Migraine: an integrated approach to complete deliverance

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Migraine: an integrated approach to complete deliverance

I. Understanding migraines: more than just a headache

Migraine is a neurological disease characterized by attacks of intense headache, often accompanied by nausea, vomiting and increased sensitivity to light (photophobia) and sound (phonophobia). Unlike ordinary headache, migraine can significantly affect the quality of life, limiting the ability of a person to work, study and engage in everyday business.

A. Classification and types of migraines:

Migraine is classified into several types, differing in symptoms and frequency of seizures:

  1. Migraine without aura (ordinary migraine): The most common type. It is characterized by headache, which lasts from 4 to 72 hours, pulsating pain, usually one -sided, moderate or severe intensity, worsening from physical activity and accompanied by nausea and/or vomiting, photophobia and/or phonophobia.
  2. Migraine with aura (classic migraine): The headache precedes or accompanies the aura – temporary neurological disorders, such as visual (flickering lights, zigzag lines, loss of vision), sensory (numbness, tingling) or speech disorders. The aura usually lasts from 5 to 60 minutes, after which the headache begins.
  3. Chronic migraine: A headache occurs 15 or more days a month for more than 3 months, and at least 8 days a month must comply with migraine criteria.
  4. Abdominal migraine: It is more common in children. It is characterized by recurrent episodes of moderate or severe abdominal pain, accompanied by nausea, vomiting and/or loss of appetite. A headache may be present or absent.
  5. Hemiplegic migraine: A rare type of migraine, accompanied by weakness or paralysis of one side of the body (hemiplegia). It can be family (hereditary) or sporadic (arising without family history).
  6. Basial migraine (now known as a migraine with a stem aura): A rare type of migraine, characterized by aura, including symptoms associated with dysfunction of the brain stem, such as dizziness, double -gathering, dysarthria (speech impairment), ears noise, loss of balance and loss of consciousness.

B. Pathophysiology of migraines: complex mechanisms

The pathophysiology of migraines is complex and has not fully studied. It is believed that the following factors participate in the development of migraines:

  1. Trigeminal-vascular system: This system includes the trigeminal nerve (V cranial nerve) and blood vessels of the brain. Activation of the trigeminal nerve leads to the release of neuropeptides, such as CGRP (calcitonin-hen-tied peptide), which cause the expansion of blood vessels of the brain (vasodilation) and inflammation. This, in turn, activates pain receptors (nociceptors) and transmits pain signals to the brain.
  2. Crimely spreading depression (CSD): This is a wave of neuronal and glial depolarization, which spreads through the cerebral cortex. CSD can activate the triple-vascular system and play a role in the development of aura during migraine with an aura.
  3. The role of genetics: Migraine is often hereditary. Studies have identified several genes associated with an increased risk of migraine development. However, genetics is not the only factor that determines the development of migraine.
  4. Neurotransmitter: Neurotransmitters, such as serotonin, dopamine and glutamate, play an important role in migraine pathophysiology. Changes in the levels of these neurotransmitters can affect the excitability of neurons, pain sensitivity and vasomotor control.
  5. Inflammation: Inflammation plays a role in the pathophysiology of migraine. The release of inflammatory mediators, such as cytokines, can sensitize pain receptors and strengthen pain signals.

C. Migraine triggers: identification and avoidance

Migraine triggers are factors that can provoke a migraine attack of susceptible people. Triggers vary from person to person, and it is important to identify their own triggers in order to avoid them or minimize their impact. Some common migraines triggers include:

  1. Food triggers: Some products and drinks can provoke migraines in certain people. These include:
    • Sustained cheeses
    • Processed meat (sausage, bacon, ham)
    • Chocolate
    • Alcohol (especially red wine and beer)
    • Aspartam (artificial sweetener)
    • Glutamate sodium (MSG)
    • Citrus fruit
  2. Environmental factors:
    • Bright light
    • Loud sounds
    • Strong smells (perfumes, chemicals)
    • Weather changes (atmospheric pressure, temperature)
    • Flickering screens
  3. Hormonal changes: In women, hormonal changes associated with the menstrual cycle, pregnancy and menopause can provoke migraines.
  4. Stress: Stress is one of the most common migraine triggers.
  5. Lack of sleep or excess sleep: Sleep disorders, such as insomnia or excessive sleep, can provoke migraines.
  6. Passing of food intake: Hunger can cause migraine.
  7. Dehydration: Insufficient fluid consumption can provoke migraines.
  8. Physical strain: Excessive physical activity can cause migraine.
  9. Medicines: Some drugs, such as oral contraceptives, can provoke migraines.

II. Migraine diagnosis: An important step to effective treatment

Migraine diagnosis is based on a careful history of the anamnesis, physical and neurological examination. The doctor will ask questions about the symptoms, frequency of attacks, triggers, family history and medications taken.

A. Criteria for diagnosing migraines:

The International Headache Society (IHS) has developed the diagnostic criteria for migraine. Diagnosis of migraine without aura requires at least five attacks that meet the following criteria:

  1. The headache lasts from 4 to 72 hours (without treatment or with ineffective treatment).
  2. The headache has at least two of the following characteristics:
    • One -sided localization
    • Pulsating in nature
    • Moderate or strong intensity
    • Deterioration from physical activity (for example, walking or climbing the stairs)
  3. The headache is accompanied by at least one of the following symptoms:
    • Nausea and/or vomiting
    • Photophobia and phonophobia

Diagnosis of migraine with an aura requires at least two attacks that meet the following criteria:

  1. The aura consists of at least one of the following reversible symptoms:
    • Visual symptoms (for example, flickering lights, zigzag lines, loss of vision)
    • Sensory symptoms (for example, numbness, tingling)
    • Speech disorders
    • Motor disorders (for example, weakness or paralysis)
    • Stem symptoms (for example, dizziness, double eyes, dysarthria)
    • Retinal symptoms (for example, Scotoma, Amaroz)
  2. At least two of the following symptoms:
    • Homolateral visual and/or sensory symptoms
    • At least one symptom of the aura develops gradually within 5 minutes and/or various symptoms of aura occur sequentially within 5 minutes.
    • Each symptom of the aura lasts from 5 to 60 minutes.
  3. The headache begins within 60 minutes after the end of the aura.

B. Differential diagnosis:

It is important to exclude other causes of headache, such as:

  1. Headache of tension: Usually bilateral, pressing or compressing pain, mild or moderate intensity, does not worsen from physical activity and is not accompanied by nausea or vomiting.
  2. Closter headache: Intensive one -sided headache arising from clusters, accompanied by redness of the eye, lacrimation, nasal congestion, or a runny nose on the same side of the head.
  3. Secondary headaches: Headaches caused by other diseases, such as infections, brain tumors, head injuries, aneurysm, glaucoma, sinusitis and others.

C. Additional examinations:

In most cases, additional examinations are not required to diagnose migraine. However, if the patient has unusual symptoms, signs of secondary headache or another disease is suspected, the doctor may prescribe:

  1. MRI of the brain: To exclude structural diseases of the brain, such as tumors, aneurysms or malformations.
  2. CT brain: To exclude hemorrhages or other acute states.
  3. Lumbal puncture (spinal puncture): To exclude infections or other diseases of the central nervous system.
  4. Blood tests: To exclude other diseases that can cause headache.

III. A comprehensive approach to the treatment of migraines: Integration of various methods

Migraine treatment requires an integrated approach, including a change in lifestyle, stopping acute attacks and preventive treatment. The purpose of treatment is to reduce the frequency, intensity and duration of migraine attacks, as well as improving the quality of life of the patient.

A. Change in lifestyle: the foundation of migraine management

  1. Identification and avoidance of triggers: Keeping a headache diary will help to identify migraine triggers. Avoiding identified triggers can significantly reduce the frequency of seizures.
  2. Regular sleep mode: Compliance with the regular sleep regime, waking up and falling asleep at the same time every day, can help prevent migraine.
  3. Regular nutrition: Passing for eating can provoke migraines. It is important to eat regularly and avoid starvation.
  4. Sufficient fluid consumption: Dehydration can cause migraine. It is important to drink enough water during the day.
  5. Stress management: Stress is one of the most common migraine triggers. It is important to learn how to manage stress using various techniques, such as meditation, yoga, deep breathing or cognitive-behavioral therapy (KPT).
  6. Regular physical exercises: Regular physical exercises can help reduce the migraine frequency. It is important to choose moderate physical activity, such as walking, swimming or riding a bicycle.
  7. Caffeine consumption restriction: Caffeine can be both a trigger or a means of alleviation of migraine. It is important to moderately use caffeine and avoid a sharp cessation of caffeine.
  8. Avoiding alcohol: Alcohol, especially red wine and beer, can provoke migraines.

B. Enhancing acute migraine attacks: relief of pain and symptoms

Medicines for stopping acute migraine attacks are taken at the first signs of headache in order to stop or reduce the intensity of the attack.

  1. Painkillers:
    • Nonsteroidal anti -inflammatory drugs (NSAIDs): Ibuprofen, steady, diclofenac can be effective with mild and moderate migraine attacks.
    • Acetaminophen (paracetamol): It can be effective for migrants of migraine, especially in combination with caffeine.
    • Aspirin: It can be effective for light and moderate migraine attacks.
  2. TRIPTA: Triptans are specific medicines for the treatment of migraines that affect serotonin receptors in the brain. They narrow the blood vessels and reduce inflammation. Triptans are effective for moderate and strong migraine attacks. Triptans include:
    • Sumatriptan
    • Ratesantan
    • Kalgrapy
    • Zolmitriptan
    • Elitepetant
    • Friends
    • Almotriptan
  3. Dihydroergotamin (DGE): DGE is a medicine that also narrows blood vessels. It is available in the form of injections, nasal spray and tablets. DGE can be effective with long and heavy migraine attacks.
  4. Antimetics: Anthematics are drugs that relieve nausea and vomiting, often accompanying migraines. These include:
    • Metoclopramide
    • Coolurperesin
    • Domordon
  5. Combined drugs: Some drugs contain a combination of painkillers (for example, acetaminophen or ibuprofen) and anti -emitics (for example, meteclopramide).
  6. Specific CGRP blockers (generative peptide associated with the calcitonin gene): Hyans and ditans.

C. Preventive treatment of migraines: reducing the frequency and intensity of seizures

Preventive treatment of migraines is prescribed to patients who have frequent, severe or disabled migraine attacks, or who are ineffective to relieve acute attacks. The purpose of preventive treatment is to reduce the frequency, intensity and duration of migraine attacks, as well as improving the quality of life of the patient.

  1. Beta blockers: Prophanolol, metoprolol, atenolol.
  2. Calcium channel blockers: Flunarizin, Verapamil.
  3. Tricyclic antidepressants: Amititriptylin, NORTRIPTILIN.
  4. Anticonvulsants: Topiramate, Valpoevaya Oilota.
  5. CGRP blockers: Erenumab, Galkaneesezmab, Fremanesezumab, Eptinezumab.
  6. Botulinoxin (Botox): Botulinotoxin injections can be effective for the treatment of chronic migraine.
  7. Other drugs: Magnesium, riboflavin (vitamin B2), Coenzyme Q10, melatonin.

D. Non -drug methods for treating migraines: alternative and additional approaches

  1. Biological feedback (BOS): Bos is a method that allows people to learn how to control physiological processes, such as heart rate, muscle tension and body temperature. Bos can help reduce the frequency of migraine, teaching people to relax and cope with stress.
  2. Acupuncture: Acupuncture is a method of traditional Chinese medicine, which includes the introduction of thin needles into certain points on the body. Acupuncture can help reduce the migraine frequency.
  3. Massage: Massage can help relax muscles and reduce stress, which can lead to a decrease in the frequency of migraine.
  4. Cognitive-behavioral therapy (KPT): KPT is a type of psychotherapy that helps people change negative thoughts and behavior that migraines can contribute. KPT can help people learn how to manage stress, improve problems to solve problems and develop healthy overcoming mechanisms.
  5. Neurostimulation:
    • Transcranial magnetic stimulation (TMS): TMS is a non -invasive method of stimulation of the brain that uses magnetic impulses. TMS can be effective for stopping acute migraine attacks and for the prevention of migraine.
    • Penettlement stimulation (STO): Sun is a surgical procedure in which electrodes are implanted under the skin in the back of the head to stimulate the occipital nerve. STOs can be effective for the treatment of chronic migraine.
    • Stimulation of the vagus nerve (SBN): SBN is a non -invasive method of stimulating the vagus nerve that uses electrical impulses. SBN can be effective for stopping acute migraine attacks.
  6. Dietary additives: Some dietary supplements can help reduce the migraine frequency. These include:
    • Magnesium
    • Riboflavin (vitamin B2)
    • Coenzim q10
    • Melatonin
    • Fitotherapy: chamomile, lavender, valerian.

IV. Individual approach to the treatment of migraines: Development of a treatment plan

There is no universal approach to the treatment of migraine. The treatment plan should be developed individually for each patient, taking into account the type of migraine, frequency and intensity of seizures, triggers, concomitant diseases and preferences of the patient.

A. Maintenance of a headache diary: Keeping a headache diary can help identify migraine triggers, evaluate treatment effectiveness and track progress.

B. Consultation with a doctor: It is important to consult a doctor to diagnose migraine and develop a treatment plan. The doctor can prescribe medications, recommend non -drug methods of treatment and send to other specialists, such as physiotherapist, psychologist or acupuncturist.

C. Regular observation: It is important to regularly visit a doctor to evaluate the effectiveness of treatment and adjust the treatment plan if necessary.

D. Active participation in treatment: The patient must actively participate in his treatment, follow the doctor’s recommendations, avoid triggers and inform the doctor about any changes in the symptoms.

V. Migraine and related diseases: relationships and management

Migraine often coexists with other diseases such as depression, anxiety, insomnia, irritable intestines (SRK), fibromyalgia and epilepsy. The presence of concomitant diseases can complicate the treatment of migraine and worsen the quality of the patient.

A. Depression and migraine: Depression is often found in people with migraine. Depression can worsen the course of migraines and reduce treatment effectiveness. Treatment of depression can help improve the course of migraine.

B. Alarm and migraine: Anxiety is also often found in people with migraine. Anxiety can provoke migraines and worsen the course of migraine. Alarm treatment can help improve the course of migraine.

C. insomnia and migraine: Insomnia is often found in people with migraine. Insomnia can provoke migraines and worsen the course of migraine. Insomnia treatment can help improve the course of migraine.

D. irritable intestines (SRK) and migraine: SRK is often found in people with migraine. SRK can worsen the quality of the patient’s life and complicate the treatment of migraines.

E. Fibromyalgia and migraine: Fibromyalgia is often found in people with migraine. Fibromyalgia can worsen the quality of the patient’s life and complicate the treatment of migraine.

F. Epilepsia and migures: Epilepsy and migraine have some common pathophysiological mechanisms. In people with epilepsy, the risk of migraine is increased, and vice versa.

G. Management of related diseases: It is important to treat related diseases simultaneously with migraine. Treatment of concomitant diseases can help improve the course of migraine and increase the effectiveness of migraine treatment.

VI. Migraine in women: features and treatment

Migraine is more common in women than in men. Hormonal changes associated with the menstrual cycle, pregnancy and menopause can provoke migraines in women.

A. menstrual migraine: The menstrual migraine is a migraine that occurs in connection with the menstrual cycle. Menstrual migraine usually occurs 2 days before the start of menstruation and within 3 days after its beginning.

B. Migraine and pregnancy: Migraine can improve during pregnancy, especially in the second and third trimesters. However, in some women, migraine may worsen during pregnancy. Migraine treatment during pregnancy should be safe for the mother and child.

C. Migraine and menopause: Migraine can worsen during menopause due to hormonal changes. Hormonal therapy can help reduce migraine frequency in menopause.

D. Migraine treatment in women: Migraine treatment in women should take into account hormonal factors. It is important to discuss treatment options with a doctor that are safe and effective for women at different periods of their lives.

VII. Migraine in children and adolescents: diagnosis and treatment

Migraine is often found in children and adolescents. Migraine can affect school performance, social activity and quality of life of the child.

A. Diagnostics of migraine in children and adolescents: Diagnosis of migraine in children and adolescents can be complicated, since children can experience difficulties with a description of their symptoms. It is important to collect a detailed history and conduct a physical examination.

B. Treatment of migraines in children and adolescents: Treatment of migraines in children and adolescents includes a change in lifestyle, relief of acute attacks and preventive treatment. It is important to use drugs that are safe and effective for children and adolescents.

C. Family support: Family support is important for children and adolescents with migraine. The family can help the child follow the doctor’s recommendations, avoid triggers and cope with stress.

VIII. New directions in the treatment of migraines: prospects and innovations

  1. New CGRP blockers: New CGRP blockers are developed, which can be more effective and have less side effects than the existing CGRP blockers.
  2. Gene therapy: Gene therapy can be used to treat migraines by influencing genes involved in the development of migraines.
  3. Immunotherapy: Immunotherapy can be used to treat migraines by influencing the immune system.
  4. New methods of neurostimulations: New neurostimulation methods are developed, which can be more effective and have less side effects than existing neurostimulation methods.
  5. Personalized medicine: Personalized medicine can be used to develop individual migraine treatment plans based on genetic, biological and environmental factors.

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

  1. Acceptance of the diagnosis: The adoption of a diagnosis of migraine is an important step to the management of the disease.
  2. Training: Migraine training can help patients better understand their condition and make more reasonable treatment decisions.
  3. Support: Support from family, friends, doctors and support groups can help patients cope with the difficulties associated with migraine.
  4. Stress management: Stress management is an important part of migraine management.
  5. Planning: Planning can help patients adapt to migraine and continue to lead an active lifestyle.
  6. Self -accident: Self -and -air is the ability to speak for yourself and defend your rights. It is important to self -button when communicating with doctors, employers and other people.
  7. Search for joy: It is important to find joy in life, despite the migraine.

X. Key conclusions: to a full life without migraine

Migraine is a complex neurological disease that requires an integrated approach to treatment. An individual treatment plan, including a change in lifestyle, stopping acute attacks, preventive treatment and non -drug methods of treatment, can help reduce the frequency, intensity and duration of migraine attacks, as well as improve the quality of the patient. It is important to consult a doctor to diagnose migraine and develop a treatment plan. Active participation in the treatment, compliance with the doctor’s recommendations and the search for support can help patients live a full life without migraine.

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