Get rid of migraines forever: integrated approach

Get rid of migraines forever: integrated approach

I. Understanding of migraines: much more than just a headache.

Migraine is much more than just a severe headache. This is a complex neurological state, characterized by recurrent attacks of a pulsating headache, often accompanied by other symptoms, such as nausea, vomiting, sensitivity to light (photophobia), sensitivity to sound (phonophobia) and sensitivity to odors (osmophobia). The severity and frequency of migraine attacks vary greatly from man to person. For some, this is a rare and moderate inconvenience, while for others it is an exhausting state that significantly affects their daily life, performance and general quality of life.

A. Neurological foundations of migraines.

For a long time it was believed that migraine was a vascular disease associated with the expansion and narrowing of blood vessels in the brain. However, modern studies have shown that migraine is a much more complex process that includes the interaction of various parts of the brain, nerves and chemicals.

1. Trigeminal nervous system: This nervous system plays a key role in the transmission of pain signals from the head and face to the brain. During a migraine attack, the trigeminal nerve is activated, which leads to the release of neuropeptides, such as CGRP (calcitonin General-body peptide).

2. CGRP (calcitonin General-related peptide): This powerful neuropeptide causes the expansion of blood vessels in the brain and contributes to inflammation, which leads to pain related to migraine. Medications that block CGRP or its receptor were effective in preventing and treating migraines.

3. Hypothalamus: This area of the brain is involved in the regulation of various functions of the body, including sleep, appetite and hormonal balance. It is believed that the hypothalamus plays a role in the occurrence of migraine, since it can affect the activity of the trigeminal nervous system and blood vessels.

4. Brain trunk: This part of the brain contains centers that control pain, sleep and wakefulness. Dysfunction in the brain stem can contribute to the development of migraine, affecting the threshold of pain and regulation of sensory information.

5. Cerebral cortex: The cerebral cortex is responsible for processing sensory information, thinking and making decisions. During migraine, a spreading cortical depression (CCD), an electrical activity that spreads through the cerebral cortex, causing various symptoms, including aura, can occur.

B. Types of migraines:

There are several types of migraines, each of which is characterized by its specific symptoms and characteristics.

1. Migraine with aura: This type of migraine is accompanied by an aura, which is a complex of neurological symptoms that usually occur 5-60 minutes before the start of a headache. The aura may include visual disturbances (for example, flickering lights, zigzag lines, visual fields), sensory disorders (for example, tingling, numbness), speech disorders and, less often, motor disorders.

2. Migraine without aura: This type of migraine is characterized by a headache that occurs without a previous aura. This is the most common type of migraine.

3. Chronic migraine: Chronic migraine is defined as a headache that occurs 15 or more days a month for more than three months, and at least 8 days a month must comply with migraine criteria.

4. Hemiplegic migraine: This is a rare type of migraine, which is accompanied by weakness or paralysis of one side of the body (hemiplegia). Hemiplegic migraine can be family (hereditary) or sporadic (arising without family history).

5. Migraine of the brain stem (basic migraine): This type of migraine is characterized by symptoms emanating from the brain trunk, such as dizziness, double -gathering, implicit speech and loss of consciousness.

6. Abdominal migraine: This type of migraine is found mainly in children and is characterized by periodic bouts of abdominal pain, accompanied by nausea, vomiting and loss of appetite.

C. Migraine triggers:

Migraine triggers are factors that can provoke a migraine attack of susceptible people. Migraine triggers vary greatly from man to person, and the same factor can provoke migraine in one person and not influence the other.

1. Life lifestyle factors:

   • Stress: Stress is one of the most common migraine triggers.
   • Lack of sleep or excess sleep: Disorders of sleep mode can provoke migraine attacks.
   • Missed meals: Unregular nutrition and starvation can cause migraine.
   • Dehydration: Insufficient fluid consumption can provoke migraines.
   • Physical strain: Excessive physical activity can cause migraine.
   • Changes in the daily mode (Jetlag): Traveling through time zones can provoke migraines.

2. Food triggers:

   • Sustained cheeses: Cheeses containing tiramin (for example, Chedder, Bree, Parmesan) can cause migraine.
   • Processed meat: Meat products containing nitrates and nitrites (for example, bacon, sausage, hot dogs) can be triggers.
   • Chocolate: Chocolate contains caffeine and other compounds that can provoke migraine in some people.
   • Alcohol: Especially red wine can cause migraine.
   • Artificial sweeteners (aspartam): Asparters contained in dietary drinks and products can be a trigger.
   • Glutamate sodium (MSG): MSG, often used as an amplifier of taste, can cause migraine.

3. Ecological triggers:

   • Bright light: The blinking light, fluorescent lamps and sunlight can provoke migraines.
   • Loud sounds: Noisy conditions can cause migraine.
   • Strong smells: Spirits, chemicals, smoke and other strong smells can be triggers.
   • Weather changes: Projects of atmospheric pressure, temperature and humidity can provoke migraines.

4. Hormonal triggers:

   • Menstruation: In many women, migraine is associated with the menstrual cycle, especially with the fall of estrogen levels.
   • Pregnancy: Migraine can improve during pregnancy, but sometimes it may worsen.
   • Menopause: Hormonal changes during menopause can cause migraine.
   • Hormonal contraceptives: Some hormonal contraceptives can provoke migraines.

II. Migraine diagnostics: key criteria and examination methods.

The exact diagnosis of migraine is crucial for the development of an effective treatment plan. The diagnosis of migraine is usually made on the basis of the patient’s history, physical and neurological examination. In some cases, additional studies may be required to exclude other possible causes of headache.

A. Diagnostic criteria for the International Society of Headache (ICHD-3):

The International Headache Society (ICHD) has developed clear diagnostic criteria for migraine. These criteria are used by doctors to diagnose migraine and differentiate it from other types of headache.

1. Migraine without aura:

   • At least five attacks that meet the following criteria:
     • The duration of the headache is from 4 to 72 hours (without treatment or with ineffective treatment).
     • The headache has at least two of the following characteristics:
       • One -sided localization (usually on one side of the head).
       • Pulsating in nature.
       • Moderate or severe intensity of pain.
       • Strengthening the pain in ordinary physical activity (for example, walking, climbing the stairs).
     • During a headache, at least one of the following symptoms is observed:
       • Nausea and/or vomiting.
       • Photophobia and phonophobia.
   • Headache is not related to another disease.

2. Migraine with aura:

   • At least two attacks that meet the following criteria:
     • One or more aura symptoms:
       • Visual (for example, flickering lights, zigzag lines, visual fields).
       • Sensory (for example, tingling, numbness).
       • Speech (for example, speech violation).
       • Motor (for example, weakness). (rarely)
       • Stem (for example, dizziness, double eyes). (rarely)
       • The retina (for example, flicker in one eye, the loss of the field of view in one eye). (rarely)
     • Each symptom of the aura lasts from 5 to 60 minutes.
     • Aura of reversible.
     • The headache corresponding to the criteria of migraine without an aura begins during the aura or within 60 minutes after the end of the aura.
   • Headache is not related to another disease.

B. Medical examination and anamnesis:

The doctor will conduct a thorough medical examination and collect a detailed history to exclude other possible causes of a headache and determine the type of migraine.

1. Anamnesis: The doctor will ask about:

   • The nature of the headache (localization, intensity, frequency, duration, pulsating in nature).
   • Concomitant symptoms (nausea, vomiting, photophobia, phonophobia, aura).
   • Headache triggers.
   • Family history of headache.
   • Previous and current diseases.
   • Medications taken.
   • Lifestyle (sleep, nutrition, physical activity, stress).

2. Physical and neurological examination: The doctor will conduct a general physical examination and a neurological examination to assess the function of the nervous system. A neurological examination may include verification of vision, hearing, reflexes, coordination, strength and sensitivity.

C. Additional research:

In most cases, anamnesis and physical examination are enough to diagnose migraine. However, in some cases, additional studies may be required to exclude other possible causes of a headache or to assess the structure of the brain.

1. Magnetic resonance tomography (MRI) of the brain: MRI is a visualization method using a magnetic field and radio waves to obtain detailed images of the brain. MRI can help exclude states such as brain tumors, aneurysms and other structural anomalies.

2. Computed tomography (CT) of the brain: CT is a visualization method that uses x -rays to obtain images of the brain. CT can help eliminate hemorrhage in the brain and other acute conditions.

3. Blood tests: Blood tests can be carried out to exclude other diseases that can cause headaches, such as infections, inflammation or anemia.

D. Keeping a headache diary:

Maintenance of a headache diary can help identify migraine triggers, evaluate the effectiveness of treatment and track the frequency and intensity of headaches. In the diary you should record:

• The date and time of the beginning and end of the headache.
• The intensity of pain (for example, on a scale from 0 to 10).
• Localization hurts.
• Related symptoms (nausea, vomiting, photophobia, phonophobia, aura).
• Possible triggers (food, drinks, stress, sleep, weather).
• Accepted drugs and their effectiveness.

III. A comprehensive approach to the treatment of migraines: a combination of drug therapy and modification of lifestyle.

Migraine treatment requires an integrated approach, which includes drug therapy and modification of lifestyle. The purpose of treatment is to reduce the frequency, intensity and duration of migraine attacks, as well as improve the quality of the patient’s life.

A. Drug therapy:

Migraine drug therapy includes two main approaches: stopping acute attacks and preventive treatment.

1. Relocation of sharp seizures: Medicines for stopping acute attacks are designed to relieve pain and other symptoms of migraine during the attack.

   • Anesthetic drugs:
     • Nonsteroidal anti -inflammatory drugs (NSAIDs): Ibuprofen, Naproxen, Diclofenac.
     • Acetaminophen (paracetamol):
   • TRIPTA: Constantin, risatriciptan, zolmitriptan, naratriptan, frutitriptan, ethletriptan, al -Prepereptan. Triptans are specific medicines for the treatment of migraine, which act by narrowing the blood vessels in the brain and blocking the release of neuropeptides, such as CGRP.
   • Ergotamines: Ergotamine, dihydroergotamine (DGE). Ergotamines are another class of drugs that narrow the blood vessels in the brain. However, they have more side effects than triptans, and are used less often.
   • Antimetics (antiemetic drugs): Metoclopramide, coolroperazin, domperidone. These drugs help reduce nausea and vomiting, which often accompany migraine.
   • Combined drugs: Some drugs contain a combination of painkillers (for example, acetaminophen) and triptan (for example, summptor).

2. Preventive treatment: Preventive treatment is designed to reduce the frequency, intensity and duration of migraine attacks. Preventive treatment is usually prescribed for people who have frequent or exhausting migraines, or if drugs for stopping acute attacks are ineffective.

   • Beta blockers: Propranolol, metoprolol, Atenolol. Beta blockers are drugs that are usually used to treat high blood pressure and heart disease. They can also be effective in preventing migraines.
   • Antidepressants: Amititriptylin, NORTRIPTILIN, WENLAFAXIN. Some antidepressants, especially tricyclic antidepressants and inhibitors of the reverse capture of serotonin and norepinephrine (SIOSSN), can be effective in preventing migraine.
   • Anticonvulsants: Topiramate, valproic acid, size. Some anticonvulsants used to treat epilepsy can also be effective in preventing migraine.
   • CGRP blockers: Erenumab, Freanzumab, Galkanzumab, Eptynesumab. These drugs are monoclonal antibodies that block CGRP or its receptor, which helps to prevent migraine.
   • Shebotulinumoxin (Botox): Botox is an injection drug that paralyzes muscles. It is approved for the treatment of chronic migraine.
   • Additional drugs: Some other drugs, such as Lisinopril, Candesartan and Magnesium, can also be effective in preventing migraine in some people.

B. Modification of lifestyle:

Modification of lifestyle plays an important role in the treatment of migraines. A change in lifestyle can help reduce the frequency and intensity of migraine attacks, as well as improve the overall state of health.

1. Identification and avoidance of triggers: It is important to identify and avoid migraine triggers. Keeping a headache diary can help determine triggers.

2. Regular sleep: It is important to maintain a regular sleep mode, go to bed and wake up at the same time every day. Try to sleep 7-8 hours a day.

3. Healthy nutrition: It is important to adhere to a healthy diet, including a large number of fruits, vegetables and whole grains. Avoid processed products, sweet drinks and excess caffeine. Do not skip food meals.

4. Regular physical exercises: Regular physical exercises can help reduce stress and improve the overall health. Try to engage in moderate physical exercises for at least 30 minutes a day, most days of the week.

5. Stress management: It is important to learn how to manage stress. Stress management techniques, such as yoga, meditation and deep breathing, can be useful.

6. Hydration: It is important to drink a sufficient amount of liquid to avoid dehydration. Try to drink at least 8 glasses of water per day.

7. Restriction of alcohol and caffeine: Alcohol and caffeine can provoke migraines in some people. It is important to limit the use of these substances or completely avoid them.

C. Alternative treatment methods:

Some people find relief from migraine using alternative treatment methods. However, it is important to consult a doctor before starting any alternative treatment.

1. Acupuncture: Acupuncture is a traditional Chinese medical practice, which includes the introduction of thin needles into certain points on the body. Some studies have shown that acupuncture can be effective in reducing the frequency of migraine attacks.

2. Biological feedback (BOS): Bos is a technique that allows people to learn how to control certain physiological functions, such as heart rate, blood pressure and muscle tension. Bos can be effective in reducing stress and muscle tension, which can provoke migraines.

3. Massage: Massage can help relax muscles and reduce stress, which can alleviate the symptoms of migraines.

4. Cognitive-behavioral therapy (KPT): KPT is a type of psychotherapy that helps people change negative thoughts and behavior. KPT can be effective in managing stress, anxiety and depression that migraine can provoke.

5. Herbs and additives: Some herbs and additives, such as magnesium, riboflavin (vitamin B2), Coenzyme Q10 and white -skinned, can be effective in preventing migraine in some people. However, it is important to consult a doctor before taking any herbs or supplements, as they can interact with other drugs.

IV. Special groups of patients: migraine in children, women and the elderly.

Migraine can manifest itself differently in different groups of patients, and treatment should be adapted to their specific needs.

A. Migraine in children:

Migraine is often underestimated in children, but it can significantly affect their performance in school, social life and general well -being. Symptoms of migraines in children may differ from symptoms in adults.

1. Symptoms: In children, migraine is often manifested by a bilateral headache, which can be pulsating or squeezing. They can also experience nausea, vomiting, abdominal pain, photophobia and phonophobia.
2. Triggers: Migraine triggers in children may include stress, lack of sleep, missed food meals, dehydration and certain foods.
3. Treatment: Migraine treatment in children includes a modification of lifestyle, drug therapy and alternative treatment methods.
   • Modification of lifestyle: It is important to identify and avoid triggers, maintain a regular sleep mode, adhere to a healthy diet and engage in regular physical exercises.
   • Drug therapy: To stop sharp attacks, you can use painkillers, such as Ibuprofen or Acetaminophene. Triptans can be used in adolescents over 12 years old. For migraine prevention, beta-blockers, antidepressants or anticonvulsants can be prescribed.
   • Alternative treatment methods: Acupuncture, biological feedback and cognitive-behavioral therapy can be useful for children with migraine.

B. Migraine in women:

Migraine is more common in women than in men, and is often associated with hormonal changes.

1. Hormonal triggers: In many women, migraine is associated with a menstrual cycle, pregnancy and menopause. Changes in estrogen levels can provoke migraine attacks.
2. Menstrual migraine: Micrual migraine is a migraine that occurs during menstruation. It can be caused by the fall of estrogen levels before menstruation.
3. Pregnancy: Migraine can improve during pregnancy, but sometimes it may worsen. Some medicines for migraine are contraindicated during pregnancy.
4. Menopause: Hormonal changes during menopause can cause migraine. Hormone therapy can relieve migraine symptoms in some women during menopause.
5. Treatment: Migraine treatment in women includes a modification of lifestyle, medicinal therapy and hormonal therapy.
   • Modification of lifestyle: It is important to identify and avoid triggers, maintain a regular sleep mode, adhere to a healthy diet and engage in regular physical exercises.
   • Drug therapy: To stop sharp attacks, you can use painkillers, triptans and ergotamins. For migraine prevention, beta-blockers, antidepressants, anticonvulsants and CGRP blockers can be prescribed.
   • Hormonal therapy: Hormone therapy can be useful for women with menstrual migraine or migraine associated with menopause.

C. Migraine in the elderly:

Migraine can continue in old age, or first arise in old age. Symptoms of migraines in older people may differ from symptoms in young people.

1. Symptoms: In older people, migraines often manifest a less intense headache, which can be less pulsating and more constant. They can also experience dizziness, impaired coordination and confusion.
2. Triggers: Migraines triggers in older people may include medicines, concomitant diseases and changes in lifestyle.
3. Treatment: Treatment of migraine in older people requires special attention to related diseases and drug interactions.
   • Modification of lifestyle: It is important to identify and avoid triggers, maintain regular sleep mode, adhere to a healthy diet and engage in moderate physical exercises.
   • Drug therapy: When choosing drugs for the treatment of migraine in older people, their concomitant diseases and drug interactions should be taken into account. To stop sharp attacks, you can use painkillers, such as acetaminophene or NSAID (with caution). Triptans and ergotamins should be used with caution in the elderly due to the risk of cardiovascular diseases. For the prevention of migraine, beta-blockers, antidepressants or anticonvulsants can be prescribed, taking into account their safety profile.
   • Alternative treatment methods: Acupuncture, biological feedback and massage can be useful for the elderly with migraine.

V. The latest achievements in the treatment of migraines: CGRP blockers and nerves stimulation.

In recent years, significant achievements have occurred in the treatment of migraines, especially in the field of CGRP blockers and nerves stimulation.

A. CGRP blockers:

CGRP blockers are a new class of drugs that block CGRP or its receptor, which helps to prevent migraine. These drugs were effective in reducing the frequency, intensity and duration of migraine attacks.

1. Types of CGRP blockers:

   • Monoclonal antibodies: Erenumab, Freanzumab, Galkanzumab, Eptynesumab. These drugs are administered subcutaneously or intravenously and block CGRP or its receptor.
   • Gapanti: Rimegepant, Urogepant, athehepant. These are small molecules that are accepted orally and block the CGRP receptor.

2. Advantages of CGRP blockers:

   • High efficiency in reducing the frequency, intensity and duration of migraine attacks.
   • Good safety profile.
   • Ease of use (subcutaneous or intravenous injections once a month or quarter, or tablets).

3. Side effects of CGRP blockers:

   • Constipation.
   • Reactions at the injection site.
   • Rare allergic reactions.

B. Nerves stimulation:

Nerves stimulation is a non -invasive method for treating migraine, which includes stimulating certain nerves using electrical impulses.

1. Types of nerve stimulation:

   • Transcranial magnetic stimulation (TMS): TMS is a method that uses magnetic impulses to stimulate certain areas of the brain.
   • Transcular stimulation of the urgent nerve (TSONS): TSONS is a method that uses electrical impulses to stimulate the urgent nerve that is located above the eye.
   • Stimulation of the vagus nerve (SVN): SVN is a method that uses electrical impulses to stimulate the vagus nerve, which is located in the neck.

2. Advantages of nerves stimulation:

   • Non -invasive treatment method.
   • Lack of systemic side effects.
   • The possibility of using sharp attacks and for the prevention of migraine.

3. Side effects of nerves stimulation:

   • Light skin irritation.
   • Muscle contractions.
   • Dizziness.

VI. Life with migraine: adaptation strategies and support.

Life with migraine can be difficult, but there are adaptation strategies and support resources that can help people cope with this state.

A. Adaptation Strategies:

1. Acceptance and understanding: It is important to accept and understand that migraine is a chronic disease that requires constant management.
2. Self -education: Learn more about migraines, its triggers, symptoms and treatment options.
3. Planning: Plan in advance and take into account the possibility of migraine attacks.
4. Organization: Keep a headache diary to track triggers, symptoms and treatment effectiveness.
5. Stress management: Learn to manage stress using relaxation techniques, such as yoga, meditation and deep breathing.
6. Maintaining a healthy lifestyle: Maintain regular sleep mode, adhere to a healthy diet and do regular physical exercises.
7. Task delegation: Feel free to ask for help and delegate tasks when you feel bad.
8. Self -suffering: Be kind to yourself and allow yourself to rest when you need it.
9. Positive attitude: Try to maintain a positive attitude and do not allow migraines to control your life.

B. Support resources:

1. Doctor: Contact a doctor who specializes in the treatment of headache.
2. Support groups: Join the support groups for people with migraine.
3. Online Forums: Participate in online forums for people with migraine.
4. National headache organizations: Contact national headache organizations for information and support.
5. Psychotherapist: Contact a therapist to receive assistance in managing stress, anxiety and depression, which can be associated with migraine.
6. Family and friends: Tell your family and friends about your migraine and ask them about support.

VII. Migraine prevention: an active approach to health management.

Migraine prevention is an active approach to health management, aimed at reducing the frequency, intensity and duration of migraine attacks. Prevention includes a combination of modification of lifestyle, drug therapy and alternative treatment methods.

A. Development of an individual prevention plan:

The development of an individual migraine prevention plan requires cooperation between the patient and the doctor. The plan should take into account individual triggers, symptoms, concomitant diseases and patient preferences.

1. Definition of prevention goals:

   • Reducing the frequency of migraine attacks by 50% or more.
   • Reducing the intensity of migraine attacks.
   • Reducing the duration of migraine attacks.
   • Improving the quality of life.

2. Identification of triggers and developing strategies for avoiding them:

   • Keep a headache diary to track triggers.
   • Develop strategies for avoiding famous triggers.

3. Modification of lifestyle:

   • Support the regular sleep mode.
   • Adhere to a healthy diet.
   • Do regular physical exercises.
   • Manage stress.
   • Maintain hydration.
   • Limit the use of alcohol and caffeine.

4. Consider medicinal therapy:

   • Discuss with the doctor options for preventive drug therapy.
   • Start with a low dose and gradually increase it until the desired effectiveness is achieved or side effects will appear.
   • Be patient, as it may take several weeks or months to see the results of drug therapy.

5. Consider alternative treatment methods:

   • Discuss with the doctor options for alternative treatment methods.
   • Try acupuncture, biological feedback, massage or cognitive-behavioral therapy.

6. Regular monitoring and adjustment of the plan:

   • Regularly visit a doctor to monitor the effectiveness of the prevention plan.
   • Correct the plan as necessary, depending on your symptoms and needs.

B. Adherence to the prevention plan:

Adherence to the prevention plan is crucial for achieving success in migraine management.

1. Install realistic goals: Do not expect you to completely get rid of migraines. The purpose of prevention is to reduce the frequency, intensifying