Migraine: how to live a full life

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Migraine: how to live a full life

I. Understanding migraines: more than just a headache

Migraine is a neurological disease that manifests itself not just a headache. This is a comprehensive state characterized by attacks of intense pulsating pain, often accompanied by other symptoms, such as nausea, vomiting, photophobia (photosensitivity) and sound (sensitivity to sounds). Unlike the usual headache, migraine can seriously limit daily activities and significantly reduce the quality of life.

A. The differences between migraine and headache of tension:

The key difference is the intensity and nature of the pain. The headache of tension is usually described as a pressure or tightening pain, covering the entire head. Migraine, as a rule, pulsating, is concentrated in one half of the head (although it can be bilateral) and is characterized by high intensity. In addition, migraine is often accompanied by other neurological symptoms, which are rarely found with headaches of tension.

B. Types of migraines:

There are several types of migraines, each of which has its own characteristics:

  1. Migraine with aura: About 25% of people with migraine experience an aura in front of or during a headache. The aura is a complex of neurological symptoms that may include visual disorders (flickering lights, zigzag lines, visual fields), sensory disorders (numbness, tingling), motor disorders (weakness) or speech difficulties. The aura usually lasts from 5 minutes to an hour and goes completely.

  2. Migraine without aura (ordinary migraine): This is the most common type of migraine. The attack is characterized by a pulsating headache, accompanied by nausea, vomiting, photophobia and sound, without any previous neurological symptoms (auras).

  3. Chronic migraine: It is diagnosed if a person has headaches of at least 15 days a month for more than 3 months, while at least 8 days a month correspond to migraine criteria. Chronic migraine can be very exhausting and significantly affect the quality of life.

  4. Hemiplegic migraine: A rare type of migraine, which is characterized by weakness or paralysis of one side of the body (hemiplegia) during an attack of headache. This can be a hereditary disease.

  5. Migraine of the brain stem: This type of migraine is accompanied by symptoms that arise due to the dysfunction of the brain stem, such as dizziness, impaired coordination, double eyes, slurred speech and impaired consciousness.

  6. Abdominal migraine: It is more common in children. It is manifested by severe pain in the abdomen, nausea and vomiting, without headache.

C. Causes of migraines: complex interaction of factors:

The reasons for the migraine have not been fully studied, but it is believed that in the development of the disease a comprehensive interaction of genetic factors, environmental factors and physiological changes in the brain plays a role.

  1. Genetic predisposition: In people whose relatives suffer from migraine, the risk of developing this disease is much higher. Certain genes associated with the functions of the nervous system and blood vessels can increase susceptibility to migraine.

  2. Changes in brain activity: Studies show that during a migraine attack, changes occur in the activity of various areas of the brain, including the cerebral cortex, the brain stem and thalamus. These changes can affect pain processing, sensory sensitivity and regulation of vascular tone.

  3. Neurotransmitter: Neurotransmitters, such as serotonin and glutamate, play an important role in transmitting nerve impulses in the brain. Violations in the levels of these neurotransmitters can contribute to the development of migraine.

  4. Vascular factors: It was previously believed that migraine is associated with the expansion and narrowing of the blood vessels in the brain. However, modern studies show that vascular changes are probably the result, and not the cause of migraine.

II. Migraine triggers: identification and avoidance

Triggers are factors that can provoke a migraine attack of predisposed people. The identification and avoidance of triggers is an important part of migraine management. Triggers can be different for different people, so keeping a headache diary can help determine individual triggers.

A. Food triggers:

Certain products and drinks can cause migraine in some people. The most common food triggers include:

  1. Tramin products: Tiramin is an amino acid that is formed during the aging of products. Products with a high tyrammin content include aged cheeses (Chedder, Bree, Camamber), smoked meat, fermented products (sauerkraut, soy sauce) and red wine.

  2. Phenylethylamine products: Feniletylamine is a substance contained in chocolate. Chocolate is a common migraine trigger for many people.

  3. Glutamate sodium (MSG): Glutamate sodium is an amplifier of taste, which is often used in Asian cuisine and processed products. MSG can cause migraine in some people.

  4. Artificial sweeteners: Aspartam and other artificial sweeteners can be migraine triggers.

  5. Alcohol: Especially red wine can provoke a migraine attack.

  6. Caffeine: Although caffeine can help relieve headache in small doses, excessive use or sharp cessation of caffeine use can cause migraine.

  7. Processed meat: Sausages, sausages, bacon and other treated meat products often contain nitrates and nitrites that can cause migraine.

B. Environmental factors:

  1. Bright light and flickering lights: Feumenization is a common symptom of migraines, so bright light, sunlight, fluorescent lamps and shimmering lights can provoke an attack.

  2. Loud sounds: Sound is also a common symptom of migraines, so loud sounds, such as music, the noise of the crowd and sirens, can cause an attack.

  3. Strong smells: Passy odors, such as perfumes, chemicals, smoke and certain foods, can be migraine triggers.

  4. Weather changes: Projects of atmospheric pressure, temperature and humidity can provoke migraines.

C. Life lifestyle factors:

  1. Stress: Stress is one of the most common migraine triggers.

  2. Lack of sleep or excess sleep: Disorders of sleep regime, such as insomnia or sleep for a long time, can cause migraine.

  3. Missed meals: Fasting or passing meals can provoke a migraine attack.

  4. Dehydration: Insufficient fluid intake can lead to dehydration, which can cause migraine.

  5. Physical stress: Excessive physical activity or hard work can be migraine triggers.

D. Hormonal changes:

  1. Menstrual cycle: In women, migraine is often associated with the menstrual cycle, especially with the period in front of menstruation (premenstrual migraine).

  2. Pregnancy: In some women, migraines may improve during pregnancy, while in others it may worsen.

  3. Menopause: Hormonal changes associated with menopause can affect migraine.

  4. Hormonal contraceptives: Reception of hormonal contraceptives can affect migraine.

III. Migraine diagnosis: steps to proper treatment

Proper diagnosis of migraine is the first step towards effective treatment and management of the disease.

A. A history of history:

The doctor will conduct a detailed survey of the patient to collect information about his medical history, symptoms, frequency and intensity of headaches, triggers, related diseases and drugs that he takes. It is important to provide the doctor as complete and accurate information.

B. Physical examination:

The doctor will conduct a physical examination to exclude other possible causes of headache. The examination may include measurement of blood pressure, assessment of neurological status and examination of the head and neck.

C. Neurological examination:

A neurological examination includes an assessment of the function of the cranial nerves, muscle strength, reflexes, coordination and sensitivity. This helps to identify possible neurological disorders that can be associated with a headache.

D. Keeping a headache diary:

The doctor may recommend keeping a headache diary in which it is necessary to record the following information:

  • The date and time of the occurrence of a headache.
  • Symptoms accompanying headache (nausea, vomiting, photophobia, sound, etc.).
  • The intensity of pain (on a scale from 0 to 10).
  • Possible triggers.
  • Medicines that were taken to relieve pain, and their effectiveness.
  • The duration of the headache.

The headache diary will help the doctor determine the type of migraine, identify triggers and evaluate the effectiveness of treatment.

E. Additional research:

In some cases, the doctor may prescribe additional studies, such as:

  1. MRI of the brain: Magnetic resonance imaging (MRI) of the brain allows you to visualize the structure of the brain and exclude other possible causes of a headache, such as tumors, aneurysms and stroke.

  2. CT brain: Computed tomography (CT) of the brain also allows you to visualize the structure of the brain, but it is less sensitive than an MRI.

  3. Blood tests: Blood tests can help exclude other diseases that can cause headache, such as infections, anemia and thyroid disease.

F. Criteria for Migraine Diagnostics (according to the international classification of headaches – ICHD -3):

To diagnose migraines without aura, the following criteria are necessary:

  • At least 5 seizures corresponding to the BD criteria.
  • The headache lasts from 4 to 72 hours (without treatment or with ineffective treatment).
  • The headache has at least two of the following characteristics:
    • One -sided localization.
    • Pulsating in nature.
    • The intensity from moderate to strong.
    • Deterioration in ordinary physical activity (for example, walking or climbing the stairs) or its avoidance.
  • During a headache, there is at least one of the following symptoms:
    • Nausea and/or vomiting.
    • Fine intention and sound.
  • Headache is not related to other causes.

To diagnose migraines with the aura, compliance with the following criteria is necessary:

  • At least 2 seizures corresponding to criteria B.
  • The aura consists of one or several of the following fully reversible symptoms:
    • Visual symptoms (for example, flickering lights, zigzag lines, loss of vision fields).
    • Sensory symptoms (for example, numbness, tingling).
    • Speech disorders.
    • Motor disorders.
    • Stem symptoms (for example, dizziness, impaired coordination, double eyes).
    • Symptoms of retina (for example, flicker, scotoma).
  • At least two of the following signs:
    • At least one symptom of the aura develops gradually within 5 minutes and/or two or more symptoms arise sequentially.
    • Each symptom of the aura lasts from 5 to 60 minutes.
    • At least one symptom of the aura is one -sided.
    • The headache develops within 60 minutes after the start of the aura.
  • Headache is not related to other causes.

IV. Migraine treatment: individual approach

Migraine treatment is aimed at alleviating the symptoms during an attack and preventing future attacks. The approach to treatment should be individual and take into account the type of migraine, frequency and intensity of seizures, as well as the presence of concomitant diseases.

A. Treatment of acute migraine attacks:

  1. Anesthetic drugs:

    • Nonsteroidal anti -inflammatory drugs (NSAIDs): Ibuprofen, steady, ketoprofen and other NSAIDs can help alleviate the light and moderate bouts of migraines. It is important to take NSAIDs as early as possible after the start of a headache.
    • Paracetamol: Paracetamol can also be effective for alleviating light and moderate migraine attacks.

  2. TRIPTA:

    • Triptans are specific drugs for the treatment of migraine, which affect serotonin receptors in the brain. They help narrow the blood vessels and reduce inflammation, which leads to relief of headaches and other symptoms of migraine. Triptans include summptane, risatriciptan, zolmitriptan, intrigratyptan, frutitrippan and ethletriptan. Triptans are most effective if they are accepted as early as possible after the start of headache.

  3. Ergotamines:

    • Ergotamines are old drugs for the treatment of migraine, which also affect serotonin receptors. However, they have more side effects than triptans, and are used less often.

  4. Antimetics:

    • Anthematics are drugs that help reduce nausea and vomiting, which often accompany migraine. Antimetics include metoclopramide, domperidone and cool ropezine.

  5. Combined drugs:

    • There are combined drugs that contain an analgesic (for example, paracetamol or aspirin) and anti -emetics.

B. Preventive treatment of migraines:

Preventive treatment of migraine is aimed at reducing the frequency, intensity and duration of seizures. It can be recommended to people who often arise migraine attacks, or in which acute drugs are not effective enough.

  1. Beta blockers:

    • Beta blockers, such as propranolol and metoprolol, are used to treat high blood pressure, but they can also be effective for migraine prevention.

  2. Tricyclic antidepressants:

    • Tricyclic antidepressants, such as amitriptylin, can help reduce the frequency of migraine attacks, even if a person does not have depression.

  3. Anticonvulsants:

    • Anticonvulsant drugs, such as sodium and topiramate, are used to treat epilepsy, but they can also be effective for migraine prevention.

  4. Calcium channel blockers:

    • Calcium channel blockers, such as fluanarisine, can help reduce the frequency of migraine attacks.

  5. Monoclonal antibodies to CGRP (Calcitonin Gene-RELEETED PEPTIDE):

    • This is a new class of drugs that block the action of CGRP, a protein that plays a role in the development of migraine. These include Erenumab, Fremenzumab, Galkanzumab and Eptynesumab.

  6. Botulotoxin type A (Botox):

    • Botox can be effective for the prevention of chronic migraine. It is inserted into the muscles of the head and neck.

  7. Magnesium:

    • Magnesium additives can help reduce the frequency of migraine attacks in some people.

  8. Riboflavin (vitamin B2):

    • Riboflavin additives can help reduce the frequency of migraine attacks.

C. Alternative treatment methods:

Some people find relief from migraine using alternative treatment methods, such as:

  1. Acupuncture:

    • Acupuncture is a method of traditional Chinese medicine, which consists in introducing thin needles into certain points on the body.

  2. Massage:

    • Massage can help reduce muscle tension and stress, which can be migraine triggers.

  3. Biological feedback:

    • Biological feedback is a method that allows you to learn how to control certain physiological functions, such as heart rate and muscle stress.

  4. Cognitive-behavioral therapy (KPT):

    • KPT is a type of psychotherapy that helps people change negative thoughts and behavior that migraines can contribute.

  5. Transcranial magnetic stimulation (TMS):

    • TMS is a non -invasive method of brain stimulation, which can help reduce the frequency of migraine attacks.

V. Life with migraine: management strategies

Life with migraine can be difficult, but with the right management strategies you can live a full and active life.

A. Maintenance of a headache diary:

Regular maintenance of a headache diary will help to track the frequency, intensity and duration of seizures, as well as identify triggers.

B. The avoidance of triggers:

After identifying triggers, it is necessary to try to avoid their impact.

C. Regular sleep mode:

Compliance with the regular sleep regime, go to bed and wake up at the same time every day, will help reduce the frequency of migraine attacks.

D. Healthy nutrition:

A balanced diet with regular meals will help maintain a stable blood sugar level and prevent starvation, which can be a migraine trigger.

E. Regular physical activity:

Moderate physical activity, such as walking, swimming or yoga, can help reduce stress and improve the general health, which can reduce the frequency of migraine attacks.

F. Stress Management:

The development of stress management techniques, such as meditation, breathing exercises and relaxation, will help reduce the effect of stress on migraine.

G. Support:

Communication with other people suffering from migraine can provide emotional support and provide useful information on how to cope with the disease. There are online forums and support groups for people with migraine.

H. Communication with a doctor:

Regularly discuss with the doctor your condition, treatment and any issues that arise. The doctor can help adjust the treatment, give recommendations on a change in lifestyle and send to other specialists, if necessary.

VI. Migraine in children and adolescents:

Migraine can occur in children and adolescents, and its symptoms may differ from symptoms in adults.

A. Features of migraine in children:

  • A headache can be shorter than in adults (from 2 to 72 hours).
  • The headache can be bilateral.
  • Nausea and vomiting can be more pronounced.
  • Abdominal migraine (abdominal pain without headache) is more common in children.

B. Diagnostics of migraine in children:

Diagnosis of migraine in children is based on a history, physical examination and maintaining a headache diary. In some cases, additional studies can be required, such as the MRI of the brain.

C. Treatment of migraines in children:

Migraine treatment in children includes:

  1. Life change change: Avoiding triggers, regular sleep mode, healthy nutrition, regular physical activity and stress management.
  2. Anesthetic drugs: Paracetamol and ibuprofen can be effective for alleviating light and moderate migraine attacks.
  3. TRIPTA: Triptans can be prescribed for children over 12 years of age with migraine.
  4. Preventive treatment: Preventive treatment can be recommended for children with frequent migraine attacks.

VII. New directions in the treatment of migraines:

In recent years, several new directions have appeared in the treatment of migraines, which promise to improve the quality of life of people suffering from this disease.

A. Monoclonal antibodies to CGRP:

These drugs are one of the most promising areas in the treatment of migraines. They block the action of CGRP, a protein that plays a role in the development of migraine.

B. Heamps:

Hyander is a new class of drugs that also block CGRP, but act with a different mechanism than monoclonal antibodies. They can be used to treat acute migraine attacks and for prevention.

C. Neurostimulation:

Neurostimulation is a method that uses electrical or magnetic impulses to stimulate certain areas of the brain. There are various methods of neurostimulations that can be effective for the treatment of migraine, such as transcranial magnetic stimulation (TMS) and non -invasive stimulation of the vagus nerve.

VIII. Conclusion: Life with migraine is possible

Migraine is a chronic disease that can seriously affect the quality of life. However, with the correct diagnosis, treatment and management strategies, you can live a full and active life. It is important to cooperate with a doctor in order to develop an individual treatment plan, avoid triggers, lead a healthy lifestyle and use affordable stress management methods. New directions in the treatment of migraines give hope for improving the quality of life for many people suffering from this disease.

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