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Neurología Mancha-Centro

Servicio de Neurología del Area Mancha Centro - Hosp. General Mancha Centro y Hosp. General de Tomelloso

Blog de Neurologia Post New Entry

LA MIGRAÑA

Posted by SANTI on June 12, 2014 at 1:40 PM




1. ¿EN QUE CONSISTE LA MIGRAÑA?   

En primer lugar, hay que decir que la “migraña” no es sinónimo de cefalea. La migraña (también denominada “jaqueca” es solo un tipo de cefalea o “dolor de cabeza” de los más de 150 tipos descritos y clasificados, si bien es uno de los más frecuentes y, junto con la cefalea tensional, supone casi el 90% de todos los casos de cefalea que acuden a nuestra consulta.

Hay que decir que la migraña es una enfermedad crónica benigna de carácter episódico, con un importante componente hereditario (aunque a día de hoy se conoce tan sólo una mínima parte de la genética de la migraña) y que se presenta en forma de crisis de dolor de cabeza muy intensas y discapacitantes.

La migraña tiene un fuerte impacto socioeconómico en nuestro país ya que repercute en la calidad de vida de los pacientes y supone en muchos casos una gran discapacidad temporal para realizar con normalidad su vida diaria laboral, social y familiar, acarreando además muchos gastos directos e indirectos.



2. ¿ES UNA ENFERMEDAD FRECUENTE?

Según la OMS la prevalencia de la migraña en España oscila entre el 12-15% de la población, que en números absolutos supone casi 5 millones de habitantes, aunque probablemente este infradiagnosticada ya que se estima que sólo 1 de cada 2 pacientes migrañosos consulta con el médico y es diagnosticado correctamente.

La migraña, que es más frecuente en la mujer (proporción 3:1) comienza en edades tempranas (en el 85% de los casos se inicia antes de los 30 años pudiendo iniciarse incluso en la infancia) y se desarrolla durante toda la vida en forma de episodios recurrentes de cefalea que en ocasiones (sobre todo por el abuso de analgésicos) puede derivar a una cefalea crónica diaria ( esto ocurren en un 3-5% de la población).



3. ¿CUÁL ES LA CAUSA?

La causa de la migraña todavía es desconocida aunque se conoce bien su fisiopatología (“como se produce”;). Se sabe que el dolor y los síntomas que acompañan a la migraña se producen por un conjunto de alteraciones neuroquímicas y de los vasos sanguíneos cerebrales en pacientes con una cierta predisposición genética ( es decir con antecedentes familiares de migraña ).

Hay una serie de factores o situaciones que precipitan o favorecen la aparición de una crisis de migraña: los más comunes son el estrés (ya sea físico o psíquico), la menstruación o la toma de anticonceptivos orales en el caso de las mujeres y la falta o el exceso de sueño. Otros elementos precipitantes menos frecuentes son los cambios de tiempo y ciertos alimentos como el chocolate, el alcohol, el café, los frutos secos, embutidos, quesos fuertes,  y condimentos de la comida china (aunque hay que puntualizar que esto no ocurre en todos los pacientes). También se ha relacionado con el ayuno y los olores intensos.



4. ¿CÓMO SE DIAGNOSTICA?

El diagnóstico de la migraña se basa en la clínica (es decir, por los síntomas que describe el paciente). Se caracteriza por la aparición de un dolor de cabeza de inicio gradual habitualmente unilateral (aunque también puede doler toda la cabeza) de carácter pulsátil (en forma de latidos en el interior de la cabeza) y de gran intensidad que empeora con una actividad física leve como agacharse o subir escaleras y que puede llegar a ser muy discapacitante dificultando o impidiendo su actividad diaria habitual. Además el dolor puede acompañarse de náuseas, vómitos e intolerancia al ruido o a la luz. Suele durar 4-72 horas si no se toma medicación.

Existen básicamente dos tipos: Migraña sin y con aura. Llamamos aura migrañosa a un conjunto de síntomas neurológicos transitorios (como pueden ser: visión de manchas o luces brillantes, sensación de “acorchamiento” u “hormigueo” en una parte del cuerpo o incluso una alteración del lenguaje) que preceden al episodio migrañoso y que ceden a medida que se instaura el dolor de cabeza.



Mediante la entrevista clínica con el paciente y una adecuada exploración neurológica los especialistas debemos diferenciar una cefalea primaria como es la migraña (en este caso la cefalea es la propia enfermedad), de las cefaleas secundarias que son aquellas en las que la cefalea no es más que un síntoma de una patología subyacente (que puede ir desde una sinusitis hasta una lesión cerebral como pueda ser un tumor mucho más grave). Existe una serie de indicadores que despiertan la alarma cuando un dolor de cabeza puede traer consigo un trastorno más grave y que ponen al especialista en alerta, como son: una cefalea de reciente aparición (sobre todo si el paciente es de edad avanzada y nunca ha padecido de dolores de cabeza, un cambio en las características de su cefalea habitual o un aumento de la intensidad del dolor a lo largo de los días, la falta de respuesta a los analgésicos, la interrupción del sueño por las noches ó la presencia de alteraciones neurológicas persistentes. Algunos pacientes llegan a la consulta preocupados porque padecen cefaleas desde hace muchos años y eso paradójicamente es un dato tranquilizador porque si llevan mucho tiempo conviviendo con el dolor no se va a asociar a nada malo.



5. ¿CÓMO TRATAMOS LA MIGRAÑA?

Es importantísimo informar y educar a la población migrañosa para evitar la automedicación que puede conducir a un abuso de analgésicos con el consiguiente riesgo de transformación de una migraña episódica a una cefalea crónica diaria resistente al tratamiento. Se debe consultar siempre con su Médico de Atención Primaria (MAP) para un diagnóstico correcto (ya que como hemos visto no todas las cefaleas son migrañas) y un tratamiento adecuado que ha ser individualizado. En algunos casos, sobre todo cuando existan dudas diagnósticas o el paciente no responda a la medicación tendrá que ser remitido al especialista que es el Neurólogo. .

La migraña no tiene tratamiento curativo (como hemos dicho es una enfermedad crónica) pero sí existen buenos tratamientos, por un lado para aliviar el dolor de las crisis agudas de migraña (tratamiento sintomático) y por otro lado podemos aplicar un tratamiento preventivo que tiene como objetivo reducir la frecuencia e intensidad de las crisis y que usaremos solo cuando éstas sean o bien muy frecuentes o muy discapacitantes.

Como tratamiento sintomático para combatir la crisis de migraña utilizaremos los antiinflamatorios (tipo ibuprofeno o naproxeno) si la intensidad del dolor es leve-moderada y un tratamiento más específico como son los triptanes si el dolor es de intensidad más severa o no responde a los antiinflamatorios. Lo que es muy importante es insistir al paciente en que debe tomar la medicación que nosotros recetemos siempre al inicio del dolor (cuanto antes mejor) ya que una vez que se instaura la migraña responde peor a los tratamientos. Para aquellos pacientes en los que la cefalea se acompaña de vómitos intensos existen formulaciones bucodispersables e intranasales o incluso puede asociarse un antiemético.

Con respecto a los tratamientos preventivos existen diferentes tipos y, como hemos dicho , sólo los aplicaremos a aquellos pacientes con crisis de migraña muy frecuentes (3 ó mas crisis al mes) ó muy discapacitantes. Usaremos uno u otro en función de las características del paciente y de su migraña y se debe tomar de forma continuada durante 3-6 meses.

Las terapias alternativas (yoga, acupuntura...) y sobre todo el ejercicio físico regular son terapias de relajación que pueden ayudar a reducir el estrés que como hemos comentado es uno de los factores desencadenante de migraña más frecuente. Además la fisioterapia cervical puede ser útil en pacientes que asocian un importante componente cervicogénico.



6. ¿QUE CONSEJOS O RECOMENDACIONES DARÍA AL PACIENTE MIGRAÑOSO?

La primera recomendación es que no se automediquen. La ingesta de fármacos sin control puede hacer que una cefalea ocasional se transforme en un dolor diario.

El paciente con dolor de cabeza debe acudir siempre a su médico para recibir un correcto diagnóstico y un adecuado tratamiento que debe ser individualizado según sus propias peculiaridades. En algunos casos precisará ser valorado por el especialista.

Otra recomendación es que el paciente no se deje llevar por fármacos “maravillosos” con los que el dolor de cabeza desaparece para toda la vida. La migraña es un trastorno crónico y no existen medicamentos curativos. No obstante con los tratamientos sintomáticos y preventivos, el 90% de los pacientes encuentra mejoría.

Para poder prevenirla de manera eficaz es importante aprender a identificar los factores desencadenantes de la migraña en su caso particular y eludir aquellos que sean evitables.

Algunos consejos útiles para el paciente migrañoso son:

  • Mantener una buena higiene del sueño (no dormir poco ni en exceso).

  • Comer con un horario regular evitando el ayuno prolongado.

  • Evitar aquellos alimentos que detecte como desencadenantes de la crisis de migraña.

  • Evitar la ingesta excesiva de cafeína.

  • Utilizar técnicas de relajación y practicar ejercicio físico regular para reducir el estrés y la ansiedad

  • Evitar el sobrepeso.

  • Evitar, si es posible, y siempre bajo consejo médico la toma de ACO.

  • Durante la crisis de migraña busque un ambiente relajado y tome la medicación indicada por su médico tan pronto como se inicien los síntomas.

  • Evitar  el consumo frecuente e indiscriminado de analgésicos y la automedicación que pueden cronificar la cefalea.


7. ¿ EN QUE CONSISTE UNA UNIDAD DE CEFALEAS?

Las Unidades de Cefaleas, como la existente en el Hospital Mancha Centro, estan integradas por neurológos expertos en el campo de la migraña y otras cefaleas que se encargan de atender a paciente complejos con cefaleas de dificil diagnóstico o manejo.


8. ¿UNA CONCLUSIÓN O MENSAJE FINAL?

Evitar automedicarse y consultar siempre con su médico . Un correcto diagnóstico, un adecuado tratamiento y un buen conocimiento de la enfermedad, así como hábitos de vida saludables , son las claves para luchar contra la migraña.



Vídeo de información sobre migraña y otras cefaleas
de la Sociedad Española de Neurología
(Ver en Youtube)

 

You need Adobe Flash Player to view this content.


© del texto Santiago Navarro. Junio de 1014.

 

Categories: Cefaleas

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