Migraine: Complete guide to get rid of triggers and pain

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Migraine: Complete guide to get rid of triggers and pain

I. Understanding migraines: more than just a headache

Migraine is a neurological disease characterized by intense headaches, often accompanied by nausea, vomiting and increased sensitivity to light (photophobia) and sound (phonophobia). Unlike ordinary headache, migraine can significantly affect everyday life, preventing the implementation of ordinary tasks and reducing the quality of life. Understanding the complexity of migraine and its mechanisms is the first step towards effective control.

A. Classification of migraines:

  1. Migraine with aura: Aura is neurological symptoms preceding a headache or arising during it. The aura usually lasts from 5 to 60 minutes and can include visual disturbances (flickering lights, zigzag lines, vision loss), sensory changes (numbness, tingling), speech disorders or motor weaknesses. When migraine with an aura, headache can occur immediately after the end of the aura or with a delay.

    • Visual aura: The most common type of aura. Symptoms may include scotomas (blind spots), shimmering lines, fortification spectra (geometric patterns) and visual distortion.
    • Sensory aura: Includes numbness or tingling, which usually begins in one hand and spreads to the face or tongue.
    • Speech aura: It includes difficulties with pronouncing words or understanding of speech.
    • Motor aura (hemiplegic migraine): A rare type of migraine with an aura, characterized by weakness or paralysis on one side of the body. Requires immediate medical care.
    • Migraine of the brain stem: It is characterized by symptoms arising from the brain trunk, such as dizziness, double -gathering, dysarthria (slurred speech) and impaired coordination.

  2. Migraine without aura: This is the most common type of migraine. A headache occurs without any previous neurological symptoms (auras). Diagnosis of migraine without aura is based on certain criteria, including the frequency, duration and characteristics of the headache, as well as the presence of concomitant symptoms (nausea, vomiting, photophobia, phonophobia).

  3. Chronic migraine: Migraine is considered chronic if headaches occur within 15 or more days a month for at least 3 months, and at least 8 of these days correspond to migraine criteria. Chronic migraine can significantly worsen the quality of life and often requires more aggressive treatment. Risk factors for the development of chronic migraine include depression, anxiety, obesity, abuse of caffeine and excessive use of painkillers.

  4. Episodic migraine: Migraine that occurs less than 15 days a month.

  5. Rare forms of migraines:

    • Ophthalmoplegic migraine: It is characterized by a headache accompanied by paralysis of the eye muscles, which leads to double in the eyes and omission of the century. Requires other serious diseases.
    • Abdominal migraine: It is more common in children and is characterized by episodic abdominal pain, nausea, vomiting and lack of appetite. A headache may be absent or not insignificant.
    • Vestibular migraine: It is characterized by episodes of dizziness that can occur with or without headache. Dizziness can last from several minutes to several days.

B. Pathophysiology of migraines: What happens in the brain?

The pathophysiology of migraines is not fully studied, but it is believed that several factors are involved in its development, including:

  1. Trigemins system: This system includes the trigeminal nerve (the main nerve responsible for the sensitivity of the face and head) and blood vessels of the brain. It is believed that 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 and inflammation.

  2. CGRP (Calcitonin-Gen-tied peptide): A powerful neuropeptide playing a key role in the development of migraine. CGRP causes the expansion of blood vessels of the brain, inflammation and transmission of pain signals to the brain. New drugs called CGRP inhibitors block the activity of CGRP and showed high efficiency in migraine prevention.

  3. Crimely spreading depression (CSD): A slow wave of depolarization of neurons, which spreads through the cerebral cortex. CSD can activate the trigeminal system and the release of inflammatory substances, contributing to the development of migraine. It is believed that CSD plays a role in the development of aura during migraine with an aura.

  4. Genetic predisposition: Migraine has a strong genetic component. People who have relatives of the first degree of kinship with migraine have a higher risk of developing this disease. Several genes associated with migraine are identified, but not one of them is the only cause of the disease.

  5. Brain dysfunction: Studies show that people with migraine can have dysfunction in certain areas of the brain, such as hypothalamus, thalamus and brain stem that play a role in the regulation of pain, mood and sleep.

II. Migraine triggers: identify and avoid

Migraine triggers are factors that can provoke a migraine attack of susceptible people. Triggers can be different for each person, and their identification is an important step in managing migraine. Keeping a headache diary can help determine individual triggers.

A. Dietary triggers:

  1. Sustained cheeses: Cheeses, such as Chedder, Bree, Parmesan and Blue cheese, contain a high level of tyrammine, amino acids, which can cause expansion of blood vessels and provoke migraines.

  2. Processed meat products: Sausage, sausages, bacon and other treated meat products contain nitrites and nitrates, preservatives that can cause expansion of blood vessels and provoke migraines.

  3. Chocolate: Chocolate contains caffeine, phenylethylamine and tiramin, which can be triggers for some people.

  4. Alcohol: Especially red wine contains thyramin and sulfites that can provoke migraines. Alcohol can also cause dehydration, which can also be a trigger.

  5. Artificial sweeteners: Aspartam, parcellosis and other artificial sweeteners can be triggers for some people.

  6. Glutamate sodium (MSG): The taste amplifier, often used in Chinese food, processed foods and fast food. MSG can cause headaches in susceptible people.

  7. Fermented and pickled products: Sved cabbage, salted cucumbers and other fermented and pickled products contain a high level of tyrammine.

  8. Citrus fruit: Citrus fruits, such as oranges, lemons and grapefruits, contain an octamine that can provoke migraines.

  9. Caffeine: Caffeine can be both a trigger and a relief for migraine. Moderate caffeine consumption can help relieve headache, but excessive use or sharp rejection of caffeine can provoke a migraine attack.

B. Environmental factors:

  1. Weather changes: Changes in atmospheric pressure, temperature, humidity and wind can provoke migraines.

  2. Bright light: Bright light, flickering light and sunlight can provoke migraines.

  3. Loud sounds: Loud sounds, sharp sounds and long -term noise can provoke migraines.

  4. Strong smells: Spirits, chemicals, smoke and other strong smells can provoke migraines.

  5. Smoke: Tobacco smoke and other types of smoke can provoke migraines.

C. Life lifestyle factors:

  1. Stress: Stress is one of the most common migraine triggers. Stress can cause muscle tension, a change in hormone levels and other physiological changes that migraine can provoke.

  2. Lack of sleep: A lack of sleep or a violation of sleep mode can provoke migraines. It is important to observe a regular sleep mode, go to bed and wake up at the same time every day.

  3. Missed meals: Passing meals can lead to a drop in blood sugar, which can provoke migraines. It is important to eat regularly and avoid passes of meals.

  4. Dehydration: Dehydration can lead to headache and provoke migraine. It is important to drink enough water during the day.

  5. Physical strain: Excessive physical activity can provoke migraines.

  6. Changes in the hormonal background: In women, changes in the hormonal background associated with the menstrual cycle, pregnancy and menopause can provoke migraines.

D. Other triggers:

  1. Medications: Some drugs, such as oral contraceptives, vasodilators and some painkillers, can provoke migraines.

  2. Muscle tension: The tension of the muscles of the neck and shoulders can provoke migraine.

  3. Dental problems: Problems with teeth, such as bruxism (grinding of teeth), can provoke migraines.

  4. Head injuries: Head injuries, even insignificant, can provoke migraines.

  5. Trips: Travels can disrupt sleep and nutrition mode, as well as subject the body to the effects of various environmental factors that can provoke migraines.

III. Migraine Diagnostics: Contact a specialist

The exact diagnosis of migraine is important for prescribing effective treatment. Diagnosis usually includes a history of anamnesis, physical examination and, in some cases, additional studies.

A. History:

The doctor will ask in detail about the nature of the headache, its frequency, duration, intensity and concomitant symptoms. It is important to inform the doctor about all factors that can provoke headache, as well as a family history of migraine.

B. Physical inspection:

The doctor will conduct a general physical examination, including a neurological examination, to exclude other diseases that can cause headache. A neurological examination may include a check of reflexes, sensitivity, muscle strength and coordination.

C. Additional research:

In most cases, anamnesis and physical examination are enough to diagnose migraine. However, in some cases, additional studies may be required, such as:

  1. MRI (magnetic resonance imaging) of the brain: MRI can help exclude structural abnormalities of the brain, such as tumors, aneurysms or malformations of blood vessels.

  2. CT (computed tomography) of the brain: CT can be used to detect hemorrhages or other acute conditions requiring immediate treatment.

  3. Lumbal puncture: Lumbal puncture (spinal puncture) can be used to exclude infections or other diseases that affect the central nervous system.

D. Differential diagnosis:

Migraine should be differentiated from other types of headaches, such as:

  1. Headache of tension: The headache of the tension is usually less intense than migraine, and is not accompanied by nausea, vomiting or increased sensitivity to light and sound.

  2. Closter headache: The cluster headache is characterized by intensive pain around one eye, which is accompanied by lacrimation, nasal congestion and sweating.

  3. Sinus headache: Sinus headache is associated with infection or inflammation of the sinus of the nose.

  4. Secondary headache: The secondary headache is caused by another disease, such as the tumor of the brain, aneurysm or meningitis.

IV. Migraine treatment: from stopping attacks to prevention

Migraine treatment is aimed at stopping headache attacks and preventing their occurrence. Treatment may include drugs, non -drug methods and a change in lifestyle.

A. Escaining migraine attacks (abortive treatment):

Abortive treatment is aimed at relieved headaches and related symptoms during migraine attacks. The sooner the treatment begin, the more effective it will be.

  1. Analgesic drugs (analgesics):

    • Nonsteroidal anti -inflammatory drugs (NSAIDs): Ibuprofen, steady, ketoprofen and diclofenac can be effective for alleviating mild and moderate headache.
    • Aspirin: Aspirin can be effective for alleviating a headache, especially if you take it at the beginning of an attack.
    • Paracetamol (acetaminophen): Paracetamol can be effective to relieve headaches, but it is less effective than NSAIDs.

  2. TRIPTA:

    • Triptans are a class of drugs that are specifically designed for the treatment of migraine. They act by narrowing the blood vessels of the brain and blocking the release of neuropeptides, such as CGRP. Triptans are available in various forms, including tablets, nasal sprays and injections. Examples of triptans include collapse, risatriciptan, gymitrippan, intrigipetan, frutriptan and ethletriptan.
    • Contraindications to tripatans: Triptans are contraindicated for people with coronary heart disease, a stroke, uncontrolled hypertension and other cardiovascular diseases.

  3. Ergotamines:

    • Ergotamines are another class of drugs that can be used to treat migraines. They act by narrowing the blood vessels of the brain. Ergotamines are less effective than triptans and have more side effects.
    • Contraindications to ergotamins: Ergotamines are contraindicated for people with coronary heart disease, stroke, uncontrolled hypertension, liver and kidney diseases, as well as pregnant women.

  4. Combined drugs:

    • Some drugs contain a combination of analgesic (for example, paracetamol or aspirin) and caffeine. Caffeine can enhance the effect of painkillers.
    • Other drugs contain a combination of analgesic and anti -tape agent.

  5. Anti -rate drugs:

    • Anti -rate drugs, such as metoclopramide and domeridon, can help alleviate nausea and vomiting, which often accompany migraine.

  6. Digidrérgotamine (DHE):

    • DHE is a form of ergotamine, which can be introduced intravenously or intramuscularly. Dhe can be effective for the treatment of severe migraine attacks that cannot be treated with other drugs.

B. Preventive treatment of migraines:

Preventive treatment is aimed at reducing the frequency, intensity and duration of migraine attacks. Preventive treatment is usually prescribed for people whose migraines often occur (more than 4 days a month), or those who have migraines’ attacks significantly affect the quality of life.

  1. Beta blockers:

    • Beta blockers, such as propranolol and metoprolol, can help reduce the frequency of migraine attacks. They act by blocking the action of adrenaline, hormone, which can cause expansion of blood vessels.

  2. Antidepressants:

    • Tricyclic antidepressants, such as amitriptylin, and selective serotonin (SIOS) reversal inhibitors, such as fluoxetine and cermein, can help reduce the frequency of migraine attacks. They act by increasing the level of serotonin in the brain.

  3. Anticonvulsants:

    • Anticonvulsants, such as topiramate and valproic acid, can help reduce the frequency of migraine attacks. They act by stabilizing electrical activity in the brain.

  4. CGRP inhibitors:

    • CGRP inhibitors are a new class of drugs that are specifically designed for migraine prevention. They act by blocking the activity of CGRP, neuropeptide, which plays a key role in the development of migraine. CGRP inhibitors are available in the form of injections. Examples of CGRP inhibitors include Erenumab, Fremenzumab, Galkanzumab and Eptynesumab.

  5. Botulininic toxin (Botox):

    • Botox can be used to prevent chronic migraines (headaches occur within 15 or more days a month). Botox is introduced into the muscles of the head and neck, and it acts by blocking the release of neurotransmitters that participate in the transmission of pain signals.

  6. Blockade of nerves:

    • The blockade of nerves, such as the blockade of the occipital nerve, can help relieve headache and reduce the frequency of migraine attacks.

C. Non -drug treatment methods:

  1. Biological feedback (biofidBEC): BiofidBek is a method that allows people to learn how to control certain physiological functions, such as heart rate, blood pressure and muscle tension. BiofidBek can help reduce the frequency and intensity of migraine attacks.

  2. Iglowerie (acupuncture): The acupuncture is a method of traditional Chinese medicine, which includes the introduction of thin needles into certain points on the body. The acupuncture can help reduce the frequency and intensity of migraine attacks.

  3. Massage: Massage can help relax the muscles of the neck and shoulders, which can reduce headache.

  4. Cognitive-behavioral therapy (KPT): KPT is a type of psychotherapy that can help people learn to cope with stress and other factors that migraine can provoke.

  5. Relaxation exercises: Relaxation exercises, such as meditation, yoga and deep breathing, can help reduce stress and tension, which can reduce headache.

  6. Compresses: Applying a cold compress to the head or neck can help relieve headache. Applying a warm compress to the neck can help relax the muscles.

D. Change in lifestyle:

  1. Regular sleep mode: It is important to observe a regular sleep mode, go to bed and wake up at the same time every day, even on weekends.

  2. Regular meals: It is important to eat regularly and avoid passes of meals.

  3. Sufficient amount of water: It is important to drink enough water during the day.

  4. Stress management: It is important to learn how to manage stress using methods such as exercises, meditation or yoga.

  5. Avoid triggers: It is important to identify and avoid migraine triggers.

  6. Physical activity: Regular physical activity can help reduce the frequency of migraine attacks. However, it is important to avoid excessive physical exertion that migraine can provoke.

V. Migraine and pregnancy: special considerations

Migraine can worsen during pregnancy, especially in the first trimester. It is important to discuss options for treating migraine with a doctor in order to choose safe and effective treatment methods during pregnancy.

A. Medicines safe during pregnancy:

  • Paracetamol (acetaminophene) is considered safe during pregnancy to relieve headache.
  • Some NSAIDs, such as Ibuprofen, can be used in the first and second trimesters of pregnancy, but they should be avoided in the third trimester, as they can affect the fetus.
  • Some tripatans, such as collaboration, can be used during pregnancy, but they should be used with caution and only under the supervision of a doctor.

B. Medicines that should be avoided during pregnancy:

  • Ergotamines are contraindicated during pregnancy.
  • Valproic acid and topiramate can cause congenital defects and they should be avoided during pregnancy.
  • Long -term use of NSAIDs should be avoided during pregnancy, especially in the third trimester.

C. Non -drug methods of treatment during pregnancy:

  • Biological feedback (biophydbek)
  • Iglowerie (acupuncture)
  • Massage
  • Relaxation exercises
  • Compresses

VI. Life with migraine: management and adaptation strategies

Life with migraine can be a difficult task, but there are strategies that can help people manage their condition and improve the quality of life.

A. Maintenance of a headache diary:

Keeping a headache diary can help determine migraine triggers, track treatment and track progress. The diary should record the date and time of the beginning of the headache, its intensity, accompanying symptoms, possible triggers and medications taken.

B. Creating a supporting network:

Communication with other people living with migraine can be very useful. There are online forums and support groups, where people can share their experience, ask questions and receive support.

C. Development of an action plan for migraines:

The development of an action plan for migraine can help prepare for headache attacks and know what to do when they arise. The plan should include a list of drugs that need to be taken, non -drug treatment methods that need to be used, and the actions that need to be taken if the headache does not pass.

D. Caring for yourself:

It is important to take care of yourself in order to reduce stress and improve the overall state of health. This can include regular exercises, healthy diet, enough sleep and time for relaxation and relaxation.

E. Education and awareness:

The more you know about migraines, the better you can control your condition. Read books, articles and websites about migraine, and attend lectures and seminars to find out more.

VII. New directions in migraine research

Migraine studies are constantly developing, and new methods of treatment and prevention are being developed. Some of the promising areas of research include:

  • New CGRP inhibitors: New CGRP inhibitors are developed, which can be more effective and have less side effects.
  • Non -invasive brain stimulation: Non -invasive methods of brain stimulation, such as transcranial magnetic stimulation (TMS) and transcranial stimulation of direct current (TSPT), are studied for the treatment and prevention of migraine.
  • Gene therapy: Gene therapy is studied as a potential method for treating migraine.

Migraine is a complex disease, but with proper treatment and management of symptoms, people with migraine can live a full life. It is important to consult a doctor to diagnose and develop a treatment plan, which is right for you. Do not despair, there are many treatment options that can help you relieve pain and improve the quality of life.

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