
marunnukalude amita upayogam thalavedana

thalavedana ozhivakkaan vedanasamhaarikal idaykkide kazhikkumbol rebound thalavedana ennum ariyappedunna amithamaya thalavedana (moh) saadhaaranayaayi sambhavikkunnu. eee kesukale palappozhum vedanasamhaariyaaya thalavedana ennu vilikkunnu. rebound thalavedana pathivayi ellah divasavum sambhavikkunnu, valare vedanaajanakavum vittumaaraatha dainamdina thalavedanayude oru saadhaarana kaaranavumaanu. migraine allengil tension-type thalavedana polulla adisthaana thalavedana desorder ulla rogikalil avaa saadhaaranayaayi sambhavikkunnu, ithu kaalakramena oru episodic avasthayil ninnu vittumaaraatha dainamdina thalavedanayaayi maarunnu, kaaranam kadutha thalavedana nivaarana marunnukal amithamaayi kazhikkunnu.
moh gurutharamayathum, vaikalyamullathum, nannayi savisheshathayullathumaaya oru rogamaanu, ithu lokamembaadumulla oru prashnathe prathinidheekarikkunnu, ippol ithu moonnaamathe ettavum saadhaaranamaaya thalavedanayaayi kanakkaakkappedunnu. vittumaaraatha dainamdina thalavedana (sii. dii. echu) ulla rogikalil 18 sathamaanam muthal 33 sathamaanam vare rogikal amithamaayi marunnukal upayogikkunnu. marunnukalude amita upayoga thalavedanayude (moh) vyaapanam padicha janasamkhyayeyum upayogicha roganirnaya maanadandangaleyum aashrayich vyathyaasappedunnu. ennirunnaalum, moh saadhaarana janasamkhyayude ekadesham <aii. dii. 1> neey baadhikkunnuvenn kanakkaakkappedunnu, ennaal dvitheeya, thritheeya paricharanatthil athinte aapekshika aavruthi valare kooduthalaanu. 
vargeekaranam.
marunnukalude amita upayogam thalavedana ennathu oru amgeekritha aii. sii. dii (thalavedana vaikalyangalude anthaaraashtra vargeekaranam) vargeekaranamaanu. varshangalayi thalavedana vaikalyangalude pradhana vidagdhar vividha diagnostic maanadandangal nirddeshikkukayum parishkarikkukayum cheythittundu. 2004-ll aii. sii. dii randaam pathippil moh enna padam aadyamaayi prathyakshappettu. eee tharatthilulla thalavedanayude adisthaanamaayi amithamaya mayakkumarunnu upabhogathinu oonnal nalkuka enna lakshyathode ithine dvitheeya thalavedanayaayi nirvachichu. mohinullah roganirnaya maanadandangalude thudarnnulla rund parishkaarangal (2005,2006) rogathinte deerghakaalaavastha (moonnu maasathil kooduthal 15 divasam/maasathil kooduthal thalavedana), mayakkumarunnu klaasukal ennivayude adisthaanathil nirvachanam parishkarikkukayum vipuleekarikkukayum cheythu, athuvazhi pradhana tharam moh thirichariyunnu. ergotamine, tripetans, opiyoyidukal, kompineshan marunnukal ennivayude kaaryatthil, prathyekichum, 3 maasatheykku 10 divasam/maasam kazhikkendathundu, athesamayam lalithamaaya vedanasamhaarikal 3 maasatheykku 15 divasam/maasam kazhikkumbol amithamaayi upayogikkunnathaayi kanakkakkunnu.
kaaranagal.
tripttaanukal, ergotamines, lalithavum samyojithavumaaya vedanasamhaarikal, opiyoyidukal ennivayulppede niravadhi vyathyastha marunnukalude pathiv upayogathodeyaanu moh sambhavikkunnathenn ariyappedunnu. thalavedanayude tharam pariganikkathe, vittumaaraatha dainamdina thalavedana aarambhikkunnathin bhakshana, aushadha kafeen upabhogam oru mithamaaya apakada gadakamaanennu thonnunnu.
aavarthichulla thalavedanayude charithramillaattha rogikalil moow valare apoorvamaanu, sandhivatham allengil prakopippikkunna malavisarjanam polulla thalavedanayillaatha vedanaykku vedanasamhaarikal kazhikkunna rogikalil ithu apoorvvamaayi maathrame vikasikkunnulloo. koodaathe, mohinte kudumbacharitram undaakumbol moh kooduthal saadhyathayullathaanu, ithu janithaka samvedanakshamathaye soochippikkunnu. neuronal ree-adjustment prakriya moolamaanu rebound thalavedana undaakunnathenn karuthappedunnu. vedanasamhaariyude upayogam vedanayude paridhi uyarthunnu. athinaal, kooduthal kaalam vedanayude uthejanam illaathathinaal, saadhaarana uthejanangal vedanayaayi anubhavappedaan thalachor veendum kaalibrett cheiyunnu.
marunnu kazhichathinushesham oraalkk amithamaayi thalavedana (emm. oo. echu) undakaan edukkunna samayam avar upayogikkunna marunninte tharatthe aasrayichirikkunnu. aarenkilum tripttaanukal (sumathriptaan muthalaayava) edukkukayaanengil, avarkk moow vikasippikkaan ekadesham 1.7 varshameduthekkaam. avar ergottukal (ergotamine muthalaayava) edukkukayaanengil, athinu ekadesham 2.7 varshameduthekkaam, avar vedanasamhaarikal (naproxen muthalaayava) edukkukayaanengil, ithinu ekadesham 4.8 varshameduthekkaam. athinaal, pathivayi marunnu kazhikkunnathum moow vikasippikkunnathum thammilulla kaalathamasam upayogikkunna marunninte tharatthe adisthaanamaakki vyathyaasappedunnu.
eee avasthayude vikaasathilekku nayikkunna adisthaana samvidaanangal ippozhum vyaapakamaayi anjjaathamaanu, koodaathe pareekshanathmaka gaveshanathinteyo anuyojyamaaya mruga maathrkakaludeyo abhavam avayude pankinekkurichulla vyakthatha thadassappeduthunnu. vividha pathophysiological asaadhaaranathakal report cheyyappettittund, vittumaaraatha thalavedana (janithaka swabhaavam, risapttar, ensime physiology, niyanthranam, maanasikavum perumattaparavumaaya gadakangal, shaareerika aashrithathvangal, sameepakaala pravarthanaparamaaya imaging phalangal) aarambhikkunnathilum nilanirthunnathilum avaykku oru pradhana pankundennu thonnunnu.
chila sandarbhangalil, vyakthikalkk janithakaparamayi marunnukalude amithamaya upayogathil thalavedana undakam. vittumaaraatha vedanasamhaarikal amithamaayi upayogikkunna rogikalil nadatthiya oru valarthumriga padanatthil thalachorinte oorbittoofrandal courtexile pravartthanam kuranjathaayi kandethi, ithu laharivasthukkalude durupayogathilum kaanapedunnu. chila vyakthikalil aasakthiyude oru adisthaana neurological samvedanakshamatha undaakaamenn ithu soochippikkunnu. ennirunnaalum, mohinte vikasanathinu kaaranamakunna gadakangalude sankeernamaaya parasparabandham poornnamaayum manasilakkaan kooduthal gaveshanam aavasyamaanu. 
thalavedana chikitsa.
opiyoyidukalum beautalbitalukalum chilappol migraine, thalavedana ennivaykkulla chikilsayaayi anuchithamayi upayogikkunnu, kooduthal phalapradavum migraine-nirddishtavumaaya chikilsakalkku anukoolamaayi ithu ozhivaakkanam. opioid, beautalbital upayogam enniva thalavedana vashalaakkukayum moh undaakkukayum cheyyum. oru rogi mattu chikilsakalodu prathikarikkunnathil paraajayappedukayo migraine nirddishta chikitsa labhyamakaathirikkukayo cheyyumbol, opiyoyidukal upayogikkaam.
paarasettamol, ensides thudangiya ovar-dhii-kaundar marunnukalude (odisi) pathivayi upayogikkunnathum mohinu kaaranamakaam. thalavedanaykkulla oo. tii. sii marunnu aazhchayil rund divasathil koodaattha reethiyil parimithappedutthanam, koodaathe eathenkilum vedana kurachu divasathil kooduthal neendunilkkumbol vaidyopadesham thedaan shupaarsha cheiyunnu. mohinoppam, thalavedana chikilsikkunnathinaayi asattaaminophen (chila rajyangalil paarasettamol ennariyappedunnu) amithamaayi upayogikkunnathu karalinu kedupaadukal varuthunnathinum amithamaayi upayogikkunnathu dahananaalathile rakthasraavathinu kaaranamakum.
prathirodham.
pothuve, idaykkide thalavedanayo migraine aakramanamo ulla eathoru rogeeyum kooduthal kooduthal vedanasamhaarikalo mattu thirichuvaravu undaakkunna marunnukaloo kazhikkaan prolsaahippikkunnathi prathirodha marunnukalkkulla saadhyathayulla sthaanaarthiyaayi kanakkaakkanam. prathirodha marunnukal divasena kazhikkunnu. chila rogikalkku varshangalolam prathirodha marunnukal aavashyamaayi vannekkaam; mattullavarkk aarr maasam polulla thaarathamyena kuranja kaalayalavilekku maathrame avaa aavashyamaayi varoo. neuronal stabilising ejantukal (aanti konvalsantukal), aantidiprasantukal, antihypertensiveukal, antihistaamains ennivayulppede niravadhi tharam marunnukalil ninnaan phalapradamaaya prathirodha marunnukal varunnathennu kandethiyittundu. elaavil (amithriptilin), depacot (vaalproyett), topamax (toppiraamett), inderal (propranolol) ennivayaanu chila phalapradamaaya prathirodha marunnukal.
chikitsa.
moh saadhaaranamaanu, chikilsikkaam. rogiyude thalavedana pariharikkunnathin amithamaayi upayogikkunna marunnukal nirtthanam, ennirunnaalum mattu prathirodha nadapadikal upayogikkaathe ithu cheyyaan kazhiyumennu soochippikkunnathinu parimithamaaya thelivukalundu. klinikkal daatta kaanikkunnath thiranjeduppinte chikitsa pettennulla marunnukal pinvalikkunnathum thudarnnu roganirodhana chikitsa aarambikkunnathum aanu. ennirunnaalum, amithamaayi upayogikkunna marunnukal nirthunnathu thalavedana, ookkaanam, chharddi, urakka takaraar, uthkanda, aswasthatha ennivaykku kaaranamakum. eee lakshanagal munbu amithamaayi upayogicha marunnukale aasrayichirikkunnu, saadhaaranayaayi rund muthal patthu divasam vare neendunilkkum. amithamaayi upayogikkunna marunnukalude kooduthal upabhogam avare aashwasippikkunnu, ithu amita upayogathinte thudarchayeyum nirthalaakkunnathilekku paalikkaathathineyum shakthippeduthum. shaareerika aashrithathvam allengil thirichuvaravu thalavedana polulla thirichuvaravu prabhavam saadhyamaakumbol, marunnukalude kramena kuravu aavashyamaayi vannekkaam. chila marunnukal pettennu nirthunnathinu munbu rogiyude doctorude upadesham thedendathu pradhaanamaan, kaaranam atharam pravarthanangalkku vaidyashaasthraparamaayi kaaryamaaya shaareerika pinvalikkal lakshanagal undakkaan kazhiyum. udaaharanathinu, beautalbital pettennu nirthunnathu chila rogikalil yadhaarthathil apasmaarathinu kaaranamakum, ennirunnaalum vaidyopadeshamillaathe rogikk surakshithamaayi thadayaan kazhiyum. pinvalikkal kaalayalavil thalavedana kuraykkaan naproxen (divasathil rund thavana 500 milligram) polulla deerghakaalamaayi pravartthikkunna vedanasamhaarikal/virudha baahyaavishkkaarangal upayogikkaam. marunnu pinvalichu rund maasathinu sesham, moh ulla rogikal saadhaaranayaayi thalavedanayude aavruthiyilum theevrathayilum ganyamaaya kuravu shradhikkunnu.
raajyathinakathum puratthum mayakkumarunnu pinvalikkal valare vyathyasthamaayaan nadathunnathu. mikka doctormaarum inpatiant prograamukalaan eshtappedunnathu, ennirunnaalum sankeernamallaatha moh rogikalil (athaayath.iii. pradhanappetta qoo-morbidittikalillaathavar, opiyoyidukalo ergotaminicso amithamaayi upayogikkathavar, avarude aadya vishaamsham illaathaakkaanulla shramathilullavar). thelivu adisthaanamaakkiyulla soochanakalude abhaavathil, moh rogikalil prathirodha ejant thiranjedukkunnathu praadhamika thalavedana tharam (migraine allengil tii. tii. echu), marunninte parshwafala profile, saha-rogaavasthayudeyum saha-nilanilkkunna avasthakaludeyum saannidhyam, rogiyude mungananakal, muun chikitsa anubavangal ennivaye adisthaanamaakkiyukallathaayi.
thalavedanayude prarambha mechappeduthalinethur, anubandha paattenilekk madangiyethumbol, rogikalil prasakthamaaya anupatham (45 sathamaanam vare) veendum sambhavikkunnu, rogalakshanamulla marunnukalude amita upayogathilekku madangunnu.
rogathinte thirichuvaravu pravachikkunnavarum chikitsa thanthrangale swaadheenikkaan saadhyathayullavarumaayava praadhamika thalavedanayude tharamaayi kanakkaakkappedunnu, athil ninnu moow vikasichu, durupayogam cheyyappedunna marunninte tharam (vedanasamhaarikal, kooduthalum vedanasamhaarikal ennivayude samyojanam, ennaal barbitturettukal allengil trankviliserukal adangiya marunnukal enniva ganyamaayi uyarnna aavarthana nirakkin kaaranamaakunnu), athesamayam lingabhedam, praayam, rogathinte dairkhyam, munkootty edutha prathirodha chikitsa enniva aavarthana nirakk pravachikkunnillenn thonnunnu.
moh vyakthamayum vaikalyathin oru kaaranamaan, mathiyaya chikitsa labhichillengil, paarshwafalangalillaatha marunnukalude amithamaya upabhogavumaayi bandhapetta qoo-morbidittikalude apakadasaadhyathaye ithu prathinidheekarikkunnu. amithamaayi upayogicha marunnu (kall) pinvalikkunnathiloodeyum pinvalicha sheshamulla kaalayalavil adutha doctor-rogi bandham vikasippikkunnathil shradha kendreekarikkunna prathyeka sameepanangaliloodeyum moh chikilsikkaam.
charithram.
rebound thalavedana aadyam vivarichathu doow. 1982ll liie cudro.

