizing the daily routine and nutrition, this should include serious psychological work aimed at reducing the exactingness of others and the formation of a more benevolent attitude towards people. Consultations can play a supporting role in this. psychologist, special trainings, psychotherapy.
Forecast
A simple migraine in itself is not a life-threatening or health-threatening disease for the patient. However, migraine attacks reduce the performance of patients, making it impossible for them to perform their work duties during the period of the attack. In addition, some patients (for example, rescuers, doctors, workers in noisy shops, cooks, etc.) are forced to change their profession, since it is associated with triggers that provoke migraines. Unfortunately, according to statistics, only in 10% of cases, doctors manage to achieve the cessation of migraine paroxysms. On the other hand, there are repeated cases when patients themselves, by changing their lives, achieved recovery.
MIGRAINE- a disease dominated by repeated bouts of intense headache. In the pathogenesis of migraine, hereditary predisposition plays an important role. For a long time, a migraine attack was associated with a change in vascular tone: a narrowing of the intracerebral arteries and an expansion 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 in the nucleus of the trigeminal nerve, and as a result of which biologically active substances are released at their ends in the vessel wall, causing focal neurogenic inflammation and edema of the vessels and the adjacent part of the dura mater. And the initiation of the attack and the genesis of the aura, an important role is played by the activation of serotonergic neurons of the suture nuclei. Migraine is more common in women between the ages of 25 and 55.
Clinically, there are 2 main forms: migraine without aura (simple migraine) and migraine with aura (classic 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 light and sound fear, thirst, frequent urination, constipation, diarrhea). In a typical case, it is unilateral (hence the name - migraine, derived from the term "hemicrania"), but in at least 40% of cases it is bilateral. The pain is usually very intense, has a pulsating character, is localized in the frontotemporal region, and increases with physical activity. The attack usually begins in the morning. The pain gradually increases (within 30 minutes - 2 hours), after which it stabilizes and then slowly disappears. The total duration of an attack is on average about a day (with fluctuations from 4 to 72 hours). Almost always accompanied by other symptoms: anorexia, nausea, less often vomiting. During an attack, there is an increased sensitivity to light, sounds, so patients tend to find a dark, quiet room. In many patients, sleep or. After an attack, fatigue, irritability, depression are often felt, but some, on the contrary, note unusual freshness and euphoria.
The aura is a 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, lasts 10-30 (no more than 60) minutes. usually occurs no later than 60 minutes after the end of the aura. A typical aura (visual, sensory, motor or aphatic) is distinguished. Most often, a visual aura is noted, manifested by flashes of light, moving flickering dots and luminous zigzags, sometimes resembling the outlines of fortress bastions, in the place of which a scotoma remains - a blind spot. Visual phenomena most often begin in the central region and gradually spread outward. Paresthesias and numbness in the hand, perioral region and half of the tongue, hemiparesis, can act as an aura.
The provoking factors are menstruation, stress (or rather, its resolution), fatigue, sleep disturbance, changes in the weather, prolonged exposure to the sun, noise, exposure to perfumes. In some patients, a provoking factor is the ingestion of certain foods: chocolate, nuts, creams, yogurt, chicken liver, avocados, citrus fruits, bananas, canned (especially pickled) foods, pork, tea, coffee, sausages, alcohol (especially red wine) , pizza, cheese.
If focal symptoms persist after the end of the headache, they speak of a complicated migraine. Currently, two separate conditions are distinguished: migraine with an elongated 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 can manifest themselves only with an aura without a headache (migraine equivalents).
Diagnosis based solely on history of headache and associated symptoms, prodromal symptoms, positive family history, relief of pain after sleep, exacerbation due to menstruation, typical triggers. The recurrence of seizures is a characteristic feature of migraine, so caution should be exercised after the first attacks - migraine-like pain may be a manifestation of the brain, sinusitis or glaucoma.
Treatment... With an attack, the patient should be placed in a quiet darkened room, apply a warm or cold compress, somewhat squeezing the head. Some patients are helped by simple analgesics: 2 tablets of aspirin or paracetamol taken at the first signs of an attack. Additionally, antiemetics are used that 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, solpadein) increases efficacy, but also increases side effects and creates the potential for abuse. For migraine, various NSAIDs are effective, but ibuprofen (200 mg), (250 mg), (75 mg), (10 mg) is more often prescribed (usually 2 tablets are taken 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 kofetamine, kofergot, etc.). Usually they 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 is more complete. Start with 1/4 of the candle (in 1 candle - 2 mg of ergotamine and 100 mg of caffeine), if ineffective, after 1 hour, inject 1/2 of the candle. 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, it is often necessary to administer an antiemetic agent (metoclopramide, chlorpromazine or pipolfen) before taking it. also causes abdominal pain, paresthesia in the distal extremities, cramps. The drug is contraindicated in pregnancy, uncontrolled arterial hypertension, stenosing lesions of the 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 at a dose of 6 mg (the drug is produced in the form of an autoinjector) or 100 mg orally, is highly effective. With a partial effect, the drug can be re-administered after 1 hour. The drug is contraindicated in ischemic heart disease, basimiric and hemiplegic migraines, and uncontrolled arterial hypertension. After the injection, pain at the injection site, paresthesia in the distal extremities, hot flashes, chest discomfort are possible. For the relief of seizures, opioid drugs (tramal), butorphanol (stadol) can also be used, 10-20 mg intramuscularly necessarily in combination with antiemetics. In case of migraine status, in addition to the above drugs, parenteral fluid administration (especially with persistent vomiting), the use of corticosteroids (dexamethasone 8-12 mg intravenously or intramuscularly, if necessary, again after 3 hours) is mandatory.
Preventive treatment consists primarily in the elimination of provoking factors, including dietary ones. Regular meals, adequate sleep, reduced consumption of caffeine and alcohol, and dosed physical activity are equally important. The patient needs to be trained in various relaxation techniques. Pharmacological treatment is indicated for frequent or severe attacks. The most commonly used are beta-blockers, calcium antagonists, NSAIDs (naproxen), antidepressants (amitriptyline). If the 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 an intense headache predominantly on one side. The disease is accompanied by vegetative disorders or the so-called aura. Usually the aura is manifested by visual impairment, nausea and vomiting, photophobia.
An attack of hemicrania can be caused by various factors: depression, fatigue, strong smells or sounds, surges in atmospheric pressure. Some food products can act as a provocateur, for example, smoked meats, red wine, chocolate, cheese.
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 vasospasm and the development of cerebral ischemia. Cases, manifestations of focal neurological symptoms (dizziness, loss of consciousness, tremor of the extremities) may indicate the development of serious pathologies that require immediate treatment.
The culprits of neurological symptoms
Vertebral artery syndrome and cervical osteochondrosis
A migraine with focal neurological symptoms can be caused by PA (vertebral artery) syndrome. Vertebral arteries (right and left) are located along the vertebral column and pass through the channels formed by the transverse processes of the cervical vertebrae. At the base of the brainstem, the vessels merge into an artery, which branches out to supply blood to the cerebral hemispheres.
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 be pursued by intense pain, starting in the region of the occipital part of the head and the seventh vertebra, spreading to the parietal region, to the region of the forehead, temple, ear and eyes. When you turn your head, you can feel a strong crunching and burning sensation in the neck area - the so-called cervical migraine.
Headaches in neurology, usually caused by excessive compression of the occipital and facial nerves, have an intense shooting character. Painful sensations spread along the nerves and differ in duration and constancy, lack of the proper effect of 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 a pharyngeal migraine. Pharyngeal migraine occurs as a result of damage to the sympathetic ligament 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, creeping) and one-sided painful sensations exciting the pharynx, hard palate, tongue may occur. Chills, increased sweating, flies in the eyes are also observed.
Any turn of the neck, a change in the position of the head leads to an increase in pain attacks. If you can find the optimal position of the head, then the headache can ease and disappear completely.
Facial migraine
Facial migraine is diagnosed as trigeminal neuralgia and is accompanied by neurotic reactions: intense 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. Seizures are difficult to relieve and may recur several times a week with accompanying pain in a specific part of the head.
Facial migraine with focal neurological symptoms can recur systematically. For unpleasant sensations, a cold wind or just communication is enough.
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, redness is visualized, and touching it is painful.
Hemiplegic migraine
To establish a diagnosis, the doctor conducts a thorough history taking and prescribes a set of examinations to exclude other causes of seizures. 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 headache attacks with central paresis, temporary impairment of speech and sensitivity.
Paresis is manifested by difficulty in motor activity of the fingers of the hand, followed by spread to the corresponding side of the body and an increase in pulsating headache.
Such disorders only in very rare cases can reach the degree of paralysis.
In contrast to the classic migraine, accompanied by an 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, and speech disorders.
In some cases, symptoms may be complicated by epileptic seizures.
Treatment, diagnostics
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 taking anamnesis and identifying characteristic complaints. In addition to collecting anamnesis, a specialist must definitely conduct additional high-tech research:
- X-ray of the cervical or lumbar spine.
- Doppler ultrasonography of blood vessels supplying the brain.
- MRI of the spine.
- A blood test for cholesterol and lipids.
Neurologists are involved in the treatment of hemicrania with focal neurological symptoms. If the 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, and also:
- Drugs that improve blood circulation, such as cinnarizine;
- Anti-inflammatory and pain relievers: nurofen, diclofenac, indomethacin nimesulide;
- Group B vitamins;
- Antispasmodics;
- Neuroprotective agents to protect the brain from hypoxia;
- Triptan drugs: Sumatriptan, Sumamigren, Imigran spray;
- Antidepressants - Simbalta, Velafax;
- Anticonvulsants.
Prevention
To correct the disease, it is necessary to consult a neurologist and comprehensive treatment. It must be understood that therapeutic measures are intended only to relieve pain and relieve inflammation.
In order for the ailment to bother, as rarely as possible, it is necessary to avoid stress, lead a healthy lifestyle: play sports, take walks in the fresh air, eat balanced.
Non-drug methods will help to 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 the 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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