Okay, buckle up. Here’s a 100,000-word article on Migraine, its management, and the limitations of complete cure. This will be incredibly detailed, covering aspects from pathophysiology to specific medications and alternative therapies. I will strive for medical accuracy and readability, using bullet points, lists, and different heading levels to break up the text and enhance SEO.

Migraine: Opportunities and restrictions in full cure

1. What is migraine? Definition, classification and epidemiology

Migraine is a common neurological disease characterized by recurrent attacks of severe headache, often accompanied by other symptoms, such as nausea, vomiting, sensitivity to light (photophobia) and sound (phonophobia). It is important to understand that migraine is not just a “ordinary” headache; This is a complex condition that requires a specialized approach to diagnosis and treatment.

1.1. Determination of migraine according to the international classification of headache (ICHD-3)

According to the international classification of headaches (ICHD-3), migraine is defined as a headache that lasts from 4 to 72 hours (without treatment or with ineffective treatment), having at least two of the following characteristics:

One -sided localization: The pain is felt on one side of the head.
Pulsating in nature: The pain has a pulsating, beating in nature.
Moderate or strong intensity: The pain significantly limits everyday activity.
Aggravated by ordinary physical activity: For example, walking or climbing the stairs.

And at least one of the following symptoms:

Nausea and/or vomiting.
Photophobia and phonophobia.

1.2. Migraine classification

Migraine is divided into several types, the most common of which:

Migraine without aura (ordinary migraine): The most common type. Attacks of headaches correspond to the criteria described above, without previous neurological symptoms.
Migraine with aura (classic migraine): Attacks of headaches are accompanied by an aura – temporary neurological symptoms, which usually precede headaches. The aura may include:
- Visual disorders: Flickering lights, zigzag lines, loss of vision.
- Sensitive violations: Tingling, numbness spreading by hand or face.
- Speech disorders: Difficulties with the selection of words, slurred speech.
- Motor disorders: Weakness in the limbs (rarely).
The aura usually lasts from 5 to 60 minutes and completely passes.
Chronic migraine: A headache occurs 15 or more days a month for more than 3 months, while at least 8 days a month correspond to migraine criteria.
Rare types of migraines: There are other, less common types of migraines, such as hemiplegic migraine (with motor weakness), basic migraine (with symptoms emanating from the brain trunk), and ophthalmoplegic migraine (with paralysis of the eye muscles).

1.3. Epidemiology Migreeni

Migraine is a global healthcare problem that affects millions of people around the world.

Prevalence: Migraine is one of the most common neurological diseases. According to estimates, about 12% of the world’s population suffer from it.
Gender differences: Migraine is much more common in women than in men. This is due to hormonal factors, especially with fluctuations in estrogen levels.
Age: Migraine usually begins in adolescence or young age and reaches a peak at the age of 30-40 years. In many people, the symptoms of migraines decrease with age.
Socio-economic influence: Migraine can significantly reduce the quality of life, influence the performance, attendance of the school and social activity. It also provides a significant economic burden on society due to the costs of medical care and performance loss.

2. Pathophysiology of migraines: What happens in the brain during an attack?

Migraine pathophysiology is a complex and not fully studied area. It was previously believed that migraine is associated exclusively with vascular changes in the brain (narrowing and expansion of blood vessels). However, modern studies show that migraine is a neurovascular disorder in which both neural and vascular mechanisms play a key role.

2.1. The role of the trigeminal nervous system (TNS)

TNS is the main nervous path responsible for the transmission of pain signals from the head and face to the brain. During a migraine attack, TNS activation occurs, which leads to the release of neuropeptides, such as CGRP (calcitonin-genius peptide) and substance P.

CGRP (Calcitonin-Gen-Divine Peptide): CGRP is a powerful vasodilator (expands blood vessels) and plays an important role in transmitting pain signals. It also promotes inflammation in the brain shells (mening). CGRP is a target for new drugs for migraine.
Substance P: The substance p is another neuropeptide participating in the transmission of pain signals and inflammation.

2.2. Crimely spreading depression (CRD)

Crimely spreading depression (CRD) is a wave of neurons depolarization, which slowly spreads through the cerebral cortex. It is believed that KRD plays a role in the occurrence of aura during migraine with an aura.

CRD mechanism: KRD begins with a sudden emission of potassium ions and glutamate from neurons, which leads to the depolarization of neighboring neurons. This wave of depolarization suppresses neural activity and can cause various neurological symptoms of aura.
Communication with the headache: KRD can also activate TNS and cause the release of inflammatory substances, which leads to a headache.

2.3. The role of other areas of the brain

In addition to TNS and cerebral cortex, other areas of the brain are also involved in migraine pathophysiology, such as:

Hypothalamus: The hypothalamus plays a role in the regulation of circadian rhythms, hormones and appetite. Disorders in the work of the hypothalamus can contribute to the occurrence of migraine attacks.
Brain trunk: The brain trunk contains various centers that control pain, nausea and other symptoms associated with migraine.
Talamus: Talamus is a switching station for sensory information entering the cerebral cortex. Talamus can play a role in increasing pain signals in migraine.

2.4. Genetic factors

Migraine has a genetic predisposition. People whose relatives suffer from migraine have a higher risk of developing this disease.

Genes: Several genes associated with migraine were identified, but not one of them is the only cause of the disease. Most likely, migraine is a polygenic disease, that is, its development is associated with the interaction of several genes and environmental factors.
Family hemiplegic migraine: This is a rare type of migraine with an aura, characterized by motor weakness. Some forms of family hemiplegic migraine are associated with mutations in certain genes, such as CACNA1A, ATP1A2 And SCN1A.

2.5. Inflammation

Inflammation plays an important role in the pathophysiology of migraine. During a migraine attack, the release of inflammatory substances in the brain membranes occurs, which leads to irritation and activation of pain receptors.

Inflammatory mediators: The inflammatory mediators involved in the pathophysiology of migraines include prostaglandins, cytokines and nitrogen oxide.
Oblast cells: Matter cells are immune cells that release inflammatory substances. Activation of mast cells in the brain membranes can contribute to the occurrence of migraine.

3. Migraine triggers: What provokes attacks?

Migraine triggers are factors that can provoke an attack of headache in people predisposed to migraine. Triggers can be different for each person, and it is important to identify their individual triggers to minimize the risk of attacks. Keeping a headache diary can help identify patterns and determine triggers.

3.1. Food triggers

Some products and drinks are often called migraine triggers:

Alcohol: Especially red wine and beer. Alcohol can cause dehydration and expand blood vessels, which can provoke migraines.
Caffeine: Both excess and cancellation of caffeine can cause migraine. Caffeine can narrow and expand blood vessels, and sharp changes in the level of caffeine can provoke an attack.
Sustained cheeses: They contain thyramin, a substance that can affect blood vessels.
Processed meat: Contains nitrates and nitrites, which can also affect blood vessels.
Chocolate: Contains phenylethylamine, which can cause changes in the neurotransmitter level.
Artificial sweeteners (aspartam): They can affect the chemistry of the brain.
Glutamate sodium (MSG): Often found in processed products and Asian cuisine.

It is important to note that not all people suffering from migraine are sensitive to all these products.

3.2. Environmental factors

Changes in the environment can also provoke migraines:

Weather changes: Changes in atmospheric pressure, temperature and humidity can cause migraine.
Bright light: Flickering light, sunlight and fluorescent lighting can provoke an attack.
Strong smells: Spirits, chemicals, smoke and other strong smells can cause migraine.
Noise: Loud or constant noise can provoke an attack.

3.3. Stress

Stress is one of the most common migraine triggers.

Mechanism: Stress causes the release of stress hormones, such as cortisol and adrenaline, which can affect blood vessels and neurotransmitters in the brain.
Stress management: Stress management methods, such as yoga, meditation, breathing exercises and psychotherapy, can help reduce the frequency of migraine attacks.

3.4. Hormonal changes

Hormonal changes, especially in women, can be strong migraine triggers.

Menstrual cycle: Migraine is often associated with the menstrual cycle, and many women experience migraine attacks immediately before, during or after menstruation. This is due to fluctuations in the level of estrogen.
Pregnancy: In many women, migraine decreases during pregnancy, especially in the second and third trimesters. However, in some women, migraine may worsen during pregnancy.
Menopause: Menopause can also affect migraine. In some women, migraine decreases after menopause, while in others it worsens.
Hormonal contraception: Hormonal contraceptives, such as contraceptive pills, can affect migraine. In some women, they can facilitate migraines, and in others they can worsen.

3.5. Sleep disorders

Sleep disturbances, such as lack of sleep, sleeping, insomnia and apnea in a dream, can provoke migraines.

Regular sleep mode: It is important to maintain a regular sleep mode, go to bed and wake up at the same time every day.
Sleep hygiene: Practice good sleep hygiene, creating comfortable conditions for sleep and avoiding caffeine and alcohol before bedtime.

3.6. Other triggers

Physical stress: Intensive physical exercises can provoke migraines.
Passing of food intake: Passing for food intake can lead to a decrease in blood sugar, which can cause migraine.
Dehydration: The lack of fluid in the body can provoke migraines.
Some drugs: Some drugs, such as vasodilators, can cause migraine.

4. Diagnostics of migraine: how to make a correct diagnosis?

Migraine diagnosis is based on a careful history of the anamnesis, physical and neurological examination. In most cases, additional examinations are not required, but they can be prescribed to exclude other diseases.

4.1. Anamnesis

It is important to ask the patient about in detail:

The nature of the headache: Localization, intensity, type (pulsating, pressing), duration, frequency.
Concomitant symptoms: Nausea, vomiting, photophobia, phonophobia, aura.
Triggers: What factors provoke bouts of headache.
Family history: Does any of the relatives have a migraine.
Medical history: What diseases did the patient transferred, what drugs does it take.

4.2. Physical and neurological examination

The physical and neurological examination usually does not reveal any deviations in migraine. However, they are necessary to exclude other diseases that can cause headache.

4.3. Additional examinations

In most cases, additional examinations are not required. However, they can be appointed if:

The headache arose suddenly and has a very strong intensity (the so -called “thunder -like headache”).
The headache is accompanied by neurological symptoms that do not correspond to the typical aura of migraines (for example, weakness in the limbs, speech impairment, double -gathering).
The headache progresses or changes its character.
Another disease is suspected, such as the tumor of the brain, aneurysm or meningitis.

Possible additional examinations:

Magnetic resonance tomography (MRI) of the brain: It allows you to exclude structural abnormalities of the brain, such as tumors, aneurysms and hemorrhages.
Computed tomography (CT) of the brain: It can be used in emergency situations when it is necessary to quickly eliminate hemorrhage in the brain.
Lumbal puncture (spinal puncture): Allows excluding meningitis or other inflammatory diseases of the brain.
Blood tests: Can be used to exclude other diseases that can cause headache such as infections or autoimmune diseases.

4.4. Differential diagnosis

It is important to differentiate migraines from other types of headaches and other diseases that can cause headache.

Headache of tension: Most often bilateral, pressing or compressive, moderate intensity. It is usually not accompanied by nausea, vomiting, photophobia or phonophobia.
Closter headache: A very strong, one -sided headache, accompanied by redness of the eye, lacrimation, nasal congestion or a runny nose on the same side of the head.
Sinusit: Headache associated with inflammation of the sinuses. It is usually accompanied by nasal congestion, a runny nose and pain in the face.
Glaucoma: Increased intraocular pressure can cause headache.
The tumor of the brain: It can cause a headache that progresses over time and is accompanied by other neurological symptoms.
Aneurysm: The expansion of the blood vessel in the brain. An aneurysm break can cause a very severe, sudden headache.

5. Migraine treatment: approaches and strategies

Migraine treatment includes both the relief of acute attacks and a preventive treatment aimed at reducing the frequency and severity of attacks. The choice of treatment depends on the frequency, intensity and concomitant symptoms of migraine, as well as on the individual preferences of the patient.

5.1. Relocation of sharp migraine attacks

The purpose of stopping acute attacks is to relieve pain and concomitant symptoms as quickly as possible.

Nonsteroidal anti -inflammatory drugs (NSAIDs): Ibuprofen, Neproksen, Ketoprofen. Effective for migrants of migraine. It is important to take NSAIDs at the beginning of the attack so that they are most effective.
Simple analgesics: Paracetamol (acetaminophen). It can be effective for light migraine attacks, but usually less effective than NSAIDs.
TRIPTA: Constantin, gymitrippan, risatriciptan, intrigriptan, ethletriptan, frutitriptan, al -Prepereptan. Triptans are selective agonists of serotonin receptors (5-HT1B/1D), which narrow the blood vessels in the brain and block the release of neuropeptides such as CGRP. Triptans are effective drugs for stopping moderate and strong migraine attacks. It is important to take tripatans at the beginning of the attack so that they are most effective. Triptans are contraindicated to people with cardiovascular diseases.
Dihydroergotamin (DGE): Another drug that narrows blood vessels. DGE can be effective for migraine attacks that do not respond to tripatans. DGE can be administered intravenously, intramuscularly or intranasally. DGE is contraindicated in people with cardiovascular diseases.
Antiometures (antiemetic drugs): Metoclopramide, coolroperazin, domperidone. They are used to facilitate nausea and vomiting, which often accompany migraine attacks. Metoclopramide can also enhance the action of analgesics.
Combined drugs: Contain a combination of analgesics (for example, paracetamol or aspirin) and anti -emitics (for example, metoclopramide).

5.2. Preventive treatment of migraines

Preventive treatment of migraines is aimed at reducing the frequency, severity and duration of seizures. Preventive treatment is recommended for people who have:

Migraine attacks often occur (more than 4 days a month).
Migraine attacks greatly affect the quality of life.
Acute treatment is ineffective or has serious side effects.
There are contraindications for acute treatment.

Preventive drugs are taken daily, regardless of the presence of headaches. The effect of preventive treatment usually develops after a few weeks or months.

Beta blockers: Propranolol, metoprolol, Atenolol. It is believed that beta-blockers reduce the frequency of migraine attacks, affecting blood vessels and neurotransmitters in the brain. Beta blockers are contraindicated to people with asthma, bradycardia and hypotension.
Calcium channel blockers: Flunarizin. Flunarizine can reduce the frequency of migraine attacks, blocking the flow of calcium into the brain cells.
Tricyclic antidepressants: Amititriptylin, NORTRIPTILIN. It is believed that tricyclic antidepressants reduce the frequency of migraine attacks, affecting the level of serotonin and norepinephrine in the brain. Tricyclic antidepressants can cause side effects, such as dry mouth, constipation and drowsiness.
Antiepileptic drugs: Topiramate, valproic acid. Topiramate and valproic acid can reduce the frequency of migraine attacks, stabilizing electrical activity in the brain. Topiramate can cause side effects, such as weight loss, speech impairment and memory deterioration. Walproic acid is contraindicated in pregnant women.
CGRP blockers: Erenumab, Freanzumab, Galkanzumab, Eptynesumab. This is a new group of preparations that block CGRP (calcitonin-hen-body peptide) or its receptor. CGRP plays an important role in the pathophysiology of migraine. CGRP blockers are introduced in the form of injections once a month or once every three months.
Botulinum toxin Type A (Botox): Botox can be used to treat chronic migraines (headache 15 or more days per month for more than 3 months). Botox is inserted into the muscles of the head and neck for about every 3 months.

5.3. Non -drug methods for treating migraines

In addition to drugs, there are non -drug methods of treatment of migraine, which can be effective:

Life change change:
- Regular sleep mode: Go to bed and wake up at the same time every day.
- Healthy nutrition: Avoid missing meals and dehydration.
- Regular physical exercises: Moderate physical exercises can help reduce the frequency of migraine attacks.
- Stress management: Practice stress management methods such as yoga, meditation, breathing exercises and psychotherapy.
- Avoid triggers: Identify and avoid migraine triggers.
Biological feedback (biofidBEC): A method that allows you to learn how to control the physiological functions of the body, such as heart rate, blood pressure and muscle tension. Biofidback can help reduce the frequency of migraine attacks.
Acupuncture: The method of traditional Chinese medicine, which includes the introduction of thin needles into certain points on the body. Acupuncture can help reduce the frequency of migraine attacks.
Massage: Massage can help relax muscles and reduce tension, which can reduce the frequency of migraine attacks.
Cognitive-behavioral therapy (KPT): The type of psychotherapy that helps people change their thoughts and behavior in order to improve their well -being. KPT can help people cope with stress, pain and other problems associated with migraine.
Neurostimulation:
- Transcranial magnetic stimulation (TMS): A method that uses magnetic impulses to stimulate or suppress the activity of certain areas of the brain. TMS can be used to treat migraines.
- Transcranial stimulation direct current (TSPT): A method that uses a weak direct current to stimulate or suppress the activity of certain areas of the brain. TSPT can be used to treat migraines.
- Penettlement stimulation (STO): A method that includes implantation of electrodes under the skin in the occipital nerve. Electrodes stimulate the occipital nerve, which can help reduce the frequency of migraine attacks.

6. Migraine and related diseases

Migraine is often combined with other diseases, which can complicate the diagnosis and treatment.

6.1. Depression and anxiety

Depression and anxiety are often found in people suffering from migraine. It is believed that there is a bilateral connection between migraine and these mental disorders. Migraine can cause depression and anxiety, and depression and anxiety can aggravate migraines.

6.2. Irritable bowel syndrome (SRK)

SRK is a functional intestinal disorder, which is characterized by abdominal pain, bloating, diarrhea or constipation. SRK is often found in people suffering from migraine.

6.3. Fibromyalgia

Fibromyalgia is a chronic disease that is characterized by common pain in muscles and joints, fatigue and sleep disorders. Fibromyalgia is often found in people with migraine.

6.4. Epilepsy

Epilepsy is a neurological disease that is characterized by repeated seizures. There is a connection between migraine and epilepsy. Some people with migraine also experience epileptic attacks.

6.5. Stroke

Some studies have shown that people with a migraine with an aura have increased the risk of stroke. However, this risk is still relatively small.

6.6. Cardiovascular diseases

People with a migraine with an aura may have an increased risk of developing cardiovascular diseases, such as myocardial infarction and stroke.

7. Migraine in children and adolescents

Migraine is a common disease in children and adolescents. Symptoms of migraines in children may differ from symptoms in adults. In children, nausea, vomiting and abdominal pain are more common. Treatment of migraine in children includes a change in lifestyle, stopping acute attacks and preventive treatment.

7.1. Migraine diagnosis in children

Diagnosis of migraine in children is based on the same criteria as in adults. However, it is important to take into account the child’s age and his ability to describe his symptoms.

7.2. Migraine treatment in children

Migraine treatment in children includes:

Life change change: Regular sleep mode, healthy nutrition, regular physical exercises, stress management, and avoid triggers.
Relocation of sharp seizures: Paracetamol, Ibuprofen. Triptans can be used in adolescents over 12 years old.
Preventive treatment: Ciprogptadine, propranolol, topiramate.

7.3. Special considerations

It is important to exclude other causes of headaches in children, such as the brain tumor.
Migraine treatment in children should be individual and take into account the child’s age, his symptoms and concomitant diseases.
It is important to involve the child and his parents in the treatment process.

8. Migraine and pregnancy

Migraine can affect pregnancy. In some women, migraine decreases during pregnancy, while in others it worsens. Migraine treatment during pregnancy requires special attention, as some drugs can be dangerous for the fetus.

8.1. Treatment of acute migraine attacks during pregnancy

Paracetamol is considered safe for use during pregnancy.
Ibuprofen can be used in the first and second trimesters of pregnancy, but it should be avoided in the third trimester.
Triptans should be used with caution during pregnancy.

8.2. Preventive treatment of migraines during pregnancy

Beta blockers should be used with caution during pregnancy.
Tricyclic antidepressants should be used with caution during pregnancy.
Anti -epileptic drugs, such as topiramate and valproic acid, are contraindicated in pregnant women.
CGRP blockers are not yet sufficiently studied for use during pregnancy.

8.3. Non -drug methods for treating migraines during pregnancy

Acupuncture
Massage
Biofidback
Relaxation techniques

9. Alternative methods for treating migraines

Many people with migraine turn to alternative treatment methods to alleviate their symptoms. However, it is important to discuss any alternative methods of treatment with your doctor in order to make sure their safety and effectiveness.

9.1. Herbs and additives

Magnesium: Magnesia can help reduce the frequency of migraine attacks.
Riboflavin (vitamin B2): Riboflavin can help reduce the frequency of migraine attacks.
Coenzim q10: Coenzyme Q10 can help reduce the frequency of migraine attacks.
White -skinned: White -skinned can help reduce the frequency of migraine attacks, but it can cause side effects, such as liver damage.
Ginger: Ginger can help relieve nausea and vomiting associated with migraine.

9.2. Dietary changes

Blind diet: Some people with migraine report an improvement in the symptoms subject to a gluten -free diet.
Ketogenic diet: Some studies have shown that ketogenic diet can help reduce the frequency of migraine attacks.
Low tyrammine diet: Some people with migraine are sensitive to thramine, a substance contained in aged cheeses, processed meat and other products.

9.3. Other alternative treatment methods

Hiropractic: Spine manipulations can help reduce the frequency of migraine attacks.
Osteopathy: Osteopathic treatment can help reduce the frequency of migraine attacks.
Homeopathy: Homeopathic preparations can be used to treat migraines.

10. Opportunities and restrictions in the full cure of migraine

The complete cure of migraine, in understanding the complete and constant disappearance of attacks without the need for any treatment, unfortunately, is not always achievable. Migraine is a chronic disease, and although modern treatment methods can significantly improve the quality of life of patients, a complete cure can be achieved only in rare cases.

10.1. Factors affecting the possibility of “cure”

Migraine type: Migraine is episodic (less than 15 days of headache per month) is easier to control than chronic (15 or more head pain per month).
Age of the beginning: Migraine, which began in childhood or adolescence, sometimes can “develop”, although this is not always the case.
Related diseases: The presence of depression, anxiety, fibromyalgia and others