Headache is a common disease. Many people suffer from migraine. The global epidemiological survey of headache shows that the proportion of headache in the general population is 50%, and the lifetime history of headache is more than 90%. The average lifetime prevalence of migraine is 18%, and the prevalence of migraine in children and adolescents is 7.7%. Patients sometimes ask the question: will it hurt to have a apoplexy? Some people will think this problem is ridiculous, but in fact, it is a good problem, and most of them do not pay enough attention to it.
Migraine is a common disease and the most characteristic headache (pulsatile headache with repeated attacks in one or both temporal parts, which can be accompanied by visual and somatosensory aura before attack, and often vomiting).
Apoplexy, also known as “apoplexy” and “cerebrovascular accident”, is an acute cerebrovascular disease.
Migraine and apoplexy, which seem unrelated, are actually inextricably linked. What is the relationship between the two? Cut constantly, manage still disorderly. Listen to me slowly
1、 Is migraine a risk factor for apoplexy?
1,Migraine is an independent risk factor for apoplexy
Apoplexy seems to have a special preference for women of childbearing age with a history of migraine. Based on the results of several large-scale epidemiological surveys in recent years, it is found that the probability of apoplexy in migraine patients without aura is three times that of normal people, while that in migraine patients with aura is as high as six times, and that in young women who take contraceptives for a long time and smoke at the same time, it is up to 14 times.
In fact, a modern neuroimaging study published in the Journal of Neurology in 2011 (including 8137 migraine patients) also confirmed that most of the patients with migraine cerebral infarction were women and had migraine with aura. Therefore, it is not too much to regard migraine as an independent risk factor of apoplexy , which should be paid more attention to women of childbearing age.
2,Migraine is one of the causes of cryptogenic apoplexy
The so-called cryptogenic apoplexy is the apoplexy that can not find the cause in the past, accounting for about 1 / 3 of all apoplexy . A survey recently completed by the University of Oxford found that about 1 / 3 of patients with cryptogenic apoplexy have a history of migraine. Once the association and mechanism of the two are determined, it will greatly reduce the proportion of cryptogenic apoplexy , and then promote the accurate prevention and treatment of apoplexy .
Migraine apoplexy can occur in both the anterior circulation and the posterior circulation, but generally speaking, it mostly occurs in the posterior circulation, and the nature and premonitory symptoms of headache are similar to those in the past. These phenomena not only have further clinical warning effect, but also open a door for the study of correlation and pathological mechanism between them. Therefore, neuroimaging examination should be carried out in time for highly suspected patients, especially magnetic resonance examination which can better show the blood supply area of posterior circulation.
2、 Migraine and apoplexy coexist in various forms
1,Migraine and apoplexy coexist: suffering from migraine and apoplexy at the same time, but the occurrence of apoplexy and the onset of migraine are not at the same time, but separated by a period of time. Due to the lack of sufficient evidence of association between migraine and apoplexy in this type of patients, prevention and treatment strategies are required to be carried out simultaneously but separately. The prognosis mainly depends on the occurrence, development and sequelae of apoplexy . The two are not directly related.
2,apoplexy with clinical characteristics of migraine: also known as apoplexy symptomatic migraine. Whether in location or pathogenesis, cerebrovascular diseases leading to apoplexy are not closely related to migraine attack, but they are very similar to migraine attack in clinical symptoms. This type of patients are most likely to be misdiagnosed and missed in clinical diagnosis. In treatment, we should mainly focus on the etiology of apoplexy (such as cerebrovascular malformation, aneurysm, etc.), and its prognosis depends on whether the inducement is eliminated in time and the degree of brain function damage caused by apoplexy .
3,Migraine induced apoplexy : apoplexy often occurs in a single or frequent attack of migraine, and is consistent with the possible responsible vessels inferred from clinical reasoning. Based on this understanding, the following criteria must be met for the clinical diagnosis of this type of apoplexy : ① the neurological signs of patients must be similar to the symptoms of previous migraine attacks; ② Apoplexy attack must be in the process of typical migraine attack; ③ Other possible factors causing apoplexy must be excluded. Because there is a reasonable correlation between apoplexy and migraine in this type of patients, the clinical focus should be on the prevention and treatment of migraine, and the prognosis depends on the degree of control of migraine attack and the number of sequelae caused by apoplexy .
Migraine is an independent risk factor for apoplexy (especially in young and middle-aged women), but it needs to be carefully distinguished by clinicians whether it is a simple comorbid relationship, two similar looking “passers-by” or a “criminal Duo”. As many problems remain unresolved, clinicians must establish a sense of crisis correlation between migraine and apoplexy .
Headache patients also need to be vigilant. If there is migraine with aura, the risk of cardiovascular disease is 2.15 times that of ordinary people; The risk of apoplexy was 1.91 times; The risk of myocardial infarction was 2.08 times.
3、 The relationship between migraine and apoplexy is complicated
1,Headache can be either a simple, personal subjective symptom or an independent disease (migraine);
2,Headache can occur before, during or after apoplexy , and the causal relationship is difficult to determine;
3,At present, the final diagnosis of most patients with primary headache still depends on the empirical judgment of clinicians;
4,At present, there are many limitations in the understanding of the pathological mechanism of primary headache. It is difficult to trace the origin without knowing the context. It is difficult to deeply understand the relationship between headache and apoplexy without knowing how headache induces apoplexy .
4、 The relationship between migraine and apoplexy should be paid enough attention by doctors
Early screening, diagnosis and treatment: patients who have a history of migraine and return to the clinic due to recurrence should not be taken lightly. Strictly speaking, clinicians should repeatedly compare the differences between this attack and previous attacks, conduct careful physical examination on patients, encourage and persuade patients to carefully record their “headache log” as much as possible, and regularly conduct cerebrovascular ultrasound and other brain imaging examinations, Investigate the causes that can induce apoplexy and headache at the same time (such as cerebral aneurysm and vascular malformation). Once found, it should be ruled out as soon as possible. This is very important for early screening and diagnosis and treatment of migraine apoplexy .
Vigilant high-risk patients: considering that the incidence rate of migraine apoplexy is not too high, and it is prevalent in young adults, especially those who have been on long-term contraceptive use or have just received abortion, induced labor, caesarean section and normal childbirth age (45 years or younger). Highly suspected patients should be kept in hospital for observation.
Establish risk awareness: more than 200 apoplexy related risk factors have been identified, including more than 10 common ones, and there is a vicious circle of superposition and aggravation among many risk factors. Clinicians should establish a apoplexy management awareness with superimposed risk factors for migraine patients. Although the linear relationship between the occurrence of apoplexy and the number of risk factors is not clear, sometimes a single risk factor is enough to directly induce apoplexy (such as hypertension), in general, the more risk factors, the higher the incidence of apoplexy in migraine patients.
5、 How should migraine patients prevent apoplexy ?
In 2000, the world headache Medical Association set guidelines for migraine patients on how to prevent apoplexy , including:
◆ if migraine patients want to prevent apoplexy , they should first have aura;
◆ if migraine with aura often occurs, avoid taking ergotamine, which is used to treat migraine but can cause vasoconstriction;
◆ reduce other risk factors of apoplexy , including not smoking, not drinking alcohol and not taking female contraceptives. Especially those who have frequent headache or migraine with aura, or the number of headaches increases, or the aura lasts for a long time, do not take contraceptives;
Men with migraine may increase the risk of cardiovascular disease. Regular health checks should be made to see if they have high blood pressure, diabetes and high cholesterol. Avoid smoking and drinking less, but also know how to adjust the pace of life and reduce stress. Because the pressure is too great, it is easy to cause headache, and long-term frequent headache will increase the crisis of apoplexy and cerebral ischemia;
◆ generally, you can’t use too many painkillers purchased on the market. If headache is frequent, don’t rely too much on painkillers. You should take headache preventive drugs regularly to reduce headache attacks. Some headache prevention drugs can also reduce hypertension, such as type B blocker, which is also helpful to the heart;
◆ if migraine patients seek medical treatment for other cardiovascular problems, they can actively inform the doctor that they have a history of migraine and adjust their medication.
Migraine is closely related to apoplexy , which needs the attention of doctors and patients. Migraine may just be an outpost of the disease. Only by paying attention to and preventing it can we “prevent it in the first place”.
People with migraines should treat migraine as an important medical problem as diabetes or hyperlipidemia. People with migraine should be actively treated, maintain normal weight and treat hypertension in order to correct the risk factors that may lead to heart disease and apoplexy .