Once and for all: effective methods of treating migraines

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Once and for all: effective methods of treating migraines

I. Understanding migraines: the roots of the problem and types of manifestation

Migraine is not just a severe headache. This is a complex neurological disease, characterized by attacks of intense, pulsating pain, most often localized in one half of the head. It can be accompanied by nausea, vomiting, sensitivity to light (photophobia) and sound (phonophobia). Migraine significantly reduces the quality of life, affecting performance, social activity and general well -being.

A. The neurological basis of migraines:

Migraine pathophysiology has not been fully studied, but there are several key mechanisms that are believed to play a role in the development of seizures:

  1. Trigeminal system: This system, which includes the trigeminal nerve, is central to transmit pain signals from the head and face to the brain. Activation of the trigeminal nerve releases neuropeptides, such as CGRP (calcitonin-genius peptide), which causes inflammation and expansion of blood vessels in the membranes of the brain (mening).

  2. Vascular changes: The expansion and narrowing of the blood vessels of the brain was previously considered the main cause of migraine. Although this theory is no longer dominant, vascular changes, especially in the context of inflammation, are still considered an important factor.

  3. Dysfunction of the cerebral cortex: Some studies show that migraine is associated with violations in the electrical activity of the cerebral cortex, in particular, with spreading cortical depression (CCD). CCD is a wave of slowdown in neural activity, which can cause aura and activate the trigeminal system.

  4. Neurotransmitter: Neurotransmitters, such as serotonin, dopamine and glutamate, play an important role in the modulation of pain and inflammation. The imbalance of these neurotransmitters can contribute to the development of migraine.

  5. Genetic predisposition: Migraine is often inherited, which indicates a genetic component. Several genes associated with an increased risk of migraine development were identified, but specific mechanisms through which these genes affect the development of the disease are still studied.

B. Classification of migraines: the main types and characteristics:

The International Headache Society (IHS) has developed a classification of headaches, which includes various types of migraines:

  1. Migraine without aura (ordinary migraine): The most common type of migraine. Attacks are characterized by an intense pulsating headache, usually one -sided, accompanied by nausea, vomiting, photophobia and phonophobia. The pain usually lasts from 4 to 72 hours.

  2. Migraine with aura (classic migraine): This type of migraine begins with an aura – temporary neurological symptoms that precede headache. The aura usually lasts from 5 to 60 minutes and can include visual (flickering, zigzag lines, field loss), sensory (tingling, numbness), motor (weakness) or speech disorders. Headache, as a rule, develops within an hour after the end of the aura.

  3. Chronic migraine: It is defined as a headache that occurs 15 or more days a month for more than three months, and at least 8 of these days correspond to the criteria of migraine. Chronic migraine can significantly worsen the quality of life and often requires more aggressive treatment.

  4. Migraine with a stem aura (previously known as basic migraine): This rare type of migraine is characterized by an aura emanating from the brain stem. Symptoms of aura may include dizziness, double -gathering, dysarthria (speech impairment), ears noise and impaired coordination.

  5. Hemiplegic migraine: This rare type of migraine is characterized by an aura that includes motor weakness (hemiparesis) on one side of the body. Hemiplegic migraine can be family (inherited) or sporadic (arising without family history).

  6. Abdominal migraine: This type of migraine is found mainly in children and is characterized by recurrent bouts of abdominal pain, accompanied by nausea, vomiting and pallor. Headache may be absent.

C. Migraine triggers: identification and avoidance of provoking factors:

Migraine triggers are factors that can provoke a migraine attack of susceptible people. Triggers vary from man to person, and the identification of their own triggers is an important step in the prevention of migraine. Some common triggers include:

  1. Dietary factors:

    • Products: Tested cheeses, chocolate, red wine, processed meat, foods containing mononarium glutamate (MSG), artificial sweeteners (aspartam).
    • Poles of food intake: Unregular nutrition and a pass of eating can cause a drop in blood sugar, which can provoke a migraine attack.
    • Dehydration: Insufficient fluid consumption can lead to dehydration, which is a famous migraine trigger.
    • Caffeine: Excessive caffeine consumption or a sharp cessation of its use can provoke migraines.

  2. Environmental factors:

    • Weather: Changes in atmospheric pressure, temperature changes, humidity, strong wind.
    • Smells: Strong smells, such as perfumes, chemicals, smoke.
    • Bright light: Little light, sunlight, bright artificial light.
    • Noise: Loud sounds, noisy places.

  3. Hormonal factors:

    • Menstrual cycle: In women, migraine is often associated with the menstrual cycle, especially with the fall of estrogen levels before menstruation.
    • Pregnancy: Migraine can improve or worsen during pregnancy.
    • Menopause: Hormonal changes associated with menopause can affect the frequency and severity of migraines.
    • Hormonal contraceptives: Some hormonal contraceptives can aggravate migraines.

  4. Life lifestyle factors:

    • Stress: Stress is one of the most common migraine triggers.
    • Lack of sleep: Insufficient sleep or violation of sleep mode can provoke a migraine attack.
    • Excessive physical activity: Intensive physical exercises can provoke migraines in some people.
    • Smoking: Smoking or exposure to tobacco smoke can increase the risk of migraine.

  5. Medical factors:

    • Some drugs: Some drugs, such as nitrates (used to treat heart disease), can provoke migraines.
    • Medical conditions: Some medical conditions, such as sinusitis, glaucoma and temporal arteritis, can cause headaches similar to migraine.

II. Migraine Diagnostics: Key to Effective Treatment

Proper diagnosis of migraine is crucial for the development of an effective treatment plan. The doctor will conduct a thorough examination, collect the anamnesis and may prescribe additional examinations to exclude other causes of a headache.

A. The collection of anamnesis and physics examination:

  1. Anamnesis: The doctor will ask questions about:

    • The nature of the headache: localization, intensity, type of pain (pulsating, pressing, acute).
    • Headache duration.
    • Concomitant symptoms: nausea, vomiting, photophobia, phonophobia, aura.
    • The frequency of attacks.
    • Migraine triggers.
    • Family history of migraines.
    • Medications taken.
    • Transferred diseases.

  2. Physical inspection: The doctor will conduct a general physical examination, including measurement of blood pressure and verification of neurological status. A neurological examination may include an assessment of vision, hearing, reflexes, coordination and muscle strength.

B. Additional examinations:

In most cases, migraine is diagnosed on the basis of an anamnesis and physicine examination. However, in some cases, the doctor may prescribe additional examinations to exclude other causes of headache, especially if there are any alarming signs, such as:

  1. MRI (magnetic resonance imaging) of the brain: MRI allows you to obtain detailed images of the brain and exclude structural anomalies, such as tumors, aneurysms or hemorrhages.

  2. CT (computed tomography) of the brain: CT also allows you to get images of the brain, but less detailed than an MRI. CT can be useful for excluding acute conditions, such as hemorrhage.

  3. GLG (electroencephalography): EEG measures the electrical activity of the brain and can be useful for eliminating epilepsy.

  4. Blood tests: Blood tests can be prescribed to exclude infections, inflammatory diseases or other medical conditions that can cause headache.

C. Differential diagnosis: Distinguish migraine from other types of headache:

It is important to distinguish migraines from other types of headache, such as:

  1. Headache of tension: The most common type of headache. The headache of tension is usually felt as a pressure or compressive pain in both sides of the head. It is usually not accompanied by nausea, vomiting or sensitivity to light and sound.

  2. Closter headache: A rare type of headache, characterized by very intensive pain in the area of one eye or temple. Closter headaches are often accompanied by lacrimation, nasal congestion, or a runny nose on the side of pain.

  3. Medicinal headache (ricocheric headache): This type of headache occurs as a result of the frequent use of painkillers to treat headaches.

  4. Headache caused by other medical conditions: A headache can be a symptom of other medical conditions, such as sinusitis, glaucoma, temporal arteritis, brain tumors or meningitis.

III. Migraine treatment: an integrated approach to relief of pain and preventing attacks

Migraine treatment includes two main directions: stopping acute attacks and prevention of seizures.

A. Escaining sharp migraine attacks:

The purpose of stopping an acute migraine attack is to relieve pain and related symptoms as quickly as possible. Treatment should begin as early as possible after the start of the attack.

  1. Non -drug methods:

    • Rest in a quiet, dark room: A decrease in sensory stimulation can help relieve headache.
    • Applying a cold compress to the forehead or temples: Cold can help narrow blood vessels and reduce pain.
    • Hydration: The use of a sufficient amount of liquid can help relieve headache, especially if it is associated with dehydration.
    • Massage: Massage of the neck and shoulders can help relax muscles and reduce tension.
    • Relaxation techniques: Respiratory exercises, meditation and yoga can help reduce stress and stress.

  2. Medication:

    • Anesthetic drugs:

      • Nonsteroidal anti -inflammatory drugs (NSAIDs): Ibuprofen, Neproksen, Ketoprofen. NSAIDs can help relieve pain and inflammation.
      • Paracetamol (acetaminophen): Paracetamol can help relieve pain, but it is less effective for relieving inflammation than NSAIDs.
      • Combined drugs: Some drugs contain a combination of painkillers (for example, paracetamol or ibuprofen) and caffeine. Caffeine can enhance the action of painkillers.

    • TRIPTA: Triptans are specific drugs for the treatment of migraine, which act by narrowing the blood vessels of the brain and blocking the release of CGRP. Triptans are effective for stopping migraine attacks, but they can be contraindicated in people with cardiovascular diseases. Examples of triptans: summptor, risatriciptan, zolmitriptan, naratriptan, eletripan, frutripitan, albraitriptan.

    • Dihydroergotamin (DGE): DGE is another drug that narrows the blood vessels of the brain. DGE is available in the form of injections, nasal spray and tablets.

    • CGRP antagonists: A new generation of drugs for the treatment of migraine that block the effect of CGRP. CGRP antagonists are available in the form of injections and tablets. Examples: Erenumab, Galkanzumab, Freanzumab, Eptinezumab, Riemegepant, Ubrogeepant, Athepant.

    • Anti -rate drugs: Anti -rate drugs, such as meteclopramide and coolroperazin, can help alleviate nausea and vomiting associated with migraine.

B. Migraine Prevention: Reducing the frequency and severity of seizures

Preventive treatment of migraines is recommended for people who have frequent or severe migraine bouts that significantly affect the quality of life. The purpose of preventive treatment is to reduce the frequency, severity and duration of migraine attacks.

  1. Life change change:

    • Identification and avoidance of triggers: Making a headache diary can help identify migraine triggers.
    • Regular sleep mode: Try to go to bed and wake up at the same time every day.
    • Healthy nutrition: Regular nutrition and avoiding food intake.
    • Regular physical exercises: Regular physical exercises can help reduce stress and improve the overall health.
    • Stress management: The use of relaxation techniques, such as breathing exercises, meditation and yoga.

  2. Medication:

    • Beta blockers: Propranolol, metoprolol, Atenolol. Beta blockers can help reduce the migraine frequency, but they can have side effects, such as fatigue and dizziness.
    • Antidepressants: Amititriptylin, NORTRIPTILIN, WENLAFAXIN. Antidepressants can help reduce migraine frequency and improve mood.
    • Anticonvulsants: Valproic acid, topiramate, size. Anticonvulsants can help reduce the frequency of migraines, but they can have side effects, such as drowsiness and weight loss.
    • Calcium channel blockers: Flunarizin. Calcium channel blockers can help reduce the migraine frequency, but they can have side effects, such as weight gain and depression.
    • CGRP antagonists: Erenyumab, Galkanzumab, Fremanesumab, Eptynesumab, athepant. CGRP antagonists are a new generation of migraine prevention preparations that block the CGRP action.

  3. Other treatment methods:

    • Botulotoxin (Botox): Botulotoxin is approved for the treatment of chronic migraine. Botox injections are introduced into the muscles of the head and neck to reduce tension and reduce the frequency of migraine.
    • Neurostimulation: Some neurostimulating devices, such as transcranial magnetic stimulation (TMS) and percutaneous stimulation of the vagus nerve (ChSBN), can help reduce the frequency of migraine.
    • Iglowerie (acupuncture): Some studies show that acupuncture can be effective for migraine prevention.
    • Biological feedback (biofidbek): Biofidbek is a technique that allows people to learn how to control physiological functions, such as heart rate and muscle tension. Biofidbek can help reduce stress and stress, which can reduce the migraine frequency.
    • Cognitive-behavioral therapy (KPT): KPT is a type of psychotherapy that helps people change their thoughts and behavior in order to cope with stress and improve the quality of life. KPT can be useful for people with migraine, especially if it is associated with stress or anxiety.

IV. Alternative methods for treating migraines: What does science say?

Many people with migraine turn to alternative methods of treatment in search of relief. It is important to remember that not all alternative methods of treatment are scientifically justified, and before using any of them you should consult a doctor.

A. Food supplements and vitamins:

  1. Magnesium: Magnesium plays an important role in the functioning of the nervous system and can help reduce the frequency of migraine.
  2. Riboflavin (vitamin B2): Riboflavin is necessary for energy exchange and can help reduce the migraine frequency.
  3. Coenzim q10: Coenzyme Q10 is an antioxidant and can help improve the function of mitochondria, which can be useful for people with migraine.
  4. Melatonin: Melatonin is a hormone that regulates the dream. Melatonin can help improve sleep and reduce the frequency of migraine.
  5. Petrushechny girl (Piremum): Petruschery girl is a grass that is traditionally used to treat headaches. Some studies show that Petruschery girl can help reduce the frequency of migraine, but additional studies are needed.
  6. Bootoprotor (Belokotnik Medicinal): A bottleneck is a grass that is also traditionally used to treat headaches. Some studies show that a bottler can help reduce the migraine frequency, but it can have side effects, such as liver problems.

B. Herbal remedies:

  1. Ginger: Ginger has anti -inflammatory properties and can help alleviate nausea associated with migraine.
  2. Lavender: The aroma of lavender can help relax and reduce stress.
  3. Peppermint: Peppermint oil can be applied to the forehead and whiskey to relieve headaches.

C. Other alternative methods:

  1. Manual therapy (chiropractic): Manual therapy includes manipulations with the spine and other joints. Some people with migraine find relief with manual therapy.
  2. Osteopathy: Osteopathy is a holistic approach to treatment, which includes manipulations with muscles, bones and joints.
  3. Homeopathy: Homeopathy is an alternative system of medicine, which is based on the principle of “like this.” There is no sufficient scientific evidence confirming the effectiveness of homeopathy in the treatment of migraine.
  4. Aromatherapy: Aromatherapy uses essential oils to improve health and well -being. Some essential oils, such as lavender and peppermint, can help relieve headache.

V. Migraine and related diseases: an integrated approach to health

Migraine often coexists with other diseases, which can complicate diagnosis and treatment. It is important to consider related diseases when developing a treatment plan for migraine.

A. Mental disorders:

  1. Depression: Migraine and depression often coexist. Antidepressants, such as amitriptylin and Wenlafaxin, can be effective for the treatment of both migraines and depression.
  2. Alarm disorders: Migraine and anxiety disorders also often coexist. Relaxation techniques, such as breathing exercises and meditation, can help reduce the alarm and migraine frequency.
  3. Bipolar disorder: Migraine is more common in people with bipolar disorder. Treatment of bipolar disorder can help improve control over migraine.

B. Cardiovascular diseases:

  1. Stroke: Migraine with an aura can increase the risk of stroke, especially in women taking hormonal contraceptives.
  2. Ichemic heart disease: Some studies show that migraine can be associated with an increased risk of coronary heart disease.
  3. Arterial hypertension: Migraine and arterial hypertension often coexist. Some drugs used to treat arterial hypertension, such as beta-blockers, can also help reduce the frequency of migraine.

C. Other diseases:

  1. Irritable intestine syndrome (SRK): Migraine and SRK often coexist.
  2. Fibromyalgia: Migraine and fibromyalgia are also often coexisted.
  3. Epilepsy: Migraine and epilepsy have some common pathophysiological mechanisms and can coexist.

VI. Life with migraine: strategies for adaptation and improvement of the quality of life

Life with migraine can be difficult, but there are strategies that can help people adapt and improve the quality of life.

A. Maintenance of a headache diary:

Keeping a headache diary can help identify migraine triggers, track treatment and plan their activities. In the diary, it should be noted:

  1. The date and time of the beginning and end of the headache.
  2. Headache intensity (for example, on a scale of 1 to 10).
  3. Localization of headache.
  4. Related symptoms (nausea, vomiting, photophobia, phonophobia, aura).
  5. Possible triggers (food, drinks, weather, stress, sleep).
  6. Taken medications and their effectiveness.

B. Planning of their activities:

  1. Plan your business in advance: Consider the possible migraine triggers when planning your activities.
  2. Be flexible: Be prepared to change your plans if you start a migraine attack.
  3. Delegate tasks: Do not be afraid to ask for help from others.

C. Support:

  1. Communicate with other people suffering from migraine: A conversation with other people who understand your problems can be very useful.
  2. Join the support groups: In support groups, you can get information, support and tips from other people living with migraine.
  3. Talk to your doctor: Discuss your problems with your doctor and ask him for help.

D. Self -help:

  1. Take care of yourself: Give the time to relax, relaxation and classes that you like.
  2. Be active: Regular physical exercises can help reduce stress and improve the overall health.
  3. Observe a healthy lifestyle: Healthy diet, regular sleep and stress can help reduce the migraine frequency.
  4. Be patient: Migraine treatment can take time. Do not give up if you do not see the results at once.

VII. Migraine in children and adolescents: Features of diagnosis and treatment

Migraine can occur in children and adolescents, and it can significantly affect their quality of life, school performance and social activity.

A. Diagnostics of migraine in children and adolescents:

Diagnosis of migraine in children and adolescents can be difficult, since they can experience difficulties with a description of their symptoms. The doctor will conduct a thorough examination, collect the anamnesis in the child and his parents and may prescribe additional examinations to exclude other causes of headache.

B. Treatment of migraines in children and adolescents:

Treatment of migraine in children and adolescents includes non -drug methods and drug treatment.

  1. Non -drug methods:

    • Identification and avoidance of triggers: Making a headache diary can help identify migraine triggers.
    • Regular sleep mode: Try to go to bed and wake up at the same time every day.
    • Healthy nutrition: Regular nutrition and avoiding food intake.
    • Regular physical exercises: Regular physical exercises can help reduce stress and improve the overall health.
    • Stress management: The use of relaxation techniques, such as breathing exercises, meditation and yoga.
    • Biological feedback (biofidbek): Biofidbek is a technique that allows people to learn how to control physiological functions, such as heart rate and muscle tension. Biofidbek can help reduce stress and stress, which can reduce the migraine frequency.
    • Cognitive-behavioral therapy (KPT): KPT is a type of psychotherapy that helps people change their thoughts and behavior in order to cope with stress and improve the quality of life. KPT can be useful for children and adolescents with migraine, especially if it is associated with stress or anxiety.

  2. Medication:

    • Anesthetic drugs: Ibuprofen and paracetamol (acetaminophen) can be used to relieve pain during migraine attack.
    • TRIPTA: Some triptans are approved for use in children and adolescents.
    • Preventive drugs: Some drugs used to prevent migraine in adults can be used in children and adolescents.

C. School adaptation:

Migraine can affect school performance and the social activity of children and adolescents. It is important that the school is aware of the child’s problem and provide him with the necessary support. The school can provide:

  1. The ability to relax in a quiet, dark room: During an attack of migraine, it can be useful to relax in a quiet, dark room.
  2. The ability to miss the lessons: If the child feels bad, he can be allowed to miss the lessons.
  3. The ability to get extra time to complete the tasks: If it is difficult for a child to focus due to headache, he may be given extra time to complete the tasks.
  4. Support from teachers and peers: It is important that the child feels support from teachers and peers.

VIII. The latest achievements in the treatment of migraines: new hopes for patients

In recent years, significant achievements have occurred in the understanding and treatment of migraines. New drugs and treatment methods offer hope for patients who have not previously been helped by traditional methods of treatment.

A. Antagonists CGRP:

CGRP antagonists are a new generation of drugs for the treatment and prevention of migraine that block the effect of CGRP. CGRP plays an important role in the pathophysiology of migraine, and blocking its action can help reduce the frequency and severity of attacks. CGRP antagonists are available in the form of injections (Erenumab, Galkanzumab, Fremenzumab, Eptinezumab) and tablets (Riemehepant, Ubrogeepant, Athepant).

B. Neurostimulation:

Neurostimulation is a treatment method that uses electrical or magnetic impulses to stimulate nerves in the brain. Some neurostimulating devices, such as transcranial magnetic stimulation (TMS) and percutaneous stimulation of the vagus nerve (ChSBN), can help reduce the frequency of migraine.

C. Gene therapy:

Gene therapy is a new and promising approach to the treatment of migraines. Gene therapy is aimed at changing genes that play a role in the pathophysiology of migraine. Currently, genetic therapy is at the stage of clinical trials.

D. Artificial intelligence (AI):

AI is used to develop new methods of diagnosis and treatment of migraine. AI can help identify migraine triggers, predict attacks and develop personalized treatment plans.

IX. Migraine forecast: long -term prospects and disease management

The forecast for migraine varies from person to person. In some people, migraines can spontaneously improve or disappear with age, while others can become a chronic disease that requires constant management.

A. Factors affecting the forecast:

  1. Frequency and severity of seizures: The more often and heavier bouts of migraine, the worse the forecast.
  2. Related diseases: The presence of concomitant diseases, such as depression, anxiety disorders and cardiovascular diseases, can worsen the prognosis.
  3. Compliance with the treatment plan: Compliance with the treatment plan, which includes a change in lifestyle, drug treatment and other treatment methods, can improve the prognosis.
  4. The presence of social support: The presence of social support from the family, friends and medical workers can help people cope with migraine and improve the quality of life.

B. Disease Management:

Migraine management is a long -term process that requires cooperation between the patient and his doctor. It is important to develop an individual treatment plan, which includes:

  1. Identification and avoidance of triggers: Making a headache diary can help identify migraine triggers.
  2. Relocation of sharp seizures: It is important to have medicines at hand to stop sharp migraine attacks.
  3. Preventive treatment: If you have frequent or severe migraine bouts, preventive treatment may be recommended for you.
  4. Life change change: Healthy diet, regular sleep and stress can help reduce the migraine frequency.
  5. Self -help: It is important to take care of yourself and devote time to relax, relaxation and activities that you like.

C. Remission:

Some people with migraine may have a remission – a period when they have no migraine attacks. Remission can be spontaneous or achieved by treatment. It is important to continue to comply with the treatment plan, even if you have a remission to prevent the return of migraine.

IX. Resources for patients with migraine: where to find information and support

There are many resources for migraine patients who can provide information, support and tips.

A. Medical workers:

  1. General practitioner (therapist): A general practitioner can diagnose migraines and prescribe treatment.
  2. Neurologist: A neurologist is a doctor who specializes in the treatment of diseases of the nervous system, including migraine.
  3. Headache specialist: Specialist

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