Does "Migraine" Need Brain Wave Examination?

        Many people have had experience of migraine, and many people will go to the outpatient clinic to ask the doctor if they need in-depth examination. However, the causes and symptoms of migraine are very extensive. This article will start with "specific headache" and "specific examination" to lead you to understand the difficult "migraine".

                What is migraine?

        Migraine is a known specific disease. The pain may not be on the side of the head, but on the middle or both sides, even on the face. The International Headache Medical Association classifies migraine as "primary headache" and "secondary headache". The concept of "primary headache" is not easy to explain, but it can be started from the relative "secondary headache". "Secondary headache" refers to a headache caused by a patient suffering from a certain disease (such as brain tumor). In other words, "primary headache" means that headache itself is a disease.

        Causes of migraine

        The cause of migraine is still unclear, but it is likely to be caused by spreading depression in the brain. This is a normal brain phenomenon, but everyone has different sensitivity; Generally, people can only appear under great stimulation (such as car accident and stroke), but migraine patients will produce only slight stimulation (such as insufficient sleep and menstruation), and some even can't feel it (such as hormonal changes during ovulation). Therefore, migraine patients sometimes feel that headache occurs under certain circumstances, but sometimes for no reason or sign.

        The brain has different sensitivity to "diffusion inhibition", which may be caused by the combination of congenital (genetic) and acquired factors. This genetic inheritance is likely to be "polygenic inheritance", and it is difficult to determine which part of the gene parents will inherit to their children. In fact, polygenic, congenital and acquired interactions are very common. For example, the height of parents is absolutely related to the height of children (parents are tall, children are usually tall), but not absolutely (some very tall parents will give birth to very short children, and vice versa). It will be affected by sleep, sports, nutrition and other factors. However, from the statistical analysis, it is clear that the heritability of migraine exists.

        How to diagnose migraine?

        According to the third edition of the International Headache Diagnostic Classification issued by the International Headache Society, the diagnostic criteria for migraine are as follows:

        　　A. At least 5 episodes meet the benchmark B~D

        　　B. Headache attack lasts for 4-72 hours

        　　C. Headache has at least 2 of the following 4 characteristics: unilateral, pulsatile, moderate or severe pain, and daily activities can aggravate the headache or avoid such activities (such as walking or climbing stairs)

        　　D. At least one of the following items occurs during headache: nausea and (or) vomiting, photophobia and fear of noise

        　　E. No other more appropriate ICHD-3 diagnosis

        What examination should migraine do?

        If it is confirmed to be migraine, in theory, no examination is required, because the examination will not find any abnormality. The problem is that even if the patient's headache characteristics meet the above diagnostic requirements, it cannot be identified as migraine 100%. If necessary, doctors may arrange examinations such as computer tomography or magnetic resonance imaging. As for EEG examination, it is mainly aimed at epilepsy, or mad cow disease, hepatic encephalopathy and other special diseases, but for headache, it is too low to detect brain tumors or strokes.

        Treatment of migraine

        Analgesics can be divided into general analgesics and migraine specific analgesics (such as: Tripod drugs). Unless you have to, it is not recommended to use opium or barbiturates to relieve pain, because these drugs are highly addictive. If you use painkillers too frequently, your headache may worsen.

        Prevention of migraine

        1. Prevention in life: First, find out the inducing factors to prevent it. Common causes include menstruation, stress, sleep, illness, weather change, etc. Some foods are easy to cause migraine, such as chocolate, cheese, citrus fruits, etc., but the proportion caused by single food is relatively low

        2. Medication prevention: There are many kinds of preventive drugs, but generally they will be effective only after taking them continuously for a while, so they are usually used by patients who have frequent attacks or have poor effects on painkillers. If you really need prevention, but don't like taking medicine every day, you can also choose to inject drugs (botulinum toxin and CGRP antagonist) once a month or three months. However, the health insurance benefits of these injections are very strict, and some of them are not even included in the health insurance benefits.

        conclusion

        It can be seen that migraine patients do not need to do brain wave examination, because the examination also does not show abnormalities. The American Academy of Neuromedicine recommends that routine brain wave examination is not necessary for simple headache. However, the problem is that it is difficult for patients to judge whether their headache is simple, so they should still seek medical advice for headache. If the doctor judges it as simple headache, no examination is needed; Too many examinations will not promote health, and may even be harmful, but will also increase the burden of health insurance and waste patients' time and money. However, if the doctor thinks that the headache may not be simple, he will usually arrange CT or MRI (the actual items depend on the clinical situation) to exclude the possibility of brain lesions.