What is Migraine and its Treatment?

What is migraine headache?
Migraine is a type of headache like tension type headache or cluster headache. Migraine pain is a severe form of headache and feels like something is throbbing in head.
 

What are symptoms of migraine headache?
Migraine is a severe, recurrent and throbbing headache. It is associated with photophobia (extreme sensitivity to light), phonophobia (fear of sounds), and nausea lasting for 4 to 72 hours. The headache worsens with body movements and the patient feels calm in a quite, dark room. The patient may complain that he/she cannot brush his/her hair, wear earrings, or feels pain when he shaves. Migraine may lead to allodynia – central pain sensitization. Watch the video below.

 
 

 

What are four phases of migraine?
Migraine headache consists of four phases: prodrome, aura, attack and prostdrome. Prodrome refers to malaise, irritability and behavioral changes some hours to days before the onset of headache. About 20% patients with migraine experience aura. Aura refers to a number of symptoms the patient with migraine pain experiences just before the onset of headache. Migraine aura can be visual (shimmering silvery zigzag lines across the visual field or scotoma), sensory (tingling or numbness), motor or verbal.
 

What are the triggers of migraine headache?
There are several triggers of migraine headache. These triggers include estrogen containing oral contraceptive pills, stress, cheese, chocolate, red wine or alcohol, intercourse, missing a meal, lack of sleep or oversleeping.
 

What is the treatment of migraine?
Treatment of migraine headache includes avoidance of triggering factors and use of simple analgesia such as Aspirin, Paracetamol or NSAIDs (non-steroidal antiinflammatory drugs). Antiemetics can be used for nausea and vomiting. Triptans (e.g. sumatriptan) should be considered for severe attacks. Other drugs which can be used for migraine treatment are calcium channel blockers, beta-blockers, antidepressants and anti-epileptic drugs.
 

What is the prophylaxis of migraine?
When a patient experiences 3-4 attacks of migraine pain in a month, then prophylactic treatment for migraine is considered. Prophylactic treatment of migraine includes avoiding triggering factors of migraine and using drugs like calcium channel blockers, beta-blockers, antidepressants and anti-epileptic drugs calcium channel blockers, beta-blockers, antidepressants and anti-epileptic drugs.

Can a Doctor Earn Online?

Can a doctor earn money online? This is the question  may arise in your mind if you have medical skills and you are interested in medical-related writing or online clinic.

The answer to the above question is "Yes of course!" Being a doctor, there are many ways to earn money online. For example, writing medical content, medical papers, giving medical advice or online clinic, writing multiple choice questions (MCQs), writing eBooks, medical proofreading, review articles, synopses, dissertations and making presentations or lectures, and many more. There are several websites where employers post their projects and ask for bidders to place bid on their projects, and then pay to them on the completion of the work/assignments. Two of the top websites include Freelancer and Upwork. You can join Freelancer or Upwork if you intend to earn money online. Also, you can earn by making a Youtube Channel on health like mine "Doctors Hub".

Watch the video below:

It is real to earn money online. You can earn money if you have any skills with some knowledge about computer use. Follow the links above, create your profile, select your skills and place bids on the projects you are interested in. Don't worry, payment is 100% with milestones. So, always insist on milestones.

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Keywords: Doctor, Online earning, Freelancer, Upwork

Causes of Migraine Headache

Migraine headache is a type of headache where the patient experiences severe throbbing/pulsating pain on the one side of the head. It may accompanied with several different signs and symptoms. The cause of migraine is not well known; however, studies reveal that it is caused by the dilatation of blood vessels and the activation of the part of our central nervous system (brain) which is supplied by trigeminal nerve (fifth cranial nerve). You may precipitate or trigger your migraine headache or the following factors cause headaches if:

• You have family history of migraine headache.
• You are alcohol user or abuser.
• You are under emotional or physical stress.
• You sleep much or do not have adequate sleep.
• You have missed your meal.
• You are the patient of migraine and you eat chocolates.
• You are having bright lights all around you.
•  You are disturbed with loud noise.
• You are under the stress of hormonal changes.
• You are on oral contraceptive pills (OCPs).

If you avoid all of the above, you may enjoy migraine relief and no need of migraine medication.
Watch the video below (in urdu)

What is Trichobezoar?

Keywords: Migraine headache, Causes, Migraine relief, Migraine medication, Risk factors

What is Tizanidine?

What is Tizanidine?

Tizanidine is a drug used to treat painful muscle spasms. Commercially, it is marketed as Tizanidine hydrochloride, a centrally acting alpha-2 agonist. In other words, it comes in the category of skeletal muscle relaxants.

What are the indications of Tizanidine?

Tizanidine is used to treat painful muscle spasms, especially caused by neurological disorders like multiple sclerosis.

What is the dose of Tizanidine?

Maximum initial dose of Tizanidine is 6mg per day in three equally divided doses. The dose can be increased up to 12 to 36 mg per day gradually. You may start with Tizanidine tablet 2mg, three times a day. If the symptoms do no subside, you may use Tizanidine 4mg, 3 times a day.

In what forms Tizanidine is available?

It is available in tablet form in 2 mg and 4mg strengths.

How to use Tizanidine tablet?

It is taken orally in divided doses. 2 to 4 tablets can be taken in 3 divided doses in a day.

What are contraindications of Tizanidine?

Hypersensitivity to Tizanidine and impaired liver functions are the contraindications to using Tizanidine tablet.

What are the precautions to be considered while using Tizanidine?

Tizanidine should be used carefully in the patients with renal impairment. Lower doses should be used in such patients. It is better to get liver function tests (LFTs) before starting Tizanidine tablet. Due to its hypotensive effect, Tizanidine should be used carefully with antihypertensive agents like diuretics, beta-blocking agents and digoxin. Also, be careful when you are on alcohol or sedatives as such agents enhance sedative effect of Tizanidine.

How to monitor the use of Tizanidine?

Tizanidine should be monitored with LFTs and renal functions tests.

Is Tizanidine safe in pregnancy and lactation?

Tizanidine comes in category C. Its safety in pregnancy and lactation is yet not known. It is better to avoid taking Tizanidine tablets when you are pregnant or breast-feeding your baby.

What are the side effects of Tizanidine?

Side effects of Tizanidine tablet include fatigue, dizziness, dry mouth, hypotension, disturbed sleep, decreased heart rate and muscle weakness.

When to discontinue Tizanidine tablet?

Discontinue Tizanindine tablets when your LFTs are deranged or when your serum levels of SGPT or SGOT are above the three times of upper normal range.

What is the treatment of Tizanidine overdose or toxicity?

Supportive measures are carried out in the case of toxicity or overdose of Tizanidine. Gastric lavage with activated charcoal can be done to clear the stomach (stomach wash). Be sure that the patient is well hydrated. Other features of Tizanidine toxicity can be managed by symptomatic measures.

What are the brand names available for Tizanidine?

Movax, Zanaflex, Tizorel, Tizigood, Tizadin, Ternelin, Soneta, Rexant, Maxlax, Fernor are some other brand names for Tizanidine.

What is the price of Tizanidine tablets?

Ten tablets of Tizanidine 2mg cost 112 PKRs or $1.09. Similarly, a pack of ten tablets of Tizanidine 4mg costs 140 PKRs or $1.37.

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Keywords: Tizanidine hydrochloride, Muscle relaxants, Movax, Interactions, Drug information, Indications, Contraindications, Side effects, multiple sclerosis, Price

Horner's Syndrome: Causes and Manifestations

What is Horner's syndrome?

Horner's Syndrome

Have you ever heard about the combination of ptosis, miosis and anhydrosis? This is what called Horner's syndrome. In Horner's syndrome, your eyelid droops, your pupil gets small in size and you cannot sweat on the affected side of your face! 

How does Horner's syndrome occur?

Horner’ syndrome occurs due to interruption or damage to the sympathetic fibers [1,3]. The postganglionic sympathetic fibers for the eye originate in the superior cervical ganglion and travel along the carotid and ophthalmic arteries and supply dilator papillae, tarsal muscle of upper eyelid and orbital muscle which tends to hold the eyeball forward. Some fibers also supply the face’s sweat glands.The interruption of sympathetic fibers may take place at many levels: at brain stem (demyelination, vascular disease), cord (syringomyelia), and thoracic outlet (Pancoast’s tumor) or on the sympathetic nerve’s trip on the carotid artery into the skull (carotid artery aneurysm) and thence to the orbit.

What are the manifestations of Horner's syndrome?

Manifestations of Horner’s syndrome develop when damage to the sympathetic fibers take place. The following manifestations are seen on the side of the lesion:

• Drooping of eyelid (Ptosis) [2,3]
• Small pupil (Miosis)
• Sunken eye (Endophthalmos)
• Loss of sweating of the face on the side of lesion (Anhidrosis) [3]

The patient’s with Horner’s syndrome may experience flushing on the affected side of the face because of dilated vessels under the skin. In children, the interruption to the sympathetic ganglion may cause difference in the colors of the two eyes [1]. 

Horner’s syndrome is known with many other names like Horner syndrome, Bernard-Horner syndrome or as oculosympathetic palsy. 

Reference

1. Lonmore M, Wilkinson I, Turmezei T, Cheung CK. Lumps in the neck: Oxford handbook of clinical medicine 7^th Ed. New York: Oxford university press 2007; 620.
2.  Ropper AH, Brown RH (2005). "14: disorders of ocular movement and pupillary function". In Ropper AH, Brown RH. Adams and Victor's Principles of Neurology (8th Ed.). New York: McGraw-Hill Professional. pp. 222–45. 
3. Nasir SA, Inayatullah M. Methods of Clinical Examination: Bedside Techniques 3^rd Ed. Multan: Saira Publishing 2006; 203

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Keywords: Horner syndrome, Bernard-Horner syndrome, Oculosympathetic palsy, Causes, Treatment