Head and pain: How to get rid of a migraine
The word "migraine" is familiar to all from childhood, from books, but for some reason it is often believed that this is synonymous with a severe headache. Despite the prevalence of this disease, occurring in 12-18% of women and 6% of men, awareness of it remains surprisingly low. Together with the neurologist Denis Korobko, we understand what a migraine is, how it differs from an ordinary headache, and why it is useless to treat it with antispasmodics.
How does migraine flow and what is aura?
Migraine is a chronic disease, the main symptom of which is, indeed, severe headache. Very often, nausea, up to vomiting, so that the first migraine attack can be easily mistaken for poisoning. Headache and nausea can be accompanied by a fear of light and sound, when any external stimulus instantly worsens the condition. According to WHO, in the UK alone, migraine is the cause of the loss of 25 million working and class hours a year; This is one of the most important causes of disability. The fact is that a headache, nausea, photophobia attack can last for several days; at this time, practically the only thing the patient is capable of is lying in a dark room under a blanket, trying to sleep in the hope that the attack will end sometime.
In about a quarter of patients, a so-called aura, that is, additional symptoms of the nervous system, precedes a migraine attack. The visual aura is the appearance of "blind spots", the narrowing of the field of view, the appearance of luminous zigzags before your eyes; most often, the aura is described as an iridescent zigzag on the periphery of the visual field of one of the eyes, which gradually expands. Sometimes Alice’s so-called syndrome develops in Wonderland when the sizes of surrounding objects and even of their own body parts are distorted. It may seem that your own legs or arms have become gigantic, and the furniture around has diminished to toy; It is believed that Lewis Carroll suffered from migraines and reflected the aura in Alice’s adventures. The aura can include hearing effects, dizziness, skin numbness or tingling, a feeling of confusion and memory impairment.
Why is this happening?
Migraine is a neurological process that is only partially studied. It is already known that the aura is associated with a reversible, temporary, disruption of electrical activity in the cerebral cortex. At the chemical level, these disorders are caused by shifts in the ionic composition, when potassium ions escape from the cells into the extracellular space, while calcium and sodium, on the contrary, move into the cells. This process is called cortical spreading depression (or depolarization); This means that in the cortex of the brain, electrical activity is suppressed, which expands in waves to larger areas. The term “depression” in this case is used as a synonym for oppression, suppression, and has no psychological relation to depression. Now, neurologists from different countries have come to the general opinion that this process is the main mechanism of migraine, and not just auras, as previously thought; most likely, a migraine without aura develops in the same way.
Scientists were able to identify certain triggers that provoke migraine attacks in some (but not all) patients. Frequent triggers include stress, lack of sleep and regime change, caffeine, hunger and the associated hypoglycemia, slight dehydration. Exercise can both prevent and provoke a migraine. Certain products (for example, chocolate, cheese and red wine) are traditionally attributed to triggers, although recent studies have linked the migraine to chocolate consumption, and only 10% of patients suffering from it have reported alcohol as a migraine trigger. Unfortunately, not so much is known about migraines, and it is not advisable to recommend the rejection of the same products to all patients; identifying personal triggers (if any) can help keep a diary.
Is migraine related to hormones or lifestyle?
Migraine has a significant hormonal component, and it occurs in women two to three times more often than in men. About half of women with migraine clearly associate seizures with the menstrual cycle. There is also a separate condition called menstrual migraine, which is associated with a cyclical decrease in estrogen levels. At the same time, there is no specific analysis, the results of which would allow the patient to say: "You have lowered the level of such and such a hormone, and this is the cause of the migraine." In such cases, stabilization of estrogen levels may help; Estrogens can be prescribed alone or as part of combined oral contraceptives. The problem is that if some women use COCs to get rid of a migraine, then for others they become the trigger. Unfortunately, migraines with aura that occur on the background of KOC intake are a direct indication of their withdrawal due to an increased risk of stroke; In this case, combined contraceptives can be replaced with progestin.
Such periods of hormonal changes, such as pregnancy or menopause, can also affect the course of migraine, and this is unpredictable: from complete disappearance or at least a decrease in the frequency and severity of attacks to their appearance for the first time in life. It does not improve the situation and the fact that hormone replacement therapy after menopause can help get rid of one woman's migraine, but provoke it from another. Different drugs may have the opposite effect in the same patient. Lifestyle also does not affect the risk of migraine unequivocally. Previously, migraine was called a disease of aristocrats, implying that only those who are not engaged in physical labor have free time to listen to themselves and complain of headaches. But in the early 2000s, Russian scientists conducted a major epidemiological study, and it turned out that the prevalence of migraine is the same among people with different levels of education, engaged in different types of work. So far, the only proven risk factor for migraine is genetics: in more than 70% of patients with migraine, it is also noted in relatives.
How to treat migraine?
So far, not a single drug has been created that could affect the alleged cause of migraine, that is, an imbalance of electrolytes (potassium, sodium and calcium) and a change in the electrical activity of the brain. But the mechanism of development of migraine includes the expansion of blood vessels, which can be affected. For this purpose, drugs of the triptans group are used; The most studied and common of them is Sumatriptan. Besides it, zolmitriptan, naratriptan, eletriptan and frovatriptan are registered in Russia. The newest triptan, rizatriptan, is not yet sold in Russia, but many patients bring it from Europe. Sumatriptan is available in tablets and as a nasal spray (and in the US it is also available for intramuscular injections). Take the dose as soon as possible after the onset of a headache. At the same time, triptans do not allow preventing an attack, therefore it is useless to take them during the aura.
In difficult cases, when the attacks occur very often or are particularly difficult, and the triptans do not give the desired effect, another treatment can be selected. For the treatment of severe migraine, ergotamine (ergot alkaloid) and opioid analgesics are used. Both in Russia is strictly on prescription; these are unsafe drugs, and their treatment should be carefully coordinated with the doctor. For migraines with a hormonal component, as described above, COCs or hormone replacement drugs can be prescribed or canceled. Migraine prophylaxis is usually not performed if seizures do not occur more than twice a month. With frequent migraine, low doses of antidepressants, anticonvulsants or beta-blockers may be prescribed for prophylaxis; the selection of treatment depends on concomitant diseases.
Antispasmodics such as a spasmalgone or naschpa with migraines are ineffective and may even worsen the condition, even more having dilated the vessels. In light attacks, regular NSAIDs sometimes help, that is, aspirin, paracetamol or ibuprofen. Not so long ago, there was evidence that infant colic, which is usually associated with abdominal pain, is nothing like a migraine. The new recommendation includes the treatment of colic with paracetamol and the elimination of stimulants (that is, being in darkness and silence). It is also important for adults to find an opportunity to lie down, and it is better to sleep in a dark, quiet and warm room, taking medication. Various new treatments for migraine are being studied, including electrical stimulation of the occipital nerve and Botox injections, but it is too early to speak about their effectiveness.
Which doctor to contact?
Diagnostics and treatment of migraine are done by neurologists. Usually, the diagnosis is made on the basis of the clinical picture, that is, descriptions of how headache attacks occur, what aura looks like (if it exists), how often these conditions occur and how long they last. Primary migraine is also called idiopathic; this means that it is not caused by any other disease. The effectiveness of triptans is considered an indirect diagnostic sign of primary migraine; if sumatriptan helps relieve an attack, then a migraine can be considered confirmed, and additional diagnostics are not required. If a migraine is associated with the menstrual cycle, pregnancy, menopause, or taking COCs, it is worth mentioning this to the gynecologist.
In typical cases of migraine according to the adopted diagnostic protocol, computed tomography or magnetic resonance imaging of the brain is not necessary; however, many patients insist on an MRI and are ready to do this procedure at their own expense for the sake of their own peace of mind. Tomography is necessary if the migraine is atypical, first appeared after forty years, if the nature of the pain suddenly changed, if the patient once had malignant tumors. In such cases, CT or MRI is performed to exclude or confirm tumor processes, aneurysms, multiple sclerosis, which may be the cause of a secondary headache.
Migraine seriously worsens the quality of life, and you need to do it thoroughly. It is important that science does not stand still, understanding of the mechanisms of the disease becomes deeper, often new diagnostic methods and innovative medicines appear. Headache should not be tolerated or treated with grandmother’s methods; it is better to contact a specialist who determines what's the matter and selects an effective treatment.
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