¿Cómo saber si tengo migrañas?

Con frecuencia los pacientes no saben cómo diferenciar un dolor de cabeza habitual de las llamadas “migrañas”, por lo que hoy intentaremos explicar un pocó sobre cómo reconocer este tipo de patología.

¿Qué es la migraña?
Una migraña (o jaqueca) es un dolor de cabeza recidivante, pulsátil e intenso que habitualmente afecta a un lado de la cabeza, aunque puede afectar a ambos. El dolor empieza repentinamente y puede estar precedido o acompañado de síntomas visuales, neurológicos o gastrointestinales. Con frecuencia se acompaña nauseas y vomitos.
Aunque la migraña puede iniciarse a cualquier edad, generalmente empieza en personas entre 10 y 30 años de edad. A veces desaparece después de los 50 y es más frecuente en mujeres que en varones.
¿Por qué puedo padecer migrañas?
Existe una predisposición genética: Uno de los factores de riesgo más potentes y consistentes para la migraña es contar con antecedentes familiares de migraña. Los resultados de estudios en gemelos sugieren que los factores genéticos subyacen en aproximadamente un tercio de la distribución familiar de la migraña.Las formas comunes de la migraña, con o sin aura, son trastornos genéticos complejos en los que múltiples polimorfismos genéticos determinan el “umbral de la migraña”. Algunas de estas huellas genéticas han sido identificadas recientemente en varios cromosomas en estudios de asociación de genoma completo.

  • Edad: En la infancia la migraña se presenta por igual en niños y niñas. A partir de la pubertad y debido a los cambios hormonales, se dispara la incidencia de migraña en las mujeres.
  • Estrés y ansiedad: Es necesario aprender a relajarse, buscar alguna distracción en momentos estresantes.
  • Ingestión de alcohol y dieta: Algunos alimentos y bebidas pueden desencadenar ataques de migraña. Por ejemplo, el alcohol, especialmente el vino tinto o burdeos; las comidas con glutamato monosódico(MSG); productos que contienen tiramina; o las carnes en conserva con nitratos.
  • Falta o exceso de sueño: También puede ser un desencadenante de la migraña.
  • Factores medioambientales: el tiempo o los cambios de temperatura, las luces deslumbrantes o las fluorescentes, las pantallas de ordenador, los fuertes olores y las elevadas altitudes.

¿Por qué se producen las migrañas?
La migraña se produce como consecuencia de la activación o irritación de las fibras del nervio trigémino, que es el nervio que transmite la sensibilidad de la cabeza y tiene tres ramas. Las fibras que provienen de la primera rama rodean los vasos sanguíneos localizados en las meninges. Las meninges están constituidas por varias capas de tejido que recubren el cerebro, y son las estructuras que “duelen”. El cerebro en sí mismo, no duele, solo sus cubiertas.
Durante un ataque de migraña se produce una inflamación en las meninges como consecuencia de la liberación de sustancias inflamatorias por parte del trigémino. Esta inflamación o “meningitis” no infecciosa, es responsable de provocar el dolor pulsátil o notar los latidos. Además esta inflamación hace que cuando movemos la cabeza el dolor empeore o aumente y por tanto que estemos más aliviados si nos acostamos o no nos movemos.
Existen dos subtipos de migraña: Migraña con aura y sin aura
¿En qué consiste el aura migrañoso?
Las manifestaciones clínicas son bastante variables dentro de un mismo paciente. La cefalea puede presentarse en cualquier periodo del día pero es más frecuente que comience en la primera hora de la mañana o incluso durante la noche y se despierte ya con dolor de cabeza.
Es posible que pueda presentar antes del dolor de cabeza, síntomas prodrómicos muy inespecíficos pero que anuncian la crisis como son por ejemplo :

  • Alteraciones en el humor o en la conducta
  • Alteraciones en la memoria o dificultad para memorizar
  • Cansancio, depresión o bien sensación de energía y claridad mental.
  • Alteraciones en el sueño. ( insomnio o hipersomnia)
  • Alteraciones en el apetito como sed, hambre, caprichos.
  • Disminución del volumen de orina.

El aura migrañosa precede en unos 10-30 minutos a la cefalea, aunque en ocasiones aparece cuando esta ha comenzado.
Los síntomas visuales se dan en un 94% de las personas con migraña, los otros síntomas deficitarios neurológicos en el 40%. El trastorno visual puede consistir en fotopsias, escotomas o alucinaciones visuales. Otras manifestaciones que pueden participar en el pródromo (hemiparesia, afasia , parestesias en la cara y mano ) de las cuales el defecto de sensibilidad con adormecimiento parcheado alrededor de la boca , en la lengua y en la mano y el antebrazo , es el más frecuente.
¿Cuándo debe de sospechar si tiene una migraña con o sin aura?

  1. Migraña con aura o migraña clásica: es una cefalea recurrente y de características pulsátiles, de predominio unilateral y se agrava con el movimiento, que puede acompañarse de náuseas , vómitos , fotofobia y sonofobia . Dura entre 4 y 72 horas. Y se precede de clínica de focalidad neurológica (aura) , siendo las manifestaciones visuales las más frecuentes.
  2. Migraña sin aura o migraña común: representa el 75% de los casos de migraña. Consiste en cefaleas de análogas características a las descritas en la migraña con aura pero sin clínica de focalidad neurológica precediendo o acompañando a la cefalea.
    El dolor, para ser considerado migraña, no se atribuye a otra enfermedad.
    Ambos tipos de migraña pueden ocurrir en una misma persona.
    Si usted presenta síntomas compatibles con estos dos tipos de migraña , acuda a su médico.

¿Qué hará el médico en la consulta?
El diagnóstico, como en la mayoría de las cefaleas primarias, se basa en los síntomas que usted refiera a su médico cuando acude a la consulta y la exploración neurológica que realizara su médico. Como no existen procedimientos de imagen ni parámetros que puedan verse en un análisis, sólo es necesaria una cuidadosa observación por parte del profesional de atención primaria y la elaboración de una historia clínica detallada. Se deben cumplir los siguientes requisitos para definir o diagnosticar la migraña:

  1. Episodios de dolor de cabeza de intensidad moderada, hemicraneal, en forma de latido o pulsátil.
  2. Se acompaña de nauseas o vómitos, y de rechazo a la luz y al ruido por agravar los síntomas.
  3. Duración entre 4 y 72 horas, siendo repetidos los episodios durante meses.
  4. No existir otras causas de cefalea.

La información que pueda facilitarle a su médico acerca de sus cefaleas y su evolución, así como de los factores que la mejoran o empeoran, pueden orientar el diagnóstico de la migraña. Generalmente, no hace falta la consulta con el neurólogo, salvo que el médico lo estime oportuno.
¿Qué tratamiento hay para estos casos?
En el tratamiento de las migrañas tenemos en cuenta siempre dos tipos de tratamiento: el tratamiento de los ataques migrañosos y cuando estos son muy frecuentes el tratamiento preventivo de los mismos.

  1. Según la intensidad del dolor el tratamiento de los ATAQUES migrañosos leves-moderados su médico le aconsejara los AINE (antiinflamatorio no esteroideos) como el Ibuprofeno, Dexketoprofeno, Naproxeno, etc. En caso de ataques moderados-graves le aconsejara la toma de los triptanes.
  2. Para la PREVENCIÓN de los ataques de migraña se usan los beta bloqueantes o los calcioantagonistas y, si no funcionan, se puede utilizar los antidepresivos tricíclicos, antiepilépticos y antagonistas de la serotonina.

Factores agravantes o precipitantes de la migraña y que deben evitarse en la medida de lo posible:

  • Alimentos como quesos fermentados, salchichas, champiñones , setas, extractos de carne, chocolate, cítricos, bebidas alcohólicas (vino tinto), glutamato, cualquier comida pesada o excesiva (“empachos”).
  • Estímulo ambientales como olores intensos (gasolina , pintura, perfumes…), luces brillantes, sol intenso, los cambios de presión atmosférica o el viento, cambios bruscos de temperatura.
  • Cambios en el ritmo de sueño tales como, trasnochar, dormir siesta o levantarse mas tarde (migraña del “fin de semana”)
  • Uso de anticonceptivos orales
  • Estrés psicofisilógico: estados de ansiedad , exámenes , acontecimientos imprevistos , viajes, banquetes o celebraciones.

Álvaro García García y Marta González Gago.
Alumnos de 6º. Facultad de Medicina.Valladolid.

Yolanda Granja Garrán.
Médico de familia. C.S Plaza del Ejército. Valladolid Oeste.

REFERENCIAS:

  • Epidemiologia del dolor de cabeza, disponible en https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/GlobalYearAgainstPain2/HeadacheFactSheets/1-Epidemiology_Spanish.pdf
  • Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol 2010;52:1088–97.
  • https://www.midolordecabeza.org/
  • Juan J.Zarranz, Capítulo 9:Cefaleas y algias craneofaciales .Neurología,Barcelona, España:Mosby/Doyma Libros ,1994; p.107-121.

Revisado: abril 2018.

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