"That no one dies of migraine seems to someone deep into an attack, an ambiguous blessing"
Definition
Classically episodic, lateralised throbbing headache associated with photophobia, phonophobia, and vomiting, and with complete freedom between episodes.
Prognosis
Most attacks of migraine subside within 72 hours at the most. Most patients respond to therapy for acute attacks, for prophylaxis, or both. Episodes reduce in frequency and severity with age.
Treatment
Suspect Mengitis whrn: A child has fever with headache. A child behaves abnormally. A child become drowsy, irritable ro restless. A child has neck stiffness. An infant has tense fontanelle, cries excessivelt or is drowsy. Refer the patient to a pediatrician for L.P and treatment.
Summary of treatment: Inj. Streptomycin 40mg/day Syp. ISOKIN 15mg/kg/day Syp. Rcin 10mg/kg/day Tab. Ethambutol 15mg/kg/day Tab. Pyrazinamide 30mg.kg.day BETNESOL drops or Tablets Intrathecal Efcorlin 10mg (Hydrocortisone hemisuccinate) General Nursing care, tube feeding or oral feeding.
Additional Treatment: If fever: Syp. CROCIN 1-2 tsp Cold compresses
If convulsions: Inj. Paraldelhyde 1ml.yr of age x deep IM Inj. CALMPOSE 1/2 to 2cc IV
If headache/irritable: L.P. to reduce intracranial tension.
If dehydration: IV fluids as required Whenever an Infant cries excessively and has bulging fontanelle, Think of TB mengitis.
Rest in quiet dark room until headache subsides. Overnight sleep is often curative. Reducing reaction to every day stresses of life, by meditation techniques, Yoga, bio-feed back, hypnosis etc. help. Cognitive behavioural therapy is helpful. In small subgroups of patients Hypnosis has a limited role.
Advice to Patient
The disease can not be cured but can be very adequately controlled. To avoid over reaction to stress. To avoid over recourse to narcotics for relief of pain. To learn self administration of SC Sumatriptan.
Inadequate Response
Recurrent attacks at short intervals would merit putting on to prophylactic drugs.
Prevention
Avoidance of precipitating factors like excess noise, bright lights, physical stress, loss of sleep, missed meals, difficult travel, emotional stress, alcohol, foods like chocolate, cheese, nuts, citrus fruits, fried foods, oral contraceptives. Avoidance of recurrent attacks as discussed above.
