Medical Health Information

How manifests a vasovagal?

The vagal is easily recognizable! Before fainting, signs are known to almost everyone: hot flushes, fatigue, blurred vision, sweating, paleness, diarrhea, hearing disorders (tinnitus). The vagus nerve also helps nausea and vomiting.

The vagal rather occurs in young patients and healthy with autonomic nervous system in good shape, and responsive. It affects pregnant women and women with painful periods, those being treated for hypertension.

With what should we not confuse the vagal?

Can be confused with other vasovagal fainting which it may be bound. An epileptic seizure or stroke also causes fainting, but the return to consciousness is long. When in doubt, a quick medical consultation is part of the things.

The transition from a lying or sitting position to a standing position can cause a sudden drop in blood pressure in people whose blood vessels are slow to respond, this is called lipothymic discomfort. Not rise sharply enough to avoid it.

Are there possible prevention of vasovagal?

Prevention requires an understanding of what triggers the discomfort repeatedly. Blood tests are done lying down and not sitting. Stress management is learned through breathing exercises or relaxation.

The avoidance of high risk situations makes sense (too rich meal, a crash effort, standing still long, warm atmospheres and confined ...). Do not push the machine! Take the rest thing and hydratatez you during your efforts.

During the early signs of malaise, there is still time to react:
Lie down immediately, legs elevated to help blood return to the heart and the head. You can put them on a chair against a wall, or ask someone to hold them up. Within minutes, the discomfort disappears and shows that it was "it."

Vagal Preparing consultation

When should you consult?
Still in an initial discomfort, the physician must find its cause.
See also if the discomfort that does not yield completely and quickly, if recurrence without obvious reason.

Of course any loss of consciousness, malaise trauma with loss, requires a comprehensive review with your doctor.

What is the doctor?

The doctor performs a clinical assessment with measurement of heart rate and blood pressure at rest, lying down and sitting. In case of doubt about the origin of discomfort, the doctor may prescribe a tilt test or challenge test malaise. An electrocardiogram is strongly recommended. Are screened early other disorders during the mild discomfort ...

Depending on the origin of the illness, different supported are possible advice and simple prevention measures, rehabilitation on a tilt table, treatment of cardiac ...

How to prepare my consultation?

It is important to describe the circumstances in which discomfort occurred, the symptoms experienced, the presence or absence of loss of consciousness, injury related to falls and if it is a recurrence. Description of witnesses malaise is useful. History of cardiovascular family are another important indicator.

The vagal resulting in loss of consciousness and "postural tone," that is to say, the muscle tension permanent base which allows involuntary hold its shape. Because of the vagus nerve stimulation, blood pressure drops, blood flow decreases, depriving the brain of oxygen, the pulse weakens or disappears.

Risk and consequence of vagal
After experiencing the warning signs of discomfort, the person faints. This usually only lasts a few seconds. The return to consciousness is completely and spontaneously.

The vagal has no immediate danger heart or brain. BUT fainting exposes the person to injury by sharp drop in 30-40% of cases, and public road accidents in 1-5% of cases. We understand that one edge of a cliff vagal unexpected or fatal.

Lying down is usually enough to return to home. It also occurs spontaneously as the person falls to the ground. If it is not possible, the malaise can persist and lack of oxygen be harmful brain (seizures possible at this time).

The vasovagal when it reproduces regularly affects the quality of life there is concern of taking the car, or left alone.

Finally, cardiovascular (bradycardia, coronary heart disease) are sometimes the cause of the problem. They must be diagnosed and treated.

Causes and origins of vagal
Our autonomic nervous system controls unconscious activities of the body, such as the frequency of the heart beat. It is composed of the sympathetic nervous system, which increases blood pressure and heart rate, and parasympathetic (vagal or system and vagus nerve), which has the opposite effect.

The cause of vasovagal is put into play excessive or inappropriate parasympathetic system, which slows heart activity. All organs, including the brain, then receive less oxygen and discomfort appears.

All the circumstances that stimulate the parasympathetic nervous system may cause vagal stimulation by excess: prolonged standing, warm and confined, intense pain, strong emotion, stress (sight of blood, a needle ...), meal or instead hypoglycemia, abrupt physical exertion ...

There may be a familial predisposition to hyperactivity of the parasympathetic system. Certain medications such as beta blockers or treatment of hypertension favor the occurrence of this type of discomfort.

Signs and symptoms of a vasovagal

The vagal is easily recognizable! Before fainting, warning signs are known to almost everyone: hot flushes, fatigue, blurred vision, sweating, paleness, diarrhea, hearing disorders (tinnitus). The vagus nerve also helps nausea and vomiting.

The vagal rather occurs in young patients and healthy with autonomic nervous system in good shape, and responsive. It affects pregnant women and women with painful periods, those being treated for hypertension.

How headache occur?

Headaches occur by definition headache: frequency, location, accompanying signs but also their duration vary diagnostics.

Migraine evolves by recurrent seizures and there is no pain between attacks (free range). Migraine may be accompanied by signs called auras: visual auras (or ophthalmic migraines) sensory, with speech disorders or muscle strength.

Tension headache is more diffuse, non-pulsatile and unmodified by the effort. It is usually less intense than migraine but can also be associated.

The cluster headache causes pain located at the orbit of the eye and takes a few minutes to 180 minutes. The pain is accompanied by at least one of the following signs: red eye, tearing, runny nose, sweating, eyelid falls on the side of pain or swelling of the eyelid.

With what should we be confused?

Headache or sudden onset or recently amended should suggest a cause to look for further investigations.

Disorders of the cervical spine (due to shock or due to osteoarthritis) can cause headaches. Similarly, a disturbance of vision uncorrected may cause headache: a measure of visual acuity and a possible correction will overcome headaches.

Is there a prevention possible?

Whatever the prescribed medication, it is essential to take the earliest possible during headache. Certain factors are aggravating or triggering crises: the spot can be avoided to the maximum. Alcohol, certain foods but also the hassle and stress are often part.

Relaxation feedback (biofeedback) therapy and stress management are effective to some psychological profiles. Acupuncture, homeopathy and cervical manipulation have not proven scientific prevention of migraine.

Headache Preparing consultation

When to consult?

The appearance of a brutal headache ("thunderclap in a clear sky") must consult emergency (subarachnoid hemorrhage ...). Similarly, the presence of unusual accompanying signs such as fever (meningitis), paralysis or seizures (AVC ...) require emergency medical consultation or call the SAMU Centre 15.

What is the doctor?

Diagnosis between migraine, tension headaches or cluster headaches face is mainly clinical, based on highly codified criteria (duration, repetition, location ...). Questioning is a fundamental step in the medical consultation. Then the doctor will perform a thorough neurological examination should be normal. In case of malfunction or doubt, additional tests will be offered, but there is no indication to perform a CT scan or MRI immediately.

However, in case of sudden onset of headache, headache, headache different from recent normal or abnormal clinical examination, a CT scan or MRI will be performed.

Other tests such as radiographs (sinus, cervical spine) or ophthalmologic examination will be offered depending on the case.

The doctor may initiate treatment drug crisis (analgesics, anti-inflammatory, triptans ...) and / or therapy.

How to prepare my next visit?

It is important to prepare the first consultation in identifying the frequency and circumstances of the occurrence of crises. Then, keeping a diary of crises can judge the effectiveness of treatment and better adapt to: attention to the misuse of painkillers that a vicious circle may result in chronic headaches abuse medication.

Headaches or headaches are a very common symptom and is found in many diseases, the most benign to the most serious. Headaches can be acute (sudden, recent) or chronic for several weeks, they may evolve in paroxysms and calm down or otherwise be permanent, and finally the location of the headache is variable: the pain is always located at the skull but can be unilateral (one side affected) or bilateral achieve a localized area or on the contrary the entire skull.

The main causes are migraine, cluster headache, chronic daily headache, tension headache or a surge of hypertension. Other more serious diseases such as stroke (CVA), a tumor or meningitis are rare and occur with other symptoms associated with headache. Fortunately, most headaches are not serious.

What are the risks and health issues headache?

The International Headache Society and the World Health Organization ranked the headache according to their causes and their frequencies, although precise epidemiological data are lacking. Headache, including tension headache, migraine, cluster headache and chronic daily headache, are responsible for a disability which may be important for patients.

Just for tension headaches, it is estimated that in industrialized countries, they affect more than 80% of women. Similarly, nearly one in 20 adults suffer from headaches almost every day. WHO has placed 19th among migraine causes of disability-adjusted life years.

What are the mechanisms of headache?

Migraine is a condition where the precise cause remains unknown. Familial predisposition and triggers have been identified, such as stress, rules, alcohol or certain foods.

The cluster headache is probably a phenomenon related to blood vessels causing headache attacks around the orbit of the eye, with associated signs such as watery eyes or a runny nose. Alcohol is a trigger seizures.

Chronic daily headache (CCQ) often follow an episode of migraine or tension headache can evolve into chronic headaches, including drug abuse and psychological factors that maintain the headaches.

With what should we be confused?
With other headache: tension headache, cluster headache, chronic paroxysmal hemicrania or. And headache with drug abuse.

The only emergency is the exclusion of a subarachnoid hemorrhage, which is not so rare: 1% of patients who present to the emergency headache subarachnoid hemorrhage (Perry et al. BMJ. 2011 Jul 18; 343: d4277).

Mortality of this disease ranges from 25 to 50% at 6 months and 30% of survivors of disabling neurological sequelae in daily life.

Can we prevent migraines?
Yes, identifying triggers crises and avoiding them whenever possible.
Relaxation therapy or stress management are more effective if the patient adheres well and integrates with daily life. In some cases, the headache disappears spontaneously during life for no apparent reason.

Migraine Preparing consultation

When do you consult?
Faced with a recurrent headache, consult quickly to establish an accurate diagnosis, a prerequisite for effective treatment. The doctor guides if necessary to a neurologist. It can also contact an migraine, neurology specialist unit within a hospital.

How to prepare for the consultation with the doctor?
Can keep a log of crises over the past two months, with the triggering circumstances if any, the period of the menstrual cycle as well as medications to relieve pain.

What is the doctor?
The doctor confirms the diagnosis by examination and scrutiny. If the diagnosis is clear, no further examination is required. It establishes an anti-migraine. In case of serious doubt, the CT or MRI eliminate brain damage, bleeding ...

Personalized treatment of migraine is sometimes difficult to establish. The opinion of a neurologist and / or anti-migraine center is required.

Drugs have two goals: to relieve the pain of the crisis, limiting the emergence of new crises. Treatments crisis should be taken as soon as it appears immediately. These analgesics (aspirin and paracetamol), anti-inflammatory drugs and triptans.

In case of severe migraine, DMARDs Preventive take off crises. They are useful if consumption of drugs taken by crisis than 6 months for at least three months. These drugs reduce background seizure frequency by about 50%. The initial prescription is usually for a period of three months.

Treatments and magnetic stimulation neuromodulation are a specialized center.

Migraine
A migraine is a headache (headache) especially. Migraine pain meets specific criteria according to the classification updated in 2005 by the International Headache Society. It is a painful crisis moderate to severe recurrent unilateral pulsatile.

It may be the only disease (primary headache), or be caused by another disease (secondary headache). Only migraine primary headache is described here.

We distinguish two subtypes: migraine without aura and migraine with aura. Aura is a sign transient neurological, premonitory migraine attack. Sometimes will persist during the crisis as it occurs rarely after. Its neurological manifestations are varied. Most often it is visual tasks, language disorders, but can be observed eg olfactory hallucinations or uncontrollable yawns.

The challenges of migraine
The average prevalence of migraine on life is 18% and the mean estimated prevalence of one year is 13%. Migraines with aura are 20 to 30% of migraines, according to the International Association for Study of Pain (IASP, 2011).

According to a Swiss cohort (Merikangas et al. BMJ. 2011; 343: d5076), the annual prevalence of migraine was 0.9% (2.8 women for every man), and that of migraine without aura 10.9% (2.2 women for every man). The cumulative prevalence in 30 years is 3% for migraine with aura, 36% for migraine without aura, with a clear tendency to the persistence of crises according to the initial course 69% of migraineurs.

Migraineurs suffer an average of 25 days per year. For WHO, health weight is higher than the epilepsy worldwide. For Gustavsson et al. (Eur Neuropsychopharmacol. 2011 21: 718-79), the annual cost European headaches in general is 285 euros per person.

It does not seem that migraine increases the risk of death in general, but perhaps cardiac risk (schurks et al. Cephalalgia. September 2011, 31 (12) :1301-14).

Nearly half of patients can be treated on its own. This self-medication poses a risk of drug abuse, the consequence of which is the installation of chronic daily headache, or more than 15 days per month.

Causes and mechanisms of migraine
Migraine is caused by a double vascular phenomenon. First, a vaso-spasm, ie closure of the cerebral vessels, which can cause neurological disorders of the aura, then a reactive vasodilation resulting cerebral edema responsible for pain and general physical reactions: gastrointestinal (nausea, vomiting), ophthalmic (refusal of light).

The initial spasm is often triggered by emotions, overwork and stress, whose influence varies from one to another migraine. The female hormonal cycle is causing catamenial migraines say.

Assets foods on blood vessels are at risk of migraine in susceptible individuals: chocolate, alcohol. Coffee has paradoxical effects: it maintains a cycle "infernal" by tightening too fast veins, causing spasm, which is the source of a new expansion reaction.

The family factor is proved but only a few genes are identified formally, as in familial hemiplegic migraine. These genes encode proteins transporting ions through the membrane of neurons. Therefore suspected disorder of brain excitability, an intricate physiological relationship between migraine and epilepsy.

There are "migralepsies" where a migrainous aura triggers epilepsy. There are migraines with "invasive cortical depression" (electrical) to support this hypothesis. Disorders of subcortical inhibition and / or dysfunction of interneurons (inhibitory or excitatory) are considered cortical (Belcastro et al. J Headache Pain. 2011, 12 :289-294).

Recently Chasman et al. (Nat Genet. 2011 Jun 12; 43 (7) :695-8) revealed seven polymorphisms potentially associated with migraine with or without aura (genetic polymorphism is non-pathological variation of a gene). Three are already validated: that is to say a person is carrying more likely to migraines than the general population.

Symptoms of migraine
Headache is the typical symptom of migraine. According to the classification of the International Headache Society, migraine is a crisis for 4 to 72 hours.

The pain must behaved two of the following criteria: unilateral (that is to say, one side of the head), pulsatility, moderate or severe intensity, aggravation by routine physical activities, such as raising or lowering of stairs.

At least one of these general signs accompanying nausea / vomiting, refusal to light (photophobia), refusing even small noises (sonophobie).

Migraine with aura is less common than migraine without aura. Auras are premonitory neurologic signs and transient, mostly visual: bright spots, distorted vision ... Auras aphasia (loss of words) also exist and are rarely isolated.

You can have a variety of more or less get behavioral and psychiatric disorders (depression, apathy sudden). They may be disturbing the first time. The occurrence of typical migraine in one hour you can correct diagnosis.