Migraine

Migraine is the most common diagnosis for headaches, which are characterized by attacks of pulsating pain in the head lasting from several hours to several days, mainly in one half of the head, more often in women, and also in young and adolescent age.

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How common is migraine?

The etiology of this disease remains a mystery to this day, as well as its pathogenetic mechanisms. The study of centuries-old information sources, including ancient ones, has resulted in fairly extensive and detailed statistical data. The disease debuts at a young age, usually before 20-25 years. Even small children can suffer from headache attacks. One of the reasons that can explain the insufficient study of migraine is the late appeal for medical help - only 15% of all migraine patients receive timely treatment and observation by qualified doctors. All the rest try to cope with unbearable pain on their own. Treatment with conventional analgesics gives a temporary effect and provokes resistance of the body to therapy with such drugs. Migraine is a serious illness that significantly reduces the quality of life and ability to work of the patient. In the WHO rating, which determines the most harmful diseases, it ranks 12th among women's diseases and 19th among men's.

Migraine occurs in 38% of people, more often women than men (3:1). It is inherited in a dominant and less often - recessive manner.

Migraine is the second most common headache after tension headache. Its prevalence varies from 11 to 25% in women and from 4 to 10% in men. Migraine usually first appears between the ages of 10 and 20. Before puberty, migraine prevalence is higher in boys, then it increases more rapidly in girls and remains significantly higher in women than in men even after age 50.

After 50 years, migraine as an independent disease is almost never encountered. However, there are references in the literature to the onset of typical migraine attacks at 65 years of age. In the overwhelming majority of cases, migraine affects women; in the period from 20 to 50 years, the ratio of women to men is 3:2 or 4:2, and after 50 years, there are almost no differences by gender. Migraine is more often observed among the urban population, especially among people leading a sedentary lifestyle. In addition to age and gender, hereditary factors play a certain role, which have now been proven beyond doubt: migraine occurs much more often in relatives of patients than in the population. Thus, if both parents had migraine, the risk of the disease in offspring reaches 60-90% (while in the control group - 11%); if one mother had migraine attacks, the risk of the disease is 72%, if one father - 20%. The mechanism of the described phenomenon is not entirely clear: some authors indicate the prevalence of the dominant type of inheritance, others - recessive.

It is also believed that it is not migraine itself that is inherited, but a predisposition to a certain type of vascular system response to various stimuli. At the same time, there is conflicting data that parents of people suffering from migraine are more often prone to hypertension, although there are indications of arterial hypotension.

Classifications and criteria of migraine

To date, the ICHD-2 – international classification of headaches has established two forms: 1.1 – migraine without aura (sensory, vegetative disorders). This form is typical for 80% of all migraine patients; 1.2 – migraine with sensory disorders, which has subtypes:

• Typical autonomic disorders with migraine pain;
• Typical aura with non-migrainous pain;
• Typical sensory disturbances without pain;
• FHM – familial hemiplegic migraine (with paralysis of muscles in the half affected by pain);
• Sporadic hemiplegic migraine (unpredictable, random attacks);
• Basilar migraine.

The symptoms and criteria for diagnosis should be carefully and attentively studied to completely exclude pathological organics of the central nervous system. The criterion for hemicrania without sensory disorders is the nature and localization of pain, migraine with vegetative disorders involves studying the clinical manifestations of the aura itself. It is also necessary to exclude the possibility of similarity of symptoms with tension headache. In addition, with some types of migraine, pain may be absent altogether, this type is called "headless" migraine.

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How to differentiate migraine?

Migraine without autonomic dysfunction – at least five episodes with attacks:

• The pain lasts from 4 hours to three days;
• Two of the following are required: one-sided pain, pulsation, intense pain, pain that occurs with exertion or activity;
• One of the following symptoms is required: vomiting, nausea, irritation provoked by sounds – phonophobia, light – photophobia;
• There are no organic lesions of the brain.

Migraine with aura:

• Two episodes with seizures;
• Three of the following are mandatory signs: several (or one) symptoms of vegetative-sensory disorders, development of an aura that lasts no more than one hour, headache that occurs after an attack or accompanies it;
• There is no organic pathology of the brain.

Factors (triggers) that can provoke migraine:

• Hormonal factors (replacement therapy, contraception, ovulation, menstrual cycle);
• Dietary factors (cocoa, nuts, eggs, dry red wines, fasting, chocolate, cheese and other products);
• Psychogenic factors (anxiety, depression, stress);
• Sensory factors (bright sunlight, flashes of light – visual stimulation, smells, sounds);
• External factors – weather dependence;
• Regime factors – skipping meals, lack of sleep, insomnia;
• Medicinal factors (histamine, estrogen-containing drugs, nitroglycerin, ranitidine);
• Neurogenic factors – TBI (traumatic brain injury), overwork, both intellectual and physical;
• Somatic factors – history of chronic diseases.

How is migraine treated?

The therapeutic strategy for treating hemicrania is very individual and depends on the form of the disease, symptoms, duration of the disease period and many other factors. The most effective drugs are those widely used in practice and have shown good results:

• 5-HT1 agonists are a group of triptans (zolmitriptan, sumatriptan, zolmigren);
• Dopamine antagonists – aminazine, domperidone, metoclopramide, droperidol;
• NSAIDs, prostaglandin inhibitors.

How to prevent migraine?

If a person has experienced a migraine attack at least twice a month, he or she needs to learn how to prevent this disease. Preventive therapy lasts at least two months and can last up to six months. Prevention is needed to solve one main problem - to reduce the number of migraine episodes. Preventive drug therapy also helps to minimize pain symptoms and increase sensitivity to the main therapy. As a rule, calcium channel blockers, β-blockers, tricyclic antidepressants, and serotonin antagonists are prescribed. Also, in addition to medications, it is necessary to create a diet and adhere to it for six months. It is strictly forbidden to include products containing the biogenic amine tyramine in the menu. Special therapeutic exercises and psychotherapeutic sessions are indicated. Migraine, despite its "mysterious" origin and average curability, is a manageable disease. Provided that you see a doctor in a timely manner and follow all therapeutic recommendations, including preventive ones, you can control migraines and maintain a good quality of life.

What is migraine?

Migraine is a pulsating pain that can appear suddenly, in attacks, and usually affects half of the head. This is where the name of the disease comes from - hemicrania or "half of the skull" (in Latin hemi cranion). According to statistics, almost 20% of people suffer from it, regardless of race, country of residence and social status.

Attacks last from 4 to 72 hours, migraine is often (but not always) unilateral, pulsating, intensifies with tension and is accompanied by vegetative symptoms (nausea, photophobia, phonophobia and hyperacusis, as well as hyperosmia). Headache may be preceded by flickering scotomas and other focal neurological disorders. The diagnosis of migraine is made on the basis of the characteristic clinical picture. For treatment, agonists of serotonin receptors 1B, 1D, antiemetics and analgesics are used. Preventive measures include lifestyle changes (sleep and diet) and taking medications (beta-blockers, amitriptyline, valproate, topiramate).

The headache is characterized by significant intensity, accompanied by nausea, sometimes vomiting, characterized by hyperesthesia to sound and visual stimuli (poor tolerance of bright light, loud sounds), lasts from 1-2 to several hours and even up to 3 days. After the attack, as a rule, lethargy, drowsiness occur, sometimes sleep brings relief. Although usually each patient has a "favorite" side of the pain, however, it can change, and sometimes migraine affects both halves of the head in the forehead, temples, crown.

Migraine: Historical Background

Migraine was familiar to our ancestors, it was mentioned by chroniclers in ancient Egyptian papyri. In those days, migraine was treated in rather exotic ways, for example, by applying crocodile skin or young toad skin to the sore half of the head. More than five thousand years ago, Sumerian writings described in some detail the signs and symptoms of an incomprehensible disease that periodically affected both women and warriors. According to ancient rulers and healers, headaches were caused by the influence of evil, all-powerful spirits. Accordingly, treatment measures were developed - fumigation of the patient with aromatic substances and the use of magical amulets. More radical measures were often used - something similar to trepanation. The spirit obviously left the body of the sufferer both figuratively and literally. Later, the Greek healer Aretaeus of Cappadocia contributed to the description and study of the disease, suggesting that headaches of this nature be called heterocrania - another, different head. A more precise name for the disease was given by the Greek physician Claudius Galen, who defined the localization of pain in the name and called the disease "hemicrania". He was also the first to suggest that the cause of attacks lies in a spasm, a change in the vessels of the head. Over time, migraine acquired the status of a "fashionable" aristocratic disease that only representatives of the upper classes could "afford". In the 18th century, migraine was treated by rubbing with a vinegar solution, and ladies carefully covered their vulnerable fragile heads with exquisite hats, which was basically correct, because bright sun can provoke a migraine attack. Later, doctors identified several forms - menstrual, hemiplegic and ocular. More specific causes and clinical symptoms were also identified.

The 19th century was marked by a breakthrough in the treatment of headaches. Migraine began to be treated with a special mixture, named after its author - Govers' mixture. It was a weak alcohol solution of nitroglycerin. The inventive doctor Govers, in search of an effective method of therapy, was not afraid to experiment with cocaine and marijuana. In Russia of that period, migraine was treated with a popular universal remedy - quinine. Only in the last century, NSAIDs - non-steroidal anti-inflammatory drugs - began to be used in the treatment of migraine. In the middle of the 20th century, a revolutionary drug was synthesized - alkaloid ergotamine. This group of drugs had many side effects and the scientific medical world sought to minimize them. At the end of the last century, completely new drugs appeared that gave a stable therapeutic result and had virtually no contraindications. Triptans activate the zones of serotonin inclusion in the vessels, as a result of which they narrow and have a blocking effect on the neurogenic inflammatory process. It cannot be said that triptan drugs completely cure migraines, but the pharmaceutical industry is working hard to create new, more advanced drugs to finally defeat migraines.