How long does a typical migraine last. What are the distinct phases of a migraine attack. How can understanding migraine progression help with symptom management. What are the key symptoms of each migraine phase. How can identifying early migraine signs assist in treatment.

The Four Phases of a Migraine Attack: A Comprehensive Overview

Migraine attacks are complex neurological events that often follow a predictable pattern. Understanding this pattern can be crucial for effective management and treatment. Let’s explore the four distinct phases of a migraine attack and their typical durations.

What are the four phases of a migraine attack?

The four phases of a migraine attack are:

1. Prodrome
2. Aura
3. Headache
4. Postdrome

It’s important to note that not everyone experiences all four phases, and the duration and intensity of each phase can vary from person to person and even from one attack to another.

Prodrome: The Early Warning Signs of an Impending Migraine

The prodrome phase, also known as the “preheadache” or premonitory phase, marks the beginning of a migraine attack for many sufferers.

How long does the prodrome phase typically last?

The prodrome phase can last anywhere from several hours to several days. This variability makes it crucial for migraine sufferers to be attuned to their body’s signals.

What are the common symptoms of the prodrome phase?

Prodrome symptoms can include:

• Mood changes (depression, irritability)
• Difficulty concentrating
• Fatigue
• Sensitivity to light and sound
• Insomnia
• Nausea
• Constipation or diarrhea
• Muscle stiffness, especially in the neck and shoulders
• Yawning
• Food cravings
• Frequent urination

Recognizing these early warning signs can be crucial for early intervention and potentially preventing the headache phase altogether.

Aura: The Visual and Sensory Disturbances Preceding Migraine Pain

The aura phase is characterized by neurological symptoms that typically precede the headache phase. However, not all migraine sufferers experience aura.

What percentage of migraine sufferers experience aura?

Approximately one-third of people with migraine experience aura as a distinct phase in their migraine attacks. However, it’s important to note that even for those who do experience aura, it may not occur during every migraine attack.

How long does the aura phase typically last?

Aura symptoms usually develop gradually over at least 5 minutes and can last for up to 60 minutes. In some cases, aura may last longer than 60 minutes, and in rare instances, it may occur after the headache phase has already begun.

What are the common symptoms of the aura phase?

Aura symptoms often involve visual disturbances, such as:

• Blurry vision or vision loss
• Appearance of geometric patterns
• Flashing or shimmering lights
• Blind spots in one or both eyes

These visual symptoms can serve as a warning sign for the impending headache phase, allowing sufferers to take preventive measures or prepare for the onset of pain.

Headache: The Primary Pain Phase of a Migraine Attack

The headache phase is what most people associate with migraine attacks. It’s characterized by moderate to severe head pain, often accompanied by other debilitating symptoms.

How long does the headache phase of a migraine typically last?

The headache phase can last anywhere from several hours to up to three days. This wide range in duration underscores the variability of migraine attacks and the importance of individualized treatment approaches.

What are the primary symptoms of the headache phase?

The headache phase typically involves:

• Moderate to severe head pain, often on one or both sides of the head
• Nausea and sometimes vomiting
• Insomnia or difficulty sleeping
• Anxiety
• Heightened sensitivity to light, sound, and smells
• Aggravation of pain by physical activity

The intensity and combination of these symptoms can vary greatly from one individual to another and even between different migraine attacks in the same person.

Postdrome: The “Migraine Hangover” and Its Lingering Effects

The postdrome phase, often referred to as the “migraine hangover,” occurs after the headache phase has subsided. However, it can be just as debilitating as the headache itself for many sufferers.

How common is the postdrome phase among migraine sufferers?

Approximately 80% of migraine sufferers experience the postdrome phase. However, like other phases, it may not occur after every migraine attack.

How long does the postdrome phase typically last?

The duration of the postdrome phase can vary significantly from person to person and even between different migraine attacks in the same individual. It can last anywhere from a few hours to several days.

What are the common symptoms of the postdrome phase?

Postdrome symptoms often include:

• Fatigue
• Body aches
• Difficulty concentrating
• Dizziness
• Continued sensitivity to light

Despite the absence of head pain, individuals in the postdrome phase are still experiencing the effects of the migraine attack and may benefit from continued trigger avoidance and relaxation techniques.

The Importance of Understanding Migraine Progression for Effective Management

Recognizing the distinct phases of a migraine attack can be a powerful tool in managing the condition and minimizing its impact on daily life.

How can understanding migraine progression help in symptom management?

Understanding the progression of a migraine attack allows sufferers to:

• Identify early warning signs and take preventive measures
• Anticipate and prepare for upcoming phases
• Time their medication intake for maximum effectiveness
• Implement lifestyle adjustments to minimize trigger exposure
• Communicate more effectively with healthcare providers about their experiences

By recognizing the patterns and symptoms associated with each phase, individuals can take a more proactive approach to managing their migraines.

Strategies for Tracking and Managing Migraine Phases

Effective migraine management often involves a combination of medication, lifestyle adjustments, and self-awareness. Implementing strategies to track and manage migraine phases can significantly improve quality of life for sufferers.

What are some effective methods for tracking migraine phases?

Some useful strategies for tracking migraine phases include:

• Maintaining a detailed headache diary
• Using migraine tracking apps on smartphones
• Keeping a consistent sleep schedule to identify patterns
• Noting potential triggers and their correlation with migraine onset
• Regularly communicating with healthcare providers about observed patterns

By consistently tracking these factors, individuals can gain valuable insights into their unique migraine patterns and triggers.

How can early intervention impact the course of a migraine attack?

Early intervention can potentially:

• Reduce the severity of the headache phase
• Shorten the overall duration of the migraine attack
• Prevent the progression from prodrome to headache phase in some cases
• Minimize the impact of migraine on daily activities and quality of life

Recognizing early warning signs and promptly implementing management strategies can make a significant difference in the overall migraine experience.

Tailoring Treatment Approaches to Individual Migraine Patterns

Given the highly individualized nature of migraine attacks, treatment approaches should be tailored to each person’s unique experience and pattern of symptoms.

Why is personalized treatment important in migraine management?

Personalized treatment is crucial because:

• Migraine patterns and triggers vary greatly between individuals
• The effectiveness of different treatments can differ from person to person
• The timing of medication administration can significantly impact its efficacy
• Lifestyle factors and comorbid conditions can influence migraine experiences
• Personal preferences and tolerance for different treatment options may vary

By working closely with healthcare providers and maintaining detailed records of their migraine experiences, individuals can develop a treatment plan that best addresses their specific needs and patterns.

What are some examples of tailored treatment approaches?

Tailored treatment approaches may include:

• Customized medication regimens based on individual migraine patterns
• Targeted lifestyle modifications to address specific triggers
• Combination therapies that address multiple aspects of migraine attacks
• Integration of complementary therapies like acupuncture or biofeedback
• Personalized stress management techniques

The key to effective migraine management lies in understanding one’s unique migraine profile and working collaboratively with healthcare providers to develop a comprehensive, individualized treatment plan.

The Timeline of a Migraine Attack

Understanding Migraine Progression Can Help You Anticipate & Manage Your Symptoms

Migraine attacks have distinct phases, and understanding them can help people manage their disease. Symptoms associated with the earliest stages of a migraine attack, like the fatigue and blurred vision that can accompany the prodrome and aura stages, can serve as warning signs and signal the need for abortive medication. Identifying and treating a migraine early can even help prevent the symptoms for some people. Additionally, identifying risk factors that can contribute to postdrome “hangovers” may help individuals anticipate the duration of their attack and its aftereffects.

The Phases of Migraine

Prodrome

Also known as “preheadache” or the premonitory phase, prodrome can mark the beginning of a migraine attack. This phase can last several hours or may even occur over several days.

Most people with migraine will experience prodrome, but not necessarily before every migraine attack. If a person with migraine is experiencing prodrome, his or her care team can study their symptoms and patterns to guide a treatment plan that may lessen the severity of the oncoming headache. During this phase, taking medication, minimizing/avoiding other trigger factors (e.g. foods, alcohol) and practicing mindfulness meditation, relaxation therapy or other biobehavioral techniques, can even prevent headache in some cases. Prodrome symptoms vary from person to person, but can include changes in mood, from feelings of depression or irritability to difficulty focusing. Other symptoms may include fatigue, sensitivity to light and sound, insomnia, nausea, constipation or diarrhea, and muscle stiffness, especially in the neck and shoulders. Symptoms that are especially unique to the prodrome phase of migraine include yawning, cravings for certain foods, and frequent urination.

Aura

Up to one-third of people with migraine experience aura as a distinct phase in the progression of their migraine attack. Like other phases, aura doesn’t necessarily occur during every migraine attack in those who experience them. People experiencing aura might endure periods of blurry vision or vision loss, or the appearance of geometric patterns, flashing or shimmering lights, or blind spots in one or both eyes. These symptoms usually gradually evolve over at least 5 minutes and can last for up to 60 minutes. Not all auras are followed by headaches, but since they typically precede the headache phase, they can serve as another warning of a potential headache. In about 20% of individuals, the aura may last longer than 60 minutes and in some, the aura may not precede the headache phase but occur after the headache has already started.

Headache

The headache phase of a migraine attack is characterized by pain on one or both sides of the head. This phase typically lasts from several hours to up to three days. Headache phase pain can vary from person to person and from incident to incident, with some migraine attacks causing mild pain, while others are debilitating. The pain can shift from one side of a person’s head to the other over the course of the headache, or more commonly, may begin on one side and then gradually involve the other side. Besides pain, headache phase symptoms can include nausea, inability to sleep, anxiety, and sensitivity to sound, light and smell. Even everyday activities — like turning on the lights or participating in physical activity — can aggravate people with migraines during this phase.

Postdrome

Postdrome, also called the “migraine hangover,” typically occurs after the end of the headache phase. Like prodrome and aura, not every person with migraine suffers from postdrome, but it does occur in most (approximately 80%). For those that do, postdrome may not follow every migraine attack they experience, and the length of this phase can vary. Postdrome can be just as debilitating as headache, according to some people with migraine. Symptoms of postdrome include fatigue, body aches, trouble concentrating, dizziness and sensitivity to light. Even though the headache is over, people in postdrome are still experiencing a migraine attack and can benefit from avoiding triggers that aggravate headache, like bright lights and strong smells. Some people have reported finding relief during this phase by engaging in relaxing activities like meditation or yoga, drinking water and avoiding stress.

Understanding your individual phases of migraine can be an essential cornerstone in finding the right treatment option. Maintaining a headache diary can help people with migraine recognize their symptoms and the phases they experience before and after each headache. Identifying these symptoms, and using them to catch and treat a migraine attack early, is key to lessening the severity of headache—or in some cases, even stopping them.

More than 36 million Americans suffer from migraine, but only one of every three patients talk with their doctor about their headaches. If you experience migraine attacks and haven’t yet partnered with a healthcare team, use the American Migraine Foundation search tool to find someone in your area who can help manage your pain today.

What Causes Migraine Headaches: Triggers, Signs and Remedies | Cove

Migraines are really painful, debilitating headaches that affect all sufferers the same way, right? Sorta. Yes, migraines are painful and debilitating, but no, they’re not all the same.

In fact, it’s normal for sufferers to experience totally different migraine symptoms, depending on their personal triggers and patterns. Plus, there are several different types of migraines to begin with.

So how do you know which type of migraine you’re dealing with—or if it’s even a migraine at all?

Doctors break down migraines into several categories, and learning more about which migraine type you might have can help you get a diagnosis and a personalized treatment that works for you.

Let’s take a look at the types of migraines, starting with the most common.

Main symptoms: throbbing pain that starts on one side of your head (for many sufferers, migraines tend to start behind the left eye), moving around tends to make the pain worse, and it’s normal to feel nauseous, dizzy, and sensitive to light and sound.

Duration: 4-72 hours

The first and most widespread type of migraine is known as the common migraine. It, like other headaches formally recognized by doctors, is listed in the International Classification of Headache Disorders (ICHD-3).

But even within this category, there’s some nuance. Ready for a few numbers? Here goes:

If, for at least three months in a row, you get a headache more than 15 times per month, and eight of them have migraine symptoms, that means your migraines might be becoming chronic. Chronic migraines will typically have the same symptoms as episodic migraines that just pop up now and then, according to the American Migraine Foundation.

When you get a common migraine, you might also notice that you feel strange in the hours or days before the actual headache sets in. This is called the “prodrome,” which is medical lingo for the first phase of a migraine attack. The prodrome can bring on:

• Difficulty speaking or reading
• Increased urination
• Irritability and depression
• Food cravings
• Frequent yawning
• Muscle fatigue or tight or stiff muscles, particularly in the neck and shoulders
• Nausea, constipation, or diarrhea
• Poor concentration
• Sensitivity to light, sound, touch, and smell
• Trouble sleeping

125rem” font-weight=”lighter”>As if that’s not enough, after the 4-72-hour headache hits, it’s normal to get a “migraine hangover,” or postdrome. The hangover can make you:

• feel moody
• feel sensitive to touch, especially in the areas where your headache was focused
• feel tired
• have stomach issues

Here’s some more info about how the common migraine progresses.

Main symptoms: visual disturbances before a migraine begins, followed by common migraine symptoms

Duration: can range from a few minutes to a full hour, usually before the migraine attack itself starts. The migraine itself can last from 4-72 hours.

About 25% of people who suffer from migraines also experience aura. Migraine with aura is a broad category listed in the ICHD-3, and can cause visual disturbances and neurological symptoms, as well as unpleasant feelings like a numb face or tongue, and pins and needles that spread across your body.

The ICHD-3 break these down even further into four types: typical aura, brainstem aura, retinal aura, and hemiplegic.

Typical aura can bring on visual symptoms, such as temporary blind spots, geometric patterns, zigzag lines, stars or shimmering spots, and flashes of light, notes The Mayo Clinic.

Brainstem aura involves symptoms that seem to originate in the brainstem, like difficulty speaking, double vision, ringing ears, or vertigo.

Hemiplegic migraine involves symptoms like motor weakness, or a loss in the strength of your muscles, usually on one side of your body, and according to Genetics Home Reference, you could struggle with language and feel confused or tired.

Like with typical aura migraines, these symptoms usually last just minutes and no more than an hour (however for some people, it can be longer), but memory loss and problems with your attention span can linger for weeks or even months. Sometimes, hemiplegic migraines can cause more serious issues, like seizures, coma, and long-term problems with brain function and body movement. These might be frightening facts to read, so know that these types of migraines are rare and the extreme side effects are uncommon.

Retinal migraine (a.k.a. ocular migraine and optical migraine) differs from a typical migraine with aura in that you only have visual disturbances in one eye. Because they cause visual issues, they’re sometimes called “ocular migraines” or “optical migraines.”

Main symptoms: coincides with your period

125rem” font-weight=”lighter”>Duration: 4-72 hours

Menstrual migraines, or “hormonal migraines” are pretty much what they sound like—migraines in women triggered by hormonal changes. They’re listed in the official ICHD-3, which notes that menstrual migraines can happen with aura or without, and usually strike just before or at the beginning of your period. If you get migraines during this time in two out of three periods, they might be menstrual migraines.

According to the US Office on Women’s Health, menstrual migraines might be triggered by the quick drop in the hormones estrogen and progesterone that happens before your period starts. They affect about 7-19% of women. That said, most women who get menstrual migraines also have migraines at other times, too.

A frustrating but good-to-know fact from the Journal of Headache and Pain is that menstrual migraines tend to last longer than your average non-menstrual migraines, and might be more painful.

Main symptoms: vertigo, dizziness, and trouble with balance

Duration: ranges from a few seconds to a few days

Vestibular migraines are surprisingly common, reports Cephalalgia, affecting 30-50% of migraine sufferers. To get more specific, vestibular migraines can give you sudden bouts of vertigo, where you either feel like you’re moving when you’re not, or see the world spinning, according to ICHD-3.

Sometimes this happens when you move your head, or when you see something particularly stimulating. Interestingly, as is listed in ICHD-3, the vertigo attacks might not always occur right before a headache sets in, like aura symptoms. In fact, Cephalalgia notes that they might last for just a few seconds or even for a few days.

Main Symptoms: no actual headache pain

Duration: each symptom can last 1 hour or less

Now this one might you do a double-take. If you get aura symptoms but never get the telltale splitting pain in your head, you might have a migraine without a headache, sometimes known as a “silent migraine,” “painless migraine,” or “acephalgic migraine.” The ICHD-3 simply calls them a typical migraine with aura without a headache.

An acelphagic migraine, or a migraine with no pain, can have all the same symptoms of migraines with aura, except the headache never shows up, according to Brigham and Women’s Hospital.

125rem” font-weight=”lighter”>Interestingly, the American Migraine Foundation notes that migraines without headaches become more likely as you get older.

Main symptom: stomach pain instead of a headache

Duration: 1-72 hours

Yep, you read that right—abdominal. Sometimes, instead of a headache, a migraine can cause extreme pain in your abdomen. This is an abdominal migraine, and it’s more common in children than adults—though 2/3 of them end up developing migraine headaches as adolescents, reports The Migraine Trust.

The ICHD-3 lists it as a condition that might be associated with migraines. According to the American Migraine Foundation, abdominal migraines cause pain near the belly button, and can also make you feel nauseous, give you no appetite, cause vomiting, and make you look pale.

Yale Medicine notes that, just like common migraines, abdominal migraines can be triggered by things like stress, bright lights, and food additives like monosodium glutamate (MSG). They’re also typically treated using the same medications as standard migraines with headaches.

Main symptoms: a migraine that that lasts more than 72 hours

Duration: 72+ hours

Status migrainosus is basically a migraine (with or without aura) that lasts longer than the standard max of 72 hours. The ICHD-3 recognizes status migrainosus, and points out that overusing migraine medications could be a likely cause.

The National Headache Foundation points out other triggers can bring them on too, however, like:

• changes in food and sleep habits
• changes in medication
• changes in weather
• head and neck traumas
• hormones
• illnesses, like the flu or a sinus infection
• sinus, tooth, or jaw surgeries
• stress

125rem” font-weight=”lighter”>Status migrainosus can be extremely frustrating, to put it mildly. The National Headache Foundation calls it a “trick candle on a birthday cake,” because the headache might briefly respond to medication, only to flood back after a break.

If none of these descriptions seem quite right, it’s possible your headaches might be something besides migraines. Other common types of headaches are:

Tension headaches are the most common headaches for adults.

• The pain is typically less severe than in migraines, more of an ache than a throbbing pain.
• They affect both sides of your head.
• They don’t usually hurt as badly as migraines.
• They don’t get worse when you’re active.
• They don’t cause symptoms like sensitivity to light and sound, or nausea.

Cluster headaches cause extreme head pain, but, unlike migraines, they appear up to eight times per day in bursts (or clusters) of weeks or months and feel more like stabbing pain, than throbbing.

Sinus headaches are caused by a sinus infection and are rare. The National Headache Foundation notes that people often think they have sinus headaches when they actually have migraines.

According to the American Migraine Foundation, post-traumatic headaches happen after a traumatic injury, and can cause symptoms that mimic migraines, like severe throbbing pain that gets worse if you move around, nausea and vomiting, and sensitivity to light and sound. It typically ends within a few months but can become “persistent” and last longer, especially if you have a family history of or already suffer from migraines.

As the American Migraine Foundation reports, new daily persistent headaches are what they sound like—headaches that suddenly begin to pop up every day, keeping you in pain for over three months, reports. You’ll need to see a doctor to learn the true cause of NDPH, but it can be treated like a migraine if the symptoms are the same.

If you have painful, recurring headaches, you know one thing: You want them to go away. The first step is finding a doctor to help you figure out just what a kind of headache you’re dealing with. Once you know that, you’ll be better able to figure out the best treatment.

The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

Photo by Hamish Duncan on Unsplash.

Migraine – Introduction & Overview

Migraine and Other Health Conditions

Studies show that the prevalence of other health conditions, particularly depression, anxiety, insomnia, gastrointestinal issues, angina, epilepsy, and allergy, is higher amongst those with migraine and severe headache than the general population (17). These are referred to as ‘comorbidities’, meaning that people with one of the conditions are more likely to have one or more others as well. Recently, the migraine in America symptoms and treatment (MAST) study identified some of the most common comorbidities, surveying over 15,000 migraine patients and 77,000 controls (17). Extracts from this study and related studies on these comorbidities are included below. 

Depression and anxiety

There have been studies linking migraine and psychiatric disorders dating back to 1990, when a study in Zürich found a strong association between migraine and depression (18). More recently, researchers found that migraine patients were two to three times as likely to have depression and more than three times as likely to have anxiety compared to the population (17, 19). This is heightened if a patient develops medication overuse headache, in which case they’re five or eight times as likely to develop depression or anxiety, respectively. While the root cause of this comorbidity still requires more research, psychiatric disorders and migraine share many biological, psychological and socio-environmental characteristics. Some key similarities are abnormal brain development and genetic traits, as well as the abnormal function of neurotransmitters and sex hormones, and stress (18). 

Insomnia

The relationship between insomnia and migraine was long thought to be a result of cause and effect – for example, having a nocturnal migraine could disrupt one’s sleep. However, studies have shown that there is crossover in the underlying pathophysiology between these disorders. This includes the importance of common brain structures in both sleep and migraine (particularly the hypothalamus), and the involvement of some of the same neurotransmitters, neuropeptides and hormones (20). As a result, people with migraine are two to three times as likely to experience insomnia than people with no medical conditions (17, 21). Migraine is also comorbid with several other types of sleep disorders. Sleep performs important functions for the brain, and a lack of sleep may play a role in the progression of development of migraine (26).

Gastric ulcer/gastrointestinal bleeding

Patients with migraine are approximately three times more likely to have gastric ulcers, gastrointestinal (GI) bleeding or other GI disorders than the general population (17). There was also a direct correlation between the severity of migraine attacks, both in pain and headache days per month, and the likelihood of experiencing GI issues (17). Currently, the nature of this connection is unclear – whether there is an underlying shared pathophysiology, or if GI issues are a side effect of medication used by migraine patients. One study found that migraine patients with GI issues were also more likely to use opiates or barbiturates, so the link between GI conditions and medication is an area for future research (22).

Angina and other cardiovascular conditions

The MAST study found that the cardiovascular conditions that were most commonly comorbid with migraine were angina (reduced blood flow to the heart) and peripheral artery disease (PAD) (17). Both conditions were approximately twice as likely in migraine patients than the general population. However, another study found that there were differences between migraine subtypes – people who experience aura were three times more likely to have angina, while those without aura had a much lower risk (23). At this stage, there is no clear medical reason for the link between migraine and these conditions, other than the increased risk. Clinical advice for patients worried about vascular diseases is to avoid smoking, or medications that could impact cardiovascular function (23). 

Epilepsy

There have been a number of studies investigating the link between migraine and epilepsy, showing that migraine patients are more than twice as likely to have epilepsy than non-migraine controls (17). Both disorders involve neuronal excitability and changing electrical functions in the brain, such as the pattern of cortical spreading depression (a mechanism thought to cause aura symptoms). This is particularly evident in patients with familial hemiplegic migraine (FHM), as there are genetic overlaps in the neurotransmitter genes and ion channel genes in these two disorders (24). 

Asthma and allergies

Many studies have shown the relationship between respiratory conditions and migraine, however the biological mechanisms causing this are still unclear. Some theories include genetic disposition, abnormal muscle function in blood vessels and airways, and mast cell activation (irregular immune system function). A notable feature of the link between respiratory issues and migraine is that the likelihood of comorbidity increases with headache days. One study found that migraine patients with fewer than 7 headache days per month were 1.5 times more likely to have hay fever, while those with 14 or more headache days were 2.6 times as likely to have hay fever (25). This trend was consistent for asthma and chronic bronchitis.

How Long Does A Migraine Last? — Doctor Migraine Britt Talley Daniel MD

This is an article by Britt Talley Daniel MD, member of the American Academy of Neurology, migraine textbook author, podcaster, YouTube video producer, and blogger.

However, the specific definition of how long a Migraine headache lasts is not the work of some vaulted neurologic panel of headache doctors.  The time frame of 4 to 72 hours has to do with the way the human brain works.

How Long Does A Migraine Last?  By definition of the International Classification of Headache Disorders v3. a single attack of Migraine headache may last 4 to 72 hours.  This reference of time, delimiting an episode of headache is helpful in differentiating Migraine from other types of headaches.

The Migraine process causes the release of 3 inflammatory neurochemicals, Neurokinan A, Substance P, and Calcitonin Gene-Related Peptide (CGRP).  CGRP is produced in both peripheral and central neurons.

CGRP is an active vasodilator and functions to transmit nociception, or pain.  In the cerebral trigeminal vascular system, the cell bodies of the trigeminal ganglion are the main source of CGRP.

The start of the headache part of a Migraine begins with release of these 3 neurochemicals, which then drain out of the brain via the jugular vein, are metabolized in the liver, and released from the body in the toilet.  It takes 4 to 72 hours for this process to occur.  This is the reason a Migraine may last from 4 to 72 hours.  It is a process dictated by human metabolism and not some headache committee.

Related questions

What is the difference between episodic and chronic Migraine?

Episodic Migraine is defined as 14 or less headaches a month, while chronic Migraine is 15 or less headaches a month, 8 of which have Migraine features.   An episode of Migraine stands out as an event of headache, nausea, vomiting, sensitivity to light and sound, and the need to be down.

Persons with chronic Migraine may have these same features every day, or 80-90% of the time, so that it seems to the afflicted individual to be just one big headach time or nearly continuous headache.  The timespan of headache being 4-72 hours may be lost with this kind of Migraine since the headaches are continuous.

Does Migraine have different phases?

The Migraine syndrome has 4 individual phases: Prodrome, Aura, Headache, and Postdrome and the following analysis refers to Migraine persons who suffer an untreated Migraine.

Prodrome Phase This first phase of migraine comes on for hours to a day before the attack.  Prodrome symptoms can be mood changes, irritability, excitability, depression, yawning, food craving, and urination.

Aura Phase. Approximately 30% of persons with Migraine have an aura.  The most common aura here are visual changes of seeing zig-zag images, black holes, or half of things.

Some persons have a spreading numbness or tingling which moves across the arm, to the hand, and then the same side of the face, lips, or tongue.  As the tingling moves up there is clearing of the involved anatomical location that happened earlier.  Tingling in the right little finger may move to the ring finger and then the middle finger but by the time numbness is to the middle finger the little finger numbness has cleared.

A smaller number of persons may develop aphasia which difficulty in understanding words and speaking.  The order of symptoms here is always visual symptoms before numbness before aphasia.  All these aura symptoms by ICHD criteria should clear within 60 minutes.

Headache Phase Headache can last 4 to 72 hours and is a headache with true Migraine features, being one-sided, severe, throbbing, associated with nausea or vomiting, and sensitivity to light and sound.  Untreated the severity of headache is worse on day 1 and better by day 3.

One survey of 1100 Migraine patients published in May 2020 in Headache reported that 44% of people said that their Migraine headache phase usually lasts up to 24 hours.  Thirty-three and a third of patients had headaches lasting longer than 24 hours. 

Postdrome Phase At this time most persons have little or no headache pain but many of them do not feel normal.  This feeling may last 24 to 48 hours.  During this time people say they are not as sharp and feel hungover, while some feel up, elated, hyper, or euphoric.  Many Postdrome Migraine patients report pain on just touching their head, a symptom called allodynia where touch is perceived as painful.

Why do many persons with Migraine only have headache for a short time?

Early treatment of a Migraine in 10,15, or 20 minutes may come for persons treating quickly and at onset of their Migraine with a triptan, especially the quick acting triptans like subcutaneous 6 mg sumatriptan, or 5 mg zolmitriptan nasal spray which both work in 10 minutes.  Intramuscular or nasal spray DHE and eye drop timolol could also be included in the quick acute onset list of drugs for Migraine.

The other oral triptans such as rizatriptan, almotriptan, and eletriptan take at least 30 minutes to work and the longer duration triptans such as naratriptan and frovatriptan take 1-2 hours to kick in.

The Signs You’re Having a Migraine

About one in seven Americans experiences the throbbing, pulsing, excruciating agony of a migraine at least once a year, and it’s one of the leading causes of emergency room visits in the United States. But as common as they are, many people don’t even realize their intense headaches are actually migraines. Recent research shows that when someone self-diagnoses a sinus headache, it’s actually a migraine a whopping 90 percent of the time.

That’s why understanding migraine symptoms is so important. If you know you’ve been having migraines, then you can start identifying migraine triggers to avoid and know when to begin administering migraine treatment.

The 4 phases of a migraine headache

The migraine sign everyone knows is a severe headache, but there’s actually more to it than that. In fact, there are four distinct stages to a migraine that can begin up to a full day before you descend into the pits of an attack. You might not go through every migraine phase every time you have one, and you may never experience some at all. Still, keep an eye out for these signs.

Phase 1: Prodrome

In the day or two before an attack, you may develop symptoms like:

• Thirstiness
• Frequent urination
• Food cravings
• Constipation
• Neck stiffness
• Mood changes
• Frequent yawning

Though these symptoms are irritating, they can serve as warning signs. This can be helpful if you’ve had migraines before and know you’ll need to take meds (either ones prescribed by your doctor, or over-the-counter drugs like Excedrin), because you’ll have a better sense of when to take the medication. The faster you treat the migraine, the more effective the treatment is likely to be.

Phase 2: Aura

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Roughly one out of every three migraine sufferers has an aura either just before or during the headache. It’s usually a visual disturbance, and can look like “colored lights, zig-zagging patterns, dots, and prism effects that tend to shimmer or scintillate and migrate across the visual field,” says Bradley Katz, MD, a neuro-ophthalmologist at the University of Utah’s Moran Eye Center who specializes in treating migraine-related light sensitivity. “There’s usually a small blind spot, too. If you were driving while having a migraine aura, you’d have to pull over and wait for it to pass.”

There can also be olfactory auras, where you think you smell something bad and chemical-like, Dr. Katz says. That’s not all: “Others can suddenly become confused, have trouble speaking or thinking of words, or experience numbness or tingling on one side of the body—stroke-like symptoms.” An aura might last for 20 to 60 minutes, and it tends to begin gradually and then build.

Phase 3: Attack

❗️A pulsing, throbbing headache

Migraines can sometimes be mild, but often they cause severe pain that throbs or pulses. Often, this pain occurs on only one side of the head, but sometimes it occurs on both sides. The pain can last four to 72 hours, on average, if left untreated, and it may be accompanied by blurred vision and lightheadedness or fainting. This migraine headache might be episodic and occur every now and then, or it could be chronic and happen more than 15 days out of each month for three months or more.

❗️Nausea or vomiting

If you feel queasy or toss your cookies alone with your headache, you’re most likely experiencing a migraine.

❗️Hypersensitivity to lights and sounds

When you feel blinded by certain kinds of lights or sounds feel especially noisy—and all you want to do is curl up in a quiet, dark room and sleep—hello, migraine. “It’s mainly non-incandescent, artificial, indoor light that irritates people with migraine,” says Dr. Katz. “This could include fluorescent light bulbs, computer screens, and the type of overhead lighting you’ll find in stores like Walmart, Lowe’s, Home Depot, or Costco.”Sometimes when a migraine hits, you can become extra-sensitive to smells and touch, too.

These telltale symptoms can be intense, which can make a migraine an especially annoying kind of headache to get. Migraines are more likely than other kinds of headaches to negatively interfere with your plans or responsibilities. For example, if you find that you can’t make it through, say, attending a child’s birthday party with your little one, you probably have a migraine.

Phase 4: Post-Drome

After the headache you might get something similar to a hangover (think: feeling drained, dizzy, weak, or confused).

When it comes to the sequence above (prodrome, aura, attack, and then post-drome), know that you may experience all of those stages or none—it varies from person to person. In fact, it’s even possible to develop an aura and no headache. “That’s far less common. It’s more likely to happen as you mature. Someone might have migraine aura with headache at a younger age and then just the aura as they get older,” says Wade Cooper, DO, director of the University of Michigan’s Headache and Neuropathic Pain Clinic in Ann Arbor.

When to call a doctor about your migraines

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If you’re not getting satisfactory relief from over-the-counter medications and lifestyle changes, or if you’re taking over-the-counter medications more than 10 to 15 times per month, talk to your primary care physician about your headaches.

“The evaluation of headaches usually starts with the primary care doctor, who assesses whether a patient has a common headache or something more serious,” says Santiago Mazuera Mejia, MD, a neurologist at the Sandra and Malcolm Berman Brain & Spine Institute at LifeBridge Health in Baltimore, Maryland. “Primary care doctors often continue to see people with infrequent migraines. However, if at some point, there is a need for more complex treatments, patients usually go to neurologists and headache specialists who have additional training in preventive and acute treatments as well as nonmedical treatments.”

It’s important to get evaluated by a doctor because taking over-the-counter medications too frequently can sometimes lead to serious side effects (like liver problems) or actually make you get headaches more often.

It’s helpful to keep a diary if you experience migraines because you may discover your triggers, which can inform which type of treatment is best for you. Write down what time your migraines occur, how long they last, how you slept the night before, what you ate/drank that day and when, how you felt emotionally that day, etc. Then bring that information to your doctor.

Tip: Keep a diary of your migraines. It may help you discover your own personal triggers.

And ask your family members about the specific symptoms above to see if any of them have ever experienced migraines, since researchers believe there may be a genetic cause. Your doctor will want to know that, too. Remember, it’s possible that your relatives have had migraines but just never knew what they were called. Many migraines, unfortunately, go undiagnosed and untreated. The good news is there are lots of migraine treatment options that may help you find major relief.

If you have any of the following headache symptoms, be sure to go to the emergency room immediately, because these may be signs of a more serious medical problem.

• A headache that occurs after a head injury, especially one that becomes increasingly severe
• A headache that gets worse when you cough, strain, or exert yourself
• A sudden, severe headache that feels like a thunderclap

Jane Bianchi
Jane Bianchi is a writer and editor with more 13 years of experience specializing in health; she formerly worked as a health editor at Family Circle, and her work has appeared in Men’s Health, Women’s Health, Esquire, and more.

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Ocular Migraines (Eye Migraines) – Pittsburgh Eye Associates

Ophthalmic (eye) migraines are quite common and often painless, although the solo term “migraine” usually brings to mind a severe type of headache.

But with eye-related migraines, visual disturbances with or without headache pain also can accompany migraine processes thought to be related to changes in blood flow in the brain.

These visual problems associated with migraines technically are known as ophthalmic migraines, but are much more commonly (though incorrectly) called ocular migraines. Because most laypeople understand the term better, this article refers to the condition as “ocular migraine.”

Migraines can be produced by the body’s neurological responses to certain triggers such as hormonal changes, flashing lights or chemicals in foods or medications. One result of these triggers may be an intense headache that, if untreated, can last for hours or even days.

During migraine processes, changes also may take place in blood flow to the area of the brain responsible for vision (visual cortex or occipital lobe). Resulting ophthalmic or ocular migraines commonly can produce visual symptoms even without a headache.

Ocular Migraine Symptoms

People with ocular migraines can have a variety of visual symptoms. Typically you will see a small, enlarging blind spot (scotoma) in your central vision with bright, flickering lights (scintillations) or a shimmering zig-zag line (metamorphopsia) inside the blind spot. The blind spot usually enlarges and may move across your field of vision. This entire migraine phenomenon may end in only a few minutes, but usually lasts as long as about 20-30 minutes.

Generally, ocular migraines are considered harmless. Usually they are painless, cause no permanent visual or brain damage and do not require treatment.

Still, always consult your eye doctor when you have unusual vision symptoms, because it’s possible that you have another condition requiring treatment, such as a detached retina, which should be checked out immediately.

What Should I Do if I Have an Ocular Migraine?

Unfortunately, a visit to the eye doctor may produce few answers in terms of how to treat or prevent ocular migraines. This is because processes that trigger ophthalmic migraines are poorly understood.

The vision symptoms accompanying painless ocular migraines are not related directly to the eyes. Instead, these visual symptoms occur as a result of the migraine “activity” in the visual cortex of the brain located in the back of the skull.

Painless ocular migraines can appear suddenly, creating the sensation of looking through a cracked window. The accompanying visual distortion spreads across the field of vision and usually disappears within about 20 minutes.

As described above, your vision and visual acuity will be affected significantly during an ophthalmic migraine attack or episode.

If sharp vision is essential for your safety, then you should stop what you are doing immediately. If you are driving, pull over until the ocular migraine passes and your vision has cleared.

Stay still until the ocular migraine resolves. If you have concerns about unusual or lingering vision symptoms, visit your eye doctor or other physician for a checkup.

Ocular Migraine Treatments

Normally, ophthalmic migraines do not require treatment.

But if these symptoms recur regularly or with increasing frequency, then you may need medication to reduce the frequency and/or severity of attacks, so consult your doctor. You may need to take these medications for extended periods of time to prevent recurrence of ophthalmic migraines.

Migraine – HealthyWomen

Overview

What Is It?

Migraine is a biologically based disorder. Its symptoms are the result of changes in the brain, not a weakness in character or an inappropriate reaction to stress.

As busy women, we can barely fit in everything we have to do as it is. Let alone while juggling the crippling pain of a migraine. But unfortunately, up to one in five women deal with migraine headaches on a regular basis.

Migraines differ from other types of headaches in that they are brutally painful and are often accompanied by nausea or sensitivity to light and sound. As anyone who’s suffered a migraine can tell you, these headaches can disrupt every aspect of a person’s life, from the ability to work to day-to-day activities to relationships. They can eventually lead to lower self-confidence and a feeling of losing control.

In the United States, about 12 percent to 16 percent of the population suffers from migraine headaches.

Women experience migraines three times more frequently than men. Researchers have found that migraines affect women more profoundly than they do men, interfering with professional development and family and social life. Gender aside, nearly half of migraine sufferers could benefit from preventive therapies, according to the American Migraine Prevalence and Prevention (AMPP) Study.

What Are Migraines?

Although some people equate them with a person’s stress level, a migraine is a biological disorder. Its symptoms result from changes in the brain, not inadequate coping mechanisms.

For many years, scientists believed migraines were linked to the dilation and constriction of blood vessels in the head. They now believe migraine results from inherited abnormalities in certain brain cells. People with migraine are predisposed to attacks triggered by a range of factors. Specific, abnormal genes have been identified for some migraine forms.

Most migraine sufferers appear to be sensitive to various triggers, such as the menstrual cycle, weather changes, skipped meals, disturbed sleep, bright lights, odors, stress, or certain foods and beverages.

An estimated 25 percent to 30 percent of migraine victims experience what’s called “aura” prior to an attack. Aura usually takes place 5 to 60 minutes before the migraine sets in and may include flashing lights or visuals resembling TV static or zigzag lines. An aura usually lasts 20 to 30 minutes but can remain for as long as an hour. Some sufferers also temporarily lose vision. Other classic symptoms of a migraine aura include speech difficulty, weakness in an arm or leg, tingling of the face or hands and confusion. Migraines with aura are known as classic migraines.

Even if you don’t have an aura, you may experience a variety of vague symptoms before a migraine, including mental fuzziness, mood changes, food cravings, fatigue or unusual fluid retention. Migraines without aura are known as common migraines. Some people experience both classic and common migraines.

Migraine sufferers often describe the pain of the headache as one-sided and intense, throbbing or pounding. They usually describe feeling the pain in the forehead, temple, ear and/or jaw, around the eye or over the entire head. It may include nausea and vomiting and can last anywhere from a few hours up to three days.

People who suffer from migraines may also experience cutaneous allodynia, a condition in which you feel pain on your scalp from a source that should not cause pain, such as brushing your hair.

Migraines can strike as often as almost every day or as rarely as once every few years. Some women get migraines in predictable patterns, such as when menstruation begins or every Saturday morning after a stressful work week.

In addition to the classic migraine described above, migraine headaches can take several other forms:

• Hemiplegic migraine: Patients with hemiplegic migraine have temporary paralysis on one side of the body, a condition known as hemiplegia. Some people with this form may experience vision problems and vertigo (a feeling that the world is spinning). These symptoms begin 10 to 90 minutes before the onset of headache pain. Complete recovery may take weeks.
• Migraine with brainstem aura: Migraine with brainstem aura involves a disturbance of a major brain artery. Preheadache symptoms include vertigo, double vision and poor muscular coordination.
• Status migrainosus: This is a debilitating migraine attack that can last 72 hours or longer. The pain and nausea are so intense that sufferers are often hospitalized. The use of certain drugs can trigger status migrainosus. Neurologists report that many of their status migrainosus patients were depressed and anxious before they started getting headache attacks.
• Abdominal migraine: If you suffer from abdominal migraine, you will feel pain in the middle of your abdomen rather than your head. Abdominal migraines usually last a few hours and occur mainly in children who later develop migraines. Symptoms may also include nausea, vomiting and diarrhea.
• Acephalgic (or silent) migraine: These occur when migraine symptoms occur but there is no headache.

Chronic migraine is a secondary diagnosis for some people who have migraines. It affects about 5 percent of the world population. Chronic migraine is when you have headaches at least half the month and some are full-blown migraines. To receive a diagnosis, you must have tension-type or migraine headaches that occur at least 15 days a month for at least three months. In addition, you must have two or more of the following symptoms on eight or more days a month for at least three months: moderate to severe headaches; headaches on one side of the body; pulsating head pain; headaches aggravated by routine physical activity; headaches that cause nausea, vomiting or both; or headaches coupled with sensitivity to light or sound.

Choosing Your Provider

If you are seeking a diagnosis and treatment for migraines, it’s important to choose the right health care provider. There are four levels of providers: primary care, neurologist, headache specialist (board certified in headache medicine), and anesthesia pain doctors or surgeons who can do advanced procedures, like implanting stimulators and doing decompression surgeries.

If you have one migraine per week or fewer, start by seeing your primary care doctor. If you have more frequent migraines, you may want to start with a neurologist and advance to a headache specialist if not satisfied after a few visits. If you have chronic migraine, you will likely want to start with a board-certified headache specialist. Anesthesia pain doctors and surgeons are usually only seen on referral from a headache specialist after preventive treatments fail.

Diagnosis

Because migraine headaches may have a genetic component, it’s important that you talk to your health care professional about your family history. Even if you are not sure whether any of your relatives suffered from migraines, try to think of past illnesses and lifestyles that may have indicated headaches. Keep in mind that the term “migraine” was not used until the 1950s, and even then many migraines were not diagnosed or referred to by this term.

Regarding family history, consider these questions:

• When growing up, do you recall a family member who was sick much of the time?
• If so, did he/she exhibit any of the following symptoms: head pain that interfered with daily activities, nausea or vomiting, sensitivity to light or sound, numbness or speech difficulty?
• To what did he or she attribute symptoms of their headache: menstrual cycle, overwork, fatigue, stress or something eaten or drunk?

Be prepared to discuss with your health care professional both the symptoms of relatives’ headaches and their methods for coping.

Diagnosing a headache involves ruling out other problems, such as tumors or strokes. A detailed question-and-answer session can often produce enough information for a diagnosis. Some women have headaches that fall into an easily recognizable pattern, while others require further testing to determine if symptoms are due to secondary causes such as dental pain, hemorrhage or tumor.

You may be asked:

• How often do you have headaches?
• Where is the pain?
• How long do the headaches last?
• When did you first develop headaches?

Your health care provider may also ask about your sleep habits and family and work situations.

Most of the time, a health care professional makes a migraine diagnosis by focusing on your history, asking about past head trauma or surgery, and looking into your medication use. Health care professionals may also order blood tests to screen for thyroid disease, anemia or infections that could cause a headache.

Additional tests to rule out other medical problems may include:

• A magnetic resonance imaging (MRI) scan is the preferred tool to rule out headaches associated with aneurysms (abnormal ballooning of a blood vessel) and brain lesions. MRI scans provide a more detailed view of the cerebral anatomy and are warranted in cases where migraine can’t be diagnosed by history alone.
• A magnetic resonance angiogram (MRA) is a type of MRI that looks at the blood vessels inside the body. It is a refined tool to pick up minute lesions of the vascular system of the brain such as small aneurysms.
• A computed tomographic (CT) scan produces images of the brain that show variations in the density of different types of tissue. The scan enables the physician to distinguish, for example, a bleeding blood vessel in the brain from a brain tumor. The CT scan is an important diagnostic tool in cases of sudden headache caused by hemorrhage.
• An eye exam checks for signs or symptoms such as weakness in eye muscle, unequal pupil size or pressure behind the optic nerve. These could be evidence of brain lesions or elevated or low cerebral spinal fluid, among other conditions. A physician who suspects that a headache patient has an aneurysm may also order an angiogram. In this test, a special fluid visible on an x-ray is injected and carried in the bloodstream to the brain to reveal any abnormalities in the blood vessels.
• A lumbar puncture (spinal tap) can rule out conditions such as pseudotumor cerebri, meningitis, encephalitis or a brain bleed if the headache is associated with neck pain, fever and/or sudden onset. The spinal tap takes about 30 minutes and may cause a headache due to the drop in cerebral spinal fluid pressure. There is also a small risk of infection with this procedure.

Your health care professional will analyze the results of these tests along with your medical history to make a diagnosis.

Head pain is typically diagnosed as one of the following types of headaches; some people have more than one type:

• Migrainous headaches, the group that includes migraine. This type of headache is recognized as being principally “neurogenic-initiated,” eventually affecting the cerebrovascular system.
• Tension-type headache. These headaches involve the tightening or tensing of facial and neck muscles.
• Cluster headaches. These are far less common than migraine and are more often found in men than women. These headaches are described as excruciating pain in one part of the head or around the eye, with features such as eye tearing and nasal congestion that occur on the same side of the head as the pain.
• Traction and inflammatory headaches. These headaches involve symptoms caused by other disorders, ranging from stroke to sinus infection to eye disorders to an abnormal growth or mass.
• Chronic migraine. To be diagnosed with chronic migraine, you must meet the criteria spelled out by the International Headache Society, which includes headaches that strike 15 or more days a month for at least three months coupled with two or more of the following symptoms on eight or more days a month for at least three months:
  • Moderate to severe headaches
  • Headaches on one side of your head only
  • Headache pain that pulsates
  • Headaches aggravated by routine physical activity

Chronic migraine diagnosis also requires headaches that cause either nausea and/or vomiting, or are coupled with sensitivity to light or sound.

Treatment

Health care professionals say that many women don’t express the true extent of the pain they feel with migraine, perhaps because they worry about “complaining” too much. Another problem may be that many people with migraines think there is nothing that can be done. They may have watched their mother or grandmother suffer from migraines and think they simply must suffer, too. Or, they may be resigned to resorting to the often-ineffective treatments their older relatives used to cope with their migraines, despite significant advances in medication and treatment options available today.

Patients commonly deal with a migraine by taking some kind of pain relief medication, lying in bed, struggling with nausea and vomiting and trying to minimize lights, noises and smells that can either trigger a migraine attack or make it worse.

If you have migraines, it is important to develop a good relationship with your health care professional because the condition is usually recurrent. Start by finding a health care professional with experience in treating migraine who understands that migraine is a biological disease.

Headache specialists also recommend looking for a health care professional who is willing to consider a variety of options for treatment, including over-the-counter and prescription medications, nonpharmacological treatments and lifestyle changes.

Communicating treatment needs can be difficult for migraine sufferers for a variety of reasons, but communication is key to effective treatment.

Many migraine sufferers find that keeping a headache calendar is a first step in gaining some control over their headaches. This tool is especially helpful as you begin designing a treatment program with your health care professional.

A headache calendar should include:

• when your headaches occur
• severity and duration of the headaches
• possible triggers, including dietary, stress, environmental, etc.
• dates of your menstrual periods
• interventions attempted

The National Headache Foundation at www.headaches.org has numerous tools and information to help headache sufferers, including a headache diary.

Many electronic diaries are available, including iHeadache, which is available for free online and through app stores. It allows you to track how your care affects your headaches over time, and you may be able to electronically share your information with your health care provider.

Another headache management technique is to make a checklist of your symptoms and treatment responses, then rank the effectiveness of your current treatment program. Use descriptors ranging from very satisfied to very dissatisfied with several categories in between to determine how satisfied you are with your current treatment program. Evaluate whether the treatment:

• is fast acting
• has minimal side effects
• is non-sedating
• relieves sensitivity to bright light and/or sound
• is easy to use
• relieves head pain
• requires only one dose per headache
• is available in an injection
• is available in a nasal spray
• is available in a tablet
• has a proven track record
• is available in several forms

Rank these attributes in terms of how important they are for you. Use the descriptors––very important to not important––to prioritize and personalize your treatment program.

Next, list those activities you feel your migraines most often disrupt. Be sure to include work, family interactions, personal time, sleep, exercise, social opportunities or other activities you’ve canceled one or more times because of migraine attacks.

In fact, recording and communicating your migraine-related disruptions and disabilities with your health care professional may be the key to receiving the most comprehensive treatment course. Health care professionals are more likely to manage your treatment more effectively and aggressively when they receive detailed information on symptoms.

Unfortunately, headache-related disability information is often overlooked during consultations. That’s why there are tools designed to improve communication about headache-related disability, such as the Migraine Disability Assessment Test to improve migraine management.

Next, make an appointment with a health care professional to discuss your migraines. Bring your checklists with you. Ask for a treatment plan that incorporates those components you feel are most important to your headache treatment and lifestyle. Before leaving the professional’s office, arrange a follow-up appointment to discuss the treatment’s success or failure.

Finally, once you begin a treatment program, keep a diary of the frequency and severity of your headaches, as well as how your treatment plan is working. Share the diary with your health care professional on your next visit and be willing to modify your treatment plan if necessary. It can take patience and several changes to find the individualized treatment program that works best for you.

Medication-Based Treatment

In general, health care professionals develop a migraine treatment plan depending on the frequency and severity of migraine headaches. Infrequent headaches, which come once or twice a month, are usually treated with a fast-acting, acute-type medication that relieves head pain, nausea and sensitivity to bright light and/or sound. Women who have migraines more frequently or who have been diagnosed with chronic migraine need a different strategy, often a preventive medication.

Drugs to treat or shorten the duration of migraines:

One of the most popular classes of drugs for migraines are called triptans, which scientists believe bind to certain receptors in the brain to shutdown neurogenic inflammation that occurs in migraine. These drugs can reduce the pain of migraines and limit symptoms such as auras. Specific triptans include naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax). All listed triptans are available in pill form. Sumatriptan and zolmitriptan are also available in nasal sprays. Sumatriptan is available via injection. The fastest acting and most effective form is the injectable form. In addition, a combination of sumatriptan and naproxen sodium, available generically and under the brand Treximet, is available.

Other medications used for acute relief of severe migraine pain include:

• Ergotamine (Ergomar), a drug that was the common prescription choice for migraines before triptans, is less expensive in the generic form than triptans but may not work as well. It is usually prescribed for people with long (greater than 48 hours) or frequent migraines.
• Dihydroergotamine (for example, Migranal nasal spray or injectable Migranol), an ergotamine derivative for migraines, has fewer side effects than ergotamine.
• Nonsteroidal anti-inflammatory agents (NSAIDs) are effective for treating moderate headaches. The NSAIDs include ibuprofen and naproxen sodium. NSAIDs in combination with caffeine may help moderate to severe migraine headaches, but limit use of these, especially caffeine, because of the risk of developing rebound headaches from overuse.
• Dexamethasone, a steroid medication given by injection for an acute attack or orally to break a prolonged cycle, can be used alone or with another acute migraine treatment.
• Indomethecin (Indocin), a prescription medication for arthritis pain that comes in a rectal suppository, may be helpful for people who experience nausea during their migraines.

Because ergotamine and dihydroergotamine can cause nausea and vomiting, they may be combined with anti-nausea drugs. Experts caution that these should not be taken in excess or by people who have angina pectoris; severe hypertension; or vascular, liver or kidney disease.

In many cases, health care professionals will recommend pain relievers first for mild to moderate migraine headaches. However, it’s important to keep in mind that you shouldn’t use these pain relievers too frequently or you could develop medication-overuse headaches or chronic daily headaches. If your headaches respond to pain relievers, you can take them for migraine attacks as long as you don’t take more than one to two doses per week.

Drugs to treat/prevent frequent migraines

• Beta-blockers block specific receptors in the heart to slow it down and reduce blood pressure and may help prevent migraines. Note: Health care professionals recommend that people taking beta blockers, especially people with a history of heart problems, do not suddenly stop taking these drugs.
• Calcium channel blockers, especially verapamil (Calan, Isoptin), may help prevent migraine in people who are prone.
• Anticonvulsants. Some drugs used to prevent seizures, such as divalproex (Depakote), gabapentin (Neurontin) and topiramate (Topamax), seem to help reduce the frequency of migraines in some people. In high doses, these medications may cause side effects.
• Antidepressants. In some cases, low-dose antidepressants are used to help prevent migraines. These include tricyclic antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor) and doxepin (Silenor). In addition, atypical antidepressants, such as venlafaxine (Effexor) may help by enabling certain brain chemicals such as serotonin, norepinephrine and dopamine to remain in the brain longer. Note: The U.S. Food and Drug Administration warns that antidepressants may increase suicide risk, particularly in adolescents and children. Anyone taking antidepressants should be carefully watched for any signs of suicidal behavior. If you are planning to take antidepressants, talk to your health care professional about these risks and always read package information.
• CGRP antagonists. These drugs help block pain transmission by blocking the calcitonin gene-related peptid (CGRP) receptor—or the CGRP itself. The first CGRP antagonist—erenumab-aooe (Aimovig)—was approved by the U.S. Food and Drug Administration (FDA) in May 2018. Aimovig is an injection given once a month. Possible side effects include constipation and pain at the site of injection. The second and third—fremanezumab-vfrm (Ajovy) and galcanezumab-gnlm (Emgality), respectively—were both FDA-approved in September 2018. Each has a possible side effect of injection site reaction.

If you have migraines and are pregnant or plan to become pregnant, you will want to see a board-certified specialist about treatments before and during your pregnancy. Most headache specialists prefer to treat pregnant women with non-medication treatments. Some medications may not be used by pregnant women.

Headache specialists may also use additional treatments such as nerve blocks (most often using lidocaine or bupivacaine) or sphenopalatine ganglion (SPG) blocks for which many newer devices are now on the market.

OnabotulinumtoxinA (Botox) therapy also is FDA-approved to prevent chronic migraine, if other preventive treatments don’t work. Treatments must be injected by a health care professional and typically are given about once three months.

Non-medication Treatment

Drug therapy for migraine can be combined with biofeedback, cognitive behavioral therapy or relaxation training.

Biofeedback is a technique used to gain control over a function that is normally automatic (such as blood pressure or pulse rate). The goal is to change these automatic responses. Biofeedback uses electronic or electromechanical instruments to monitor, measure, process and feed back information about skin surface temperature, blood pressure, muscle tension, heart rate, brain waves and other physiologic functions.

You can practice biofeedback at home with a portable monitor. The ultimate goal of treatment is to wean you from the machine so you can use biofeedback methods anywhere at the first sign of a headache.

Relaxation training involves learning to counteract muscle tension by relaxing your mind and body through methods such as yoga, meditation, progressive relaxation and guided imagery. Relaxation techniques may be used alone or in combination with biofeedback.

In addition, the FDA approved a medical device that uses transcutaneous electrical nerve stimulation (TENS) to help prevent migraines. Research showed that the device reduces the number of migraines experienced per month and the amount of migraine medication required. The battery-powered device, Cefaly, attaches to an electrode placed on the forehead that applies electric current to the forehead to stimulate branches of a nerve that have been associated with migraines. The device is only for adults and requires a prescription; women who are pregnant or might become pregnant should discuss usage with their health care professionals.

Cognitive-Behavioral Therapy

This therapy helps you identify areas in your life and environment that may be triggering your headaches. People with migraine have the same sorts of stressors most people grapple with, but for migraine patients, that stress can trigger migraine episodes. Thus, stress management training helps you to recognize the thoughts, feelings and behaviors that bring on headaches and work to handle them without triggering a headache.

Dietary Treatment

Some migraine sufferers benefit from a treatment program that includes eliminating headache-provoking foods and beverages. That’s why it is so important to keep a migraine diary to identify your unique triggers.

A diet that prevents low-blood sugar (hypoglycemia) may help some migraine sufferers. This condition can occur after a period without food: overnight, for example, or if you skip a meal. Those who wake up in the morning with a headache may be reacting to the low-blood sugar caused by the lack of food overnight.

Treatment for headaches caused by low-blood sugar consists of scheduling smaller, more frequent meals. A special diet designed to stabilize your body’s sugar-regulating system may help. For the same reason, many specialists also recommend that migraine patients avoid oversleeping on weekends. Sleeping late can lower the body’s normal blood sugar level and lead to a headache. Metformin may also be prescribed to help manage blood sugar levels.

Prevention

While appropriate medication and avoiding known or suspected migraine triggers can help extinguish migraine pain, other headache management strategies can also help, including:

• Adopting regular sleeping habits.
• Establishing regular meal times—avoid skipping or missing a meal.
• Taking vitamin B2 (to increase riboflavin in the diet) and supplements to increase magnesium levels
• Increasing exercise, which improves blood flow to the brain and boosts the production of endorphins, naturally occurring painkilling substances the body produces.
• Staying hydrated.

The key to managing migraine headaches is identifying the unique triggers that provoke your headaches and then minimizing or eliminating them. Common triggers include:

• Hormonal triggers. Women may have headaches around the time of their menstrual period, possibly related to the body’s fluctuation of estrogen and progesterone. But there are no steadfast rules when it comes to hormonal triggers. Taking oral contraceptives and hormone replacement therapy and even pregnancy have been blamed for causing severe and frequent migraine attacks. But other women who suffer from migraine say these things improve their condition or make the attacks disappear altogether. Following menopause, when estrogen and other hormone levels decline, women who previously suffered from migraines may find their headaches subside significantly, if not completely. In some women, however, migraines come on or worsen during menopause as a result of fluctuating hormone levels.

  Some migraine sufferers have an acute sensitivity to a specific food or foods. Researchers are not certain why particular foods provoke migraine headaches.

  Tyramine, for example, a chemical produced as a result of the natural breakdown of the amino acid tyrosine, is a common migraine provoker. Tyramine levels increase in some foods when they are aged, fermented or stored for long periods of time. Red wine, aged cheeses and processed meats (like hot dogs and bologna) are good examples. Other common food-related triggers include: champagne, ripened cheeses (cheddar, Stilton, Brie, Camembert), nuts and nut spreads, sourdough bread, onions, lentils, snow peas, citrus fruits, bananas, sour cream, chocolate and MSG (the flavor enhancer found in soups, restaurant food, artificial sweeteners, frozen foods and potato chips). Additionally, if you’re used to caffeinated beverages, foods or painkillers, withdrawal from these substances can trigger a headache, though not necessarily a migraine.

  In addition to some foods, a change in eating patterns can trigger headache, although not necessarily a migraine. Fasting, missing meals or dieting may also cause low-blood sugar levels, another possible migraine trigger.

• Environmental triggers. Altitude changes, excessive light and noise and changes in weather patterns (such as high winds and high humidity) are a few of the many environmental triggers of migraines. Airplane travel is one of the biggest triggers. Cabin pressurization can cause significant dehydration, which can trigger migraine, so it’s important to stay well hydrated during air travel. Bright light, whether from television, a movie screen or the sun, may also provoke attacks. Excessive or repetitive noises can trigger migraine headaches, as well as strong odors (such as cigarette smoke). As with food triggers, you should carefully identify environmental triggers and avoid them when possible.
• Emotional triggers. Anticipation, excitement, stress, anxiety, anger and depression are known to trigger migraine attacks. Even “positive” excitement, such as a job promotion or a wedding, can provoke a migraine. An effective stress management system can help a migraine sufferer prevent or minimize headaches triggered by these factors and can contribute to a sense of overall good health.
• Activity triggers. Changes in lifestyle patterns can also bring on a migraine. Women have reported migraines resulting from too little sleep, too much sleep, overworking and physical overexertion. Vacation time, with its inherent rushing, excitement and altered daily schedule, can trigger a migraine. Sexual activity may also provoke migraine attacks. Other triggers include motion (such as plane, car, bike and carnival rides), head injuries and interaction with certain drugs, including over-the-counter pain relievers. Always consult your health care professional about medications.

Facts to Know

1. Migraine may start in childhood, but first attacks typically occur in adolescence or early adulthood. The headaches usually continue throughout adulthood, but may diminish with menopause. Some patients complain of migraine attacks throughout their lives. Each individual attack usually lasts from four to 72 hours.
2. An estimated 12 percent to 16 percent of Americans experience migraine headaches. Migraines cost billions per year due to absenteeism and lost productivity at work, as well as medical expenses.
3. Women experience migraines about three times as often as men.
4. Migraine is a biological disorder. Its symptoms result from changes in the brain. It may be triggered by a difference in the way you react to stress, as well as other factors.
5. In an estimated 25 percent to 30 percent percent of migraine cases, the headaches are preceded by visual, auditory or physical auras, bright spots or uneven, unstable lines moving before the eyes.
6. Many women fail to seek help for their migraines, perhaps figuring there are no effective treatments.
7. Certain factors are known to trigger migraines. These include menstrual and ovulatory cycles, certain foods, weather changes, inadequate rest, strong odors, bright or flashing lights and stress.
8. Migraines can strike as often as several times a week or as rarely as once every few years. Episodes can occur at any time.
9. Many migraine sufferers have a close relative who also suffers from the headaches.
10. People suffering from frequent, long-lasting, or disabling migraine headaches may want to consider preventive medication such as antidepressants, heart medication such as beta blockers and calcium channel blockers, and antiseizure medication. In people who suffer from migraines less frequently, drugs such as triptans can help treat acute attacks.

Questions to Ask

Review the following Questions to Ask about migraine so you’re prepared to discuss this important health issue with your health care professional.

1. Do you frequently treat headaches?
2. What tests should I have to find out what’s causing my headaches?
3. What drug treatments do you recommend for me?
4. What nondrug treatments do you recommend for me?
5. What are the potential side effects of the drugs you recommend? What is the risk of interactions with food or other drugs I’m taking?
6. Should I make any lifestyle changes that would help me manage my migraines?
7. How can I identify triggers that can set off my migraines, and what can I do to avoid them in the future?
8. How long will it take for me to see results from this treatment plan?
9. If this treatment doesn’t seem to be helping, will you help me find something else?
10. What can I do to reduce the pain of a migraine after it starts?
11. Are you sure that I have migraines and not another medical condition linked to headache?

Key Q&A

1. Do migraine headaches run in families?
   Research suggests that migraine headaches often run in families. Many migraine sufferers have a close relative who also suffers from them.
2. Some of my headaches go away with aspirin and some don’t. Should I get medical help for my headaches?
   Absolutely. You may very well be a migraine sufferer. Many migraine sufferers are unaware that their pain is from a migraine. Some attribute their headaches incorrectly to sinus trouble or stress or they simply don’t question the source of the headache. Another study showed that the typical patient suffers headache pain for more than three years before seeking treatment. If you suffer from headache pain you should take an active role from the start, along with your health care professional, in determining the type of headache and its cause.
3. I have debilitating headaches only once or twice a year. Should I bother to seek treatment?
   Yes. It is not uncommon for migraine sufferers to experience infrequent episodes. Now would be a good time to seek advice from a health care professional, since migraines can become more frequent due to lifestyle changes, hormonal fluctuations or other increases in exposure to triggers.
4. I don’t want to take a pill every day for my migraines. Are there treatment options for me?
   Yes. Some medications taken at the onset of symptoms can be very effective at relieving migraine pain. Nonpharmacological treatments such as biofeedback and preventive measures such as eliminating triggers can also work well. It is important to share your treatment preferences with your health care professional so that you can find a treatment you can live with.
5. There are so many possible triggers for migraines. How can I figure out which ones are causing my headaches?
   Unless your triggers are obvious to you, such as getting a migraine every time you fly in an airplane, the only way to identify them is by keeping a headache calendar. Your calendar should include: when your headaches occur; severity and duration of the headache; possible triggers, such as foods you’ve eaten and beverages you’ve consumed, weather patterns and dates of your menstrual periods; and symptom-relief interventions attempted.
6. I do not experience “auras” or any other problems with my vision during my headaches. Does this mean my headaches are not migraines?
   Migraines do not have to include auras. Migraines with auras affect an estimated 25 percent to 30 percent of migraine sufferers. These migraines are characterized by the appearance of neurological symptoms, such as flashing lights, zigzag lines or loss of vision, five to 20 minutes before the migraine. They usually last 20 to 30 minutes but can remain up to an hour.
7. My schedule is so crazy that I don’t have time to eat regular meals. Could this be contributing to my headaches?
   Yes. Migraines can occur after a period without food: overnight, for example, or when a meal is skipped. Prevention of these headaches includes maintaining regular meal schedules, avoid skipping a meal or fasting. You may want to avoid oversleeping on weekends, which may lead to a headache, although not necessarily a migraine.
8. What are some things I can do prevent the onset of migraine?
   In addition to avoiding triggers for your headaches, there are some basic lifestyle changes that may help you control your headaches and increase your overall health. They include: adopting regular sleeping habits, modifying eating habits to include a healthy diet and increasing exercise.

Organizations and Support

For information and support on coping with Migraines, please see the recommended organizations, books and Spanish-language resources listed below.

American Migraine Foundation
Website: https://americanmigrainefoundation.org/
Address: 19 Mantua Rd.
Mt. Royal, NJ 08061
Phone:856-423-0043
Email: [email protected]

American Pain Society
Website: http://americanpainsociety.org/
Address: 8735 W. Higgins Road, Suite 300
Chicago, IL 60631
Email: [email protected]

National Headache Foundation
Website: http://www.headaches.org
Address: 820 N. Orleans, Suite 217
Chicago, IL 60610
Hotline: 1-888-NHF-5552 (1-888-643-5552)
Email: [email protected]

National Institute of Neurological Disorders and Stroke
Website: http://www.ninds.nih.gov
Address: NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Hotline: 1-800-352-9424
Phone: 301-496-5751

Books

Life Beyond Headaches – The Ultimate Weapon for Correcting the Real Cause of Headaches Forever!
by Jeffry Finnigan

Migraine – 50 Essential Things to Do
by Charlotte Libov

No More Headaches No More Migraines – A Proven Approach to Preventing Headaches and Migraines
by Zuzana Bic

Spanish-language resources

Medline Plus: Migraine
Website: http://www.nlm.nih.gov/medlineplus/spanish/migraine.html
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: [email protected]

90,000 “How long does a migraine last and what to do with it?” – Yandex.Kew

Patients who have experienced a severe headache for the first time want to know if they really have migraines, how serious the diagnosis is, and how many days the continuous headache will last. Only a neurologist will answer these questions after a personal consultation and examination. In order to find out how long a migraine attack can last, you need to undergo an examination. This is necessary in order to exclude other diagnoses, to find out which disorder symptom may be the characteristic pain of a certain part of the head.

  How long does a migraine last?  

Also, patients are interested in who has this pathology more often: in a man or a woman, is it possible to cure the disease completely, how many days can the pain be intense and, if it lasts for a long time, is such a headache dangerous?

The duration of an attack depends on the cause of pain and on the characteristics of the organism, on the sex and age of the patient, on concomitant and transmitted diseases.The doctor will select the drugs that are right for you and will help you understand how long the pain-free period lasts, that is, how often attacks can recur.

A migraine headache can last as little as 2-3 hours, or for several days in a row: 2,3,4,5, or even a week, in rare cases it reaches 9-10 days, depending on the reasons that cause it called.

If the pain persists for 2-3 days, consult a doctor.

A migraine attack has 4 phases:

1. Prodromal (mood swings, muscle spasms, aggravation of sensitivity, etc.))
2. Aura (visual impairment, ciliated scotoma, tingling sensation in the hand, local loss of sensitivity, confusion of speech, weakness, dizziness).
3. Painful (unilateral or less often bilateral pain, pulsating, intense, sensitivity to light, sounds, blurred vision and consciousness, nausea).
4. Postdromal (pain relief, neck tension, soreness in the seizure area, cognitive impairment, fatigue)

Not in all cases, the seizure is accompanied by four phases.Often only two or one of them are present. The total duration of a migraine attack, which, in a particularly severe case, can last for several days in a row (up to 10), depends on the number of phases and the duration of each of them.

  How to treat?  

Treatment of migraine is carried out in several directions:

• Prevention of attacks
• Relief of pain symptom
• Surgical intervention

When contacting a specialist to identify the causes of the disease and to answer the question, how many days does the migraine pass , possibly timely treatment, the purpose of which is to reduce the intensity of attacks or prevent their occurrence.

If the main phase of migraine is preceded by a preparatory phase or aura, then the patient may try to prevent or reduce the severity of pain by taking painkillers prescribed by the doctor in advance. With a duration of a migraine attack of 1.5-2 days, rest and silence are necessary. You can relieve symptoms by lying still in a dark, quiet room. With the exclusion of irritation factors and increased headache, the attack will end in less than than in 3 days.

If the migraine lasts several days, see your doctor. Self-medication in this case is unacceptable . When the attack lasts more than a week, the migraine can have complications. Only a specialist will determine what to do in each specific case, urgently relieve pain in one way or another, and select a potent medicine that is right for you. A competent experienced neurologist will answer the question of how long a migraine goes through, what to do with the duration of a migraine attack.He will conduct an examination, clarify the diagnosis, and prescribe a course of therapy.

If prophylactic and medication do not work, you may be advised to have surgery.

Read more about migraine on the website of the Clinic for Restorative Neurology newneuro.ru

Diagnostics and treatment of migraine in the clinic MEDSI

Table of Contents

There are four types of headache most commonly encountered:

• Tension headache. This is the most common form of headache that anyone can experience from time to time. Despite the fact that tension headache does not pose a threat to human life and health, it can significantly impede daily activities. People with frequent tension headaches should be seen by a doctor
• Bundle (cluster) headache.
  A rare disease (occurs in about 3 out of 1000 people). Bundle (cluster) headache occurs 5 times more often in men, in contrast to most other forms of headache, where women predominate.As a rule, the first attack occurs between the ages of 20 and 40, however, the onset of cluster headache can occur at any age 90 030

• Chronic daily headache. This term includes headaches that occur 15 or more days a month for more than 3 months
• Migraine

What is a migraine?

Migraine is a neurological disorder.It manifests itself in seizures, which can occur with varying frequency – from 1-2 times a year to several times a month.

The main manifestation of a migraine attack is headache, which can be very severe. Other common symptoms include nausea and vomiting, and intolerance to light and sound.

If during a headache you feel nauseous, irritated by light or sound, and the headache interferes with your usual activity, then most likely it is a migraine.

Why does migraine occur?

The cause of migraine is in the brain. Migraine pain is associated with abnormalities in structures that are responsible for carrying pain and other sensations. There is a hereditary predisposition to the development of migraine, that is, you can inherit it from one of the parents.

Who gets a migraine?

One in seven adults suffers from migraine, so the disease is quite common.Migraines are three times more common in women than in men. It usually begins in childhood or adolescence. In girls, migraines usually start around puberty. Since there is a hereditary predisposition to the development of migraine, this disease is transmitted from generation to generation.

How does a migraine manifest itself?

All migraine symptoms occur during an attack, which has four stages of development, although not all of them can be fully represented.Most people with migraines feel good between attacks.

The precursor phase of migraine (prodrome) occurs earlier than all other symptoms of an attack and in no more than half of the patients. If you have a prodrome, you may feel irritable, depressed or tired for a few hours or even a couple of days before the headache develops. On the contrary, some may notice an unusual increase in activity. Some people may have an increased appetite, some “just know” they are going to have a seizure.

Aura , if present, is the next phase. Only a third of migraine patients have ever experienced an aura, and it may not develop in every attack.

Aura is a reflection of a certain process (transitory and harmless to health) that takes place in the brain and is associated with the mechanism of a migraine attack. It lasts 10-30 minutes, but it can be longer. Most often, there is a visual aura. You may “see” blind spots, flashes of light, or a multi-colored zigzag line extending from the center of the field of view to the periphery.Less commonly, sensitive symptoms occur – a tingling sensation or numbness that occurs in the fingertips on one side, spreads up to the shoulder, sometimes spreads to the cheek or tongue on the same side. Sensitive symptoms are almost always accompanied by visual disturbances. In addition, during the aura there are speech difficulties or difficulty in finding words.

The headache phase is the most severe for most people, lasting from several hours to 2-3 days.A migraine headache is usually very severe, often occurs in one side of the head, but can also affect the entire head. Most often, pain occurs in the frontal or temporal region, although it can be localized in any part of the head. This is usually a throbbing or bursting pain that worsens with movement and physical exertion. Often there is nausea and even vomiting, which subjectively relieves the headache. Light and sounds can be unpleasant during an attack, and most patients prefer to be alone in a quiet and dark room.

The headache phase is followed by a resolution phase. During this period, you may again feel tired, irritable or depressed, it is difficult for you to concentrate. These symptoms can persist for up to 24 hours before you feel completely healthy.

What causes migraines?

There are many reasons for migraines and they are very diverse:

• Diet: some foods (and alcohol), but only in some patients; much more often an attack can be caused by skipping meals, inadequate nutrition, caffeine withdrawal and insufficient water intake 90 030
• Sleep: Sleep change, both lack of sleep and excessive sleep
• Other factors of life: intense physical activity, long journeys, especially with jet lag
• External: bright or flickering light, strong odors, change in weather
• Psychological: emotional stress or, oddly enough, relaxation after stress
• Hormonal factors in women: 90,087 menstruation, hormonal contraceptives and hormone replacement therapy

One of the common causes of migraine is hunger or insufficient food intake.This is especially true for young patients – children with migraines should not skip breakfast! In women, fluctuations in hormones associated with the menstrual cycle are a significant potential cause.

What treatment can I use?

Medicines that are used to relieve an existing migraine attack are called migraine relief agents. The right medicines can be very effective when taken correctly and in small amounts.These include over-the-counter analgesics, most of which contain aspirin, ibuprofen, or paracetamol; paracetamol is the least effective among them. Soluble forms of these drugs, such as effervescent tablets, work faster and better.

If you are very concerned about nausea or vomiting, antiemetics can be used. Some of them actually enhance the action of analgesics, as they increase their absorption in the gastrointestinal tract.If you experience severe nausea or vomiting, then you can use these drugs in the form of rectal suppositories.

When buying a drug, the pharmacist can advise you on the best OTC analgesic to take. If none of the drugs of this class helps you, or you need a dose of the drug that exceeds the recommended dose, then you should consult a neurologist.

A neurologist may prescribe you one of the specific anti-migraine drugs.These drugs should be used if analgesics and antiemetics do not relieve your symptoms and do not quickly return you to daily activity. According to the principle of action, anti-migraine drugs differ from conventional pain relievers. They act not on pain, but on pathological processes occurring in the brain during a migraine attack. These drugs include ergotamine, which is widely used in some countries and not available in others, and a group of newer drugs called triptans.If the doctor has prescribed these drugs for you, then, if necessary, you can combine them with analgesics and antiemetics.

What if this treatment does not work?

If migraine attacks are very frequent or severe, and are difficult to treat with relief drugs, then there is a preventive treatment. Unlike remedies for arresting an attack, preventive treatment requires taking drugs every day, since this treatment is aimed at preventing the development of migraine attacks.In other words, preventive treatment can raise the threshold for a migraine attack.

When prescribing one or more drugs to you, carefully follow the directions for their use. Studies have shown that the most common reason for the lack of effectiveness of preventive treatment is non-adherence to the therapy regimen.

What else can you do to help yourself?

Exercising regularly and keeping fit will significantly improve your well-being.It is advisable to avoid predisposing factors and causes, so it makes sense to know all possible provocateurs. Try to rule out at least some of them, even if other causes are difficult to identify or cannot be avoided.

Do you need additional examinations?

In most cases, the diagnosis of migraine is straightforward. There are no examination methods to confirm the diagnosis of migraine. The diagnosis is based on your description of the characteristics of the headache and accompanying symptoms, and it is imperative that there are no abnormalities in the medical examination.Try to describe your headache to the neurologist in as much detail as possible. It is very important to tell your doctor how often and how much you are taking pain relievers or other medications for your headache.

Can migraines be cured?

There is no complete cure for migraines. However, for most people with migraines, attacks become less frequent with age.

How to save yourself from seasonal headache attacks – Rossiyskaya Gazeta

Gloomy autumn days bring sadness.Why?

Physiologists explain: it’s all about the biochemistry of the brain. Lack of light – the brain does not produce enough “hormones of joy”. And from this some people do not visit even sadness – a real depression.

What could be worse? The answer is known to those who often have headaches.

“Classics of the genre”

Migraine is the most severe among the common types of headaches. Usually attacks only half of the head. It rolls in waves: pulsates, beats, presses, aches.May be accompanied by a rapid heartbeat, increased excretion of fluid from the body, increased thirst, vomiting, and facial swelling.

For many, the pain “wanders” from left to right and back during the entire attack. Less commonly, it covers the entire head at once. It intensifies when climbing stairs and other physical exertion. And also when coughing, sneezing, tilting the head.

All these sufferings last for someone four hours, and for someone even three days. Opportunities to take a breath between them are also different for everyone: for some, the disease gives only a few days or a week, for others – a month.

Harbingers of migraine

The disease usually warns of an impending attack. Suddenly, there is a craving for sweets (or for bitter, salty, sour). Everything – sounds, smells, light, troubles – begins to be perceived sharply. Psychomotor agitation is growing. It is replaced by bouts of yawning. Performance falls. It becomes difficult to grasp the meaning of someone else’s speech and even more difficult to coherently say something yourself. Some are surprised to notice that their hands periodically go numb, or a strange tingling sensation spreads through them.

An hour (or 5 minutes) before the onset of pain, a “blind” spot may appear in front of the eyes, and around it – flashes of light, bright points of light or spots, flickering zigzags.

Alice’s Syndrome

But classically migraine occurs in no more than a quarter of patients. Some people get by with an incomplete “set” of symptoms. Someone has an “incomplete” phase of the development of an attack.

For example, 80 percent of migraine sufferers have no idea about any “blind spots” and glowing zigzags.There are those who, on the contrary, this phase accompanies each attack, but it lacks the main thing – pain. (“Headless migraine”)

In children, the so-called Alice’s syndrome can act as a harbinger of pain instead of an “aura”. People and objects begin to seem elongated or, conversely, shortened to them.

Transformed migraine

For many, the disease, having begun “classically”, changes greatly over the years (after 40 years). Headache attacks are getting weaker, but pestered almost every day.There are at least two reasons for this.

The first is drug abuse. A headache has a relationship with the products of pharmaceutical companies about the same as that of bacteria: it survives, mutating. And at some stage, medications (even in high doses) stop helping against it.

Second: pain begins to “create” several scenarios at once. The “author” of migraines is the brain. The pain develops due to a violation of the biochemical processes going on in it. But another pain can be initiated, for example, by muscles (face, scalp and neck) – if they are chronically tense.In tension, the muscles squeeze the vessels. And it can develop from emotions (anger, discontent, resentment) – if you constantly restrain them. Or because of the need for a long time to be in a posture supported by the muscles of the neck. And this is a different biochemistry.

Pain of this origin (tension headache) is not pulsating, but pressing. Presses on the whole head at once. It is rarely very strong. But it can torment him for two weeks or longer.

Help “RG”

In different countries with a diagnosis of “migraine” is observed in specialists from 8 to 18 percent of the population.At the same time, scientists believe that only a quarter of migraine sufferers go to doctors.
Women suffer from migraines 2-3 times more often than men.
In 70 percent of cases, migraine is transmitted with genes.
Migraine attacks most often begin during adolescence. (Boys and girls are equally vulnerable.) But she regularly and persistently pesters mainly people of “productive age”: from 25 to 55 years old. If the headaches started after forty, most likely it is not a migraine.

specifically

Five migraine provocateurs

1 Stress, anxiety, anxiety, depression. Lack of sleep or, conversely, excess sleep. Bright light, sparkling lights. Changes in weather or climate. Overwork, physical strain.

2 Hormones. More than half of women suffering from migraine attacks develop mainly on the eve of “critical days”. And in 14 percent, they happen exclusively during this period (“menstrual migraine.”) This is how hormones work.It is not surprising that hormonal drugs (in particular, birth control) provoke seizures.

3 Migraine headaches can begin with hunger. When we skip meals, the blood sugar drops. Migraine responds with an attack.

But in about a quarter of patients, seizures are provoked by food (even taken in time). As well as alcohol and medicine. These groups of provocateurs are related by special biological compounds – biogenic amines. They tend to “trigger migraines”.

4 Smells. A migraine attack can trigger an odor. (Everyone has their own.) Some scientists see this as an “allergic trail.”

5 Diseases. There is also a trace “hepatic”: more than a third of patients also have problems with the liver or gall bladder (“hepatic migraine”). For many, migraine attacks provoke exacerbations of chronic diseases of the intestines or pancreas.

Today, headaches are not only treated with drugs. Massage, psychotherapy, and training in relaxation techniques are actively used.As a result, the general condition of the body improves, depression recedes, and with it the pain. Make daily long walks at a good pace – with the “hormones of joy” will be all right.

“Sensitive brain” or migraine – how to treat and get along?

Severe, throbbing pain in the head, sensitivity to light and sound – this is migraine, the second most common reason why people of working age due to migraine headaches cannot perform their work and household duties, and are forced to take time off from work.Despite this, migraine is still surrounded by many myths – the presence of a severe headache to others can neither be shown nor proven. How to distinguish migraine from ordinary headache, how it is diagnosed and what to do to make migraine attacks less frequent, advises Doctor of Medical Sciences from Riga Stradins University, neurologist “Veselības center 4” Elina Putsite.

Headache is one of the most common health problems that each of us has encountered.In general, in medicine, there are several dozen different types of headaches associated with various other diseases or caused by an external cause, for example, we sat at the computer for too long, straining our eyes and shoulder muscles. However, migraine is a primary headache, which means that it is not caused by other illnesses. Migraine is a very common condition that affects an average of 12% of people.

What happens in the head during a migraine?

Migraine is often called a “sensitive brain” disease – for various reasons, including hereditary, in some people, brain cells – neurons – are extremely sensitive to various internal and external factors.When faced with any contributing and irritating factor, neurons are excited, they are activated, transmitting electrical impulses that propagate in the form of waves throughout the rest of the brain. Migraine is a set of complex processes in which the pain centers of the brain, free nerve endings are involved, various inflammatory mediators or chemicals are released, and other interrelated processes occur, the result of which is extremely severe, even paralyzing pain, which can be accompanied by nausea, sensitivity to sound and light.Any physical activity increases the pain, so a person with a migraine usually stops any activity and tries to move to a quiet, dark room.

The manifestations of migraine and its course can be very individual, but a typical migraine has four phases:

1. prodromal stage , which lasts from one to two days before the onset of the headache – a person may become emotionally agitated or, conversely, drowsy, depressed , there is a change of mood;
2. aura – approximately 25% of patients have the so-called migraine aura – various precursors of migraine headaches.For example, a bright, bright point may gradually appear in the field of view, which gradually unfolds, flashes or flashing in the form of a zigzag may appear in front of the eyes. Various sensitivity disorders are also possible, for example, numbness on one side of the body. The aura can also manifest itself as a speech disorder, slip of the tongue, or, less commonly, motor movement disorders. The migraine aura lasts up to one hour, after which the symptoms completely disappear;
3. migraine pain phase , which can last from four hours to three days without medication; the headache is most often unilateral, but it can also be bilateral, pulsating, especially when the intensity of the headache increases.The pain can be accompanied by nausea, vomiting, fear of light and sounds, so a person is looking for a quiet, dark room in which to sleep peacefully, because after sleep the headache often diminishes;
4. postdromal period – after a migraine, a person feels empty, physically weak and tired.

What is a migraine provoking factor or “trigger”?

Well known to migraine patients, the term “triggers” is a collection of circumstances that can contribute to the onset of a headache.They are individual for each patient with migraine – what provokes an attack in one may not have any effect on another. The frequency of pain is also very individual – some people suffer from migraines once a week or more, while others have migraines once a month or every six months.

The most common causes that can trigger the onset of migraine:

• stress and emotional distress;
• Hormonal fluctuations: Migraine is more common in women – on average 17% of women suffer from it, and it is often associated with changes in estrogen levels.For this reason, some patients have migraine attacks before or during menstruation;
• irregular food intake and fasting;
• sudden changes in weather;
• Sleep cycle changes and irregular sleep patterns;
• Odor and Light – Usually bright light or harsh, strong odor;
• alcohol and smoking – in some patients, migraines can be caused by alcohol consumption;
• heat and stifling weather.

Pay attention! It is important to emphasize that triggers are not the cause of severe headaches, but their initial provoking factor.When the pain is present, eliminating the triggers won’t help.

How is migraine treated?

One of the most effective methods of managing migraines is to avoid situations and things that trigger a migraine in a particular person. By eliminating triggers, there is the possibility that migraine attacks will occur much less frequently. Therefore, one of the most important tasks of the doctor, in cooperation with the patient, is to identify the most frequent situations that cause an attack. For this reason, doctors may advise patients to keep a so-called “pain diary” in which they will record various everyday details on the day of the migraine attack.

Migraine-induced pain is controlled with a variety of medications, including non-steroidal pain relievers available over the counter such as ibuprofen, paracetamol, citramone, and others. The most important rule is to try to take the medicine as soon as the first signs of pain or aura appear. When the migraine process begins in the head, it is more difficult to interrupt it with the help of medication.

Attention! Patients with migraines should be extremely careful when taking pain medications – overuse can cause medication-related headaches, which means that over-medication causes headaches to become more frequent and chronic.The more often it hurts, the more often the person takes the pill, which causes more frequent episodes of pain, and a vicious circle arises. Excessive medication can also damage the stomach and kidneys, so be sure to check with your doctor if you are taking pain relievers more than two to three times a week!

If conventional pain relievers do not work, your doctor may prescribe so-called “triptans” or other prescription pain relievers. If migraine attacks often recur, it is necessary to start preventive therapy, which is chosen depending on other comorbidities.Antidepressants, beta blockers, and antiepileptic medications can be used to prevent migraine headaches. One of the newest preventive treatments is injections of monoclonal antibodies directed at the calcitonin-linked gene-related peptide. It is done once a month or every three months, and this method is suitable for patients who have migraines very often, intolerable, and other remedies do not help.

How is migraine diagnosed?

Migraine in patients who suffer from it can start at different ages – some patients have their first attacks in childhood or adolescence, while others later – a large peak of the first episode occurs between the ages of 30-40.As a person ages, migraines usually decrease. Research shows that approximately 40% of people over 65 no longer have migraines. In other elderly patients, migraines persist, but episodes tend to become more rare and pain less intense. Not knowing that they have migraines, patients during the first attacks due to severe pain can even get into the admission department of the hospital.

For people with suspected migraines, it is important to consult a family doctor or neurologist.The doctor’s advice will be useful not only for diagnosing migraines, but also for eliminating the possibility that other diseases are not hiding behind regular, severe pain. In the case of classic manifestations of migraine, the best diagnostic assistant for the doctor is a conversation with the patient. However, in the most difficult cases, to exclude other diseases, the neurologist may prescribe other examinations, for example, magnetic resonance.

The most important task of the doctor is to identify the trigger factors for migraine with the patient and select the best medicines or their combination to control the migraine episode.Untreated migraines or mismanaged migraines can lead to more frequent migraine episodes that are much more difficult to treat.

Appointment with a doctor and additional information:
Anti-Aging Institute branch “Health center 4”
Address: Baznicas street, 18
Tel .: 25418181
www.antiaging.lv

How to treat migraines

Alina Kostyrina

treats migraine

Seven years ago, conventional pain medications stopped helping me, so I started looking for other ways to treat migraines.

Migraine is one of the most common neurological diseases, affecting almost a billion people worldwide. I have had headaches since childhood. I thought for a long time that this was due to the weather: my head hurt as often as the clouds replaced the sun. I always had pain pills at hand: I knew which of them were the most powerful and would definitely help, and which were useless.

After pregnancy, attacks became more frequent, and the usual remedies stopped helping. Then I went to a neurologist and found out that I had a migraine.I’ll tell you how I treated her and what helped me.

See your doctor

Our articles are written with a passion for evidence-based medicine. We refer to reputable sources and go for comments from reputable doctors. But remember: the responsibility for your health lies with you and your doctor. We do not write prescriptions, we make recommendations. It is up to you to rely on our point of view or not.

What is migraine and how does it manifest

Migraine is a disease in which attacks of severe headache occur.They last from 4 to 72 hours. The headache is more often on one side, it can be pulsating, and intensifies with physical exertion. Sometimes accompanied by nausea, sensitivity to light, sounds, smells. Not everyone has all these symptoms: two or three additional manifestations of the disease can be combined with a headache.

Migraine – MSD Physician’s Guide

Migraine – UK NHS

Migraine – Medscape Medical Guide

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There are two main types of migraine:

1. With aura – this is a temporary neurological disorder that usually appears about 5-60 minutes before the onset of the headache, but can occur after or during an attack. Most often, these are visual impairments, such as spots or streaks in the eyes, but there may also be numbness in body parts or speech impairment.
2. No aura, when migraine occurs without any warning signs.This is the most common type of illness.

According to some reports, migraine with aura is more dangerous to health, as it may be associated with an increased risk of cardiovascular disease. For this reason, with such a migraine, combined oral contraceptives are prescribed with caution. They can increase the likelihood of stroke, especially if there are other risk factors such as smoking.

Migraines and birth control pills – British Migraine Research Foundation

Migraine attacks can occur several times a week, or only occasionally.Chronic migraine is considered if the attacks occur at least 15 days a month or more. Some people have mild to moderate headaches on a daily or almost daily basis, and occasionally have bouts of severe pain. Chronic migraine significantly reduces the quality of life – performance and mood deteriorate.

Overview of Chronic Headaches – Medical Guide for Physicians Uptodate

When you need to see a doctor for migraine your over-the-counter pain reliever that always helps.That is, the disease does not reduce the quality of life, you control it, you know what causes seizures and how to relieve them.

You need to go to a neurologist when a migraine becomes a problem, reduces the quality of life, interferes with work, occurs often, for example, once or twice a week. I have patients who have seizures 20-25 times a month, but after them there is still a post-attack period: after a severe headache, a person feels overwhelmed, cannot work and live fully. In such cases, you need to consult a doctor so that he picks up drugs, including for the prevention of migraine attacks.

How did I know I had a migraine

The headaches that I had since childhood worsened seven years ago during pregnancy. They did not pass around the clock, and nothing stronger than ibuprofen and paracetamol could be taken. I remember the despair with which I woke up at night from pain and realized that there was nothing to be done with it, all that was left was to endure. Sometimes it passed after sleep, but it happened that I got up in the morning with the same pain, knowing that there was a day full of torment ahead. I went to work, but I couldn’t do household chores, walk, read or watch TV.If I was at home, I just lay there.

Headaches became more frequent after childbirth. I have visited many doctors – paid and free therapists and neurologists. Some sent me to others and back, in the end I left with nothing. I was either prescribed regular painkillers, which did not help, or they told me that I needed to be less nervous. Once a neurologist even issued a prescription for tranquilizers. I took them for a while, life really became calmer – I stopped being nervous about little things.Nevertheless, the headaches never went away.

Then I was saved only by small stocks of “Pentalgin-N” with codeine, which I managed to buy when it was sold in pharmacies without a prescription. Then the rules for dispensing from pharmacies changed, and besides, codeine – although a weak, but still a narcotic substance, did not want to get used to it at all.

In the summer of 2020, I turned to another neurologist in an ordinary Moscow district polyclinic. At that time, I had already read many articles on migraines, listened to podcasts and lectures, and most importantly, I began to keep a headache diary.I started it on the recommendation of a neurologist blogger from Instagram. In it, she noted when I had a headache, and was preparing to show it to the doctor in order to prove that seizures occur frequently. It was then that I assumed that I had a migraine, and the doctor confirmed the diagnosis. She immediately prescribed me special drugs for the relief of seizures and their prevention.

How to diagnose if migraine is suspected

Eduard Yakupov

Doctor of Medical Sciences, Head of the Department of Neurology, Neurosurgery and Medical Genetics, KSMU

Migraine is a clinical diagnosis, no additional examination is needed to make it, it is enough to know how the disease progresses.There are three universal questions, the answers to which suggest that a person has a migraine:

1. There is a headache in only one half of the head: yes or no?
2. Headache accompanied by nausea or vomiting: yes or no?
3. Headache accompanied by light or sound phobia: yes or no?

If the person answered yes to two or all three questions, then this is a migraine. After that, the clarification of the situation already begins: the doctor finds out how the headache appears, whether there is an aura, how often attacks occur.

It is widely believed that in case of headache, additional examination is necessary: ​​MRI or CT of the brain, USDG of the vessels of the brain and neck, blood tests, and so on. However, this is only necessary if secondary headaches are suspected, when the head hurts due to a tumor, stroke, meningitis, or other serious illness. This is rare, more than 90% of headaches are primary, that is, they are not associated with other diseases.

In Russia, it is customary to always look for the cause of pain, so there is such a situation: MRI showed some changes, maybe individual characteristics.They begin to be treated with vitamins, drugs that improve blood circulation, and other means, and migraines remain untreated.

As a result, it either becomes chronic and the person suffers from pain for years, or headaches appear associated with the frequent use of painkillers – they are called abusal. That is, pain arises from taking pills, but a person cannot stop drinking them, as this causes an increase in seizures.

An additional examination is prescribed only if there are alarming symptoms.For example, the pain in the head changed, became intense, unbearable, neurological manifestations appeared: numbness of the limbs, impaired consciousness. Or a headache is combined with a high fever.

How and why to keep a migraine headache diary

I showed my headache diary for several months to the neurologist who diagnosed me. If you have frequent headaches, I advise you to start leading it right now. So you can see the dynamics earlier and understand when it is time to seek medical help.And it will also help to track patterns, to find out the cause of the onset of illness attacks, for example, to understand on what days or after what events the headache appeared.

Headache Diary – British Migraine Research Foundation

Migraine Diary – British National Migraine Center

You can keep a diary using a mobile application, in ordinary notes on your phone or on paper – whatever you like, as long as you have statistics that can be shown to the doctor for an accurate diagnosis.

It is recommended to note in a diary every day whether there was a headache today, how long the attack lasted, how severe the pain was, what other symptoms arose, whether they took any medications and they helped or not.

Headache Diary Template – Downloadable

It is convenient for me to mark days with a headache in the Migrebot telegram bot. It is free and suitable for anyone with frequent headaches. The bot can send the entire diary to the mail to you or your doctor, as well as show statistics for the week and month.

Migrebot has already informed me several times that I have exceeded the monthly dosage of drugs, and warned me about the danger of an abuse headache – caused by drugs. This is a kind of addiction to drugs, when the head hurts already because of the drugs themselves.

This is how the dialogue with Migrebot looks like

Six months passed from the moment I started keeping a diary until the first visit to the neurologist. Then the attacks became more frequent: the number of days a month with a headache increased from 5 to 20.As a person who gave birth without anesthesia, I can say that the degree of my pain sometimes reaches eight points out of ten.

Now I continue to keep a diary of headaches and plan to do so until the migraine leaves me for a long time or scientists find a way to cure it altogether. The telegram bot does not take a lot of time, keeping a diary is easy. I like to document the state of health, and any doctor would be happy to receive such information from the patient to complete the picture.

The bot sends the diary by e-mail.The plate clearly shows how often and how badly the patient’s head hurts. You can send the file directly to the doctor’s mail. I had a particularly difficult period in August – this can be seen from the number of days with headaches marked in red

What affects the appearance of migraine attacks

The most common triggers are:

1. Hormonal changes, in particular fluctuations in the female hormone estrogen before or during menstruation, during menopause, during pregnancy.Hormonal contraceptives can also make seizures worse or more frequent, although sometimes the opposite effect is observed: pain is less common in those who use this method.
2. Some products: aged cheeses, pickles, semi-finished products.
3. Alcohol and beverages containing caffeine.
4. Food Additives: Artificial sweetener aspartame, found in diet sweets and sugar-free sodas, and flavor enhancer monosodium glutamate, which is often added to convenience foods.
5. Changes in sleep: lack of sleep, too long sleep, change of time zones with a violation of the usual rhythm of sleep and wakefulness.
6. Hunger.
7. Abrupt weather changes.
8. Psycho-traumatic situations.
9. Bright light, loud sounds, harsh odors. For example, for some people, a headache attack can be triggered by someone else’s perfume or cigarette smoke.

There is no need to try to exclude all triggers from the list, as they are individual for everyone. It is usually recommended to give up one thing and see how this affects the frequency of attacks.I don’t drink alcohol just in case: after champagne, wine or beer I may have a seizure. I also have a headache from hunger or overwork.

Why it is important to identify migraine triggers

Eduard Yakupov

Doctor of Medical Sciences, Head of the Department of Neurology, Neurosurgery and Medical Genetics, KSMU

A neurologist always finds out from a patient with migraine what causes headache attacks. You must first deal with the provoking factors, and then select drugs, otherwise the treatment will be ineffective.For example, a person has headache attacks due to lack of sleep – then prevention may not work if it does not normalize sleep. Usually, those who suffer from migraines for many years already understand themselves that they cannot and what mode of life to follow.

How are migraines treated

What medications relieve a migraine attack


To relieve a migraine attack, different groups of drugs are used, mainly:

1. pain relievers and non-steroidal anti-inflammatory drugs – ibuprofen, paracetamol, nimesulide, naproxen and others, they are sold without a prescription;
2. Triptans are prescription drugs for the treatment of migraines.

Sometimes different groups of drugs are combined with each other. They may also additionally prescribe remedies for nausea and vomiting, if required.

Step therapy is used for migraine headaches. They start with the simplest over-the-counter pain relievers like paracetamol. If they do not help, then add non-steroidal anti-inflammatory drugs. The next step, if over-the-counter drugs don’t work, is the administration of triptans, which act on the migraine mechanism itself.In this case, the treatment is selected individually: in each group there are several drugs, the reaction to them is different, one helps someone, someone else. Only a doctor should be involved in the selection of therapy.

There is no point in using Triptans for the prevention of migraine, they only work when an attack has already begun. They need to be taken immediately after the onset of the attack, but not before it, that is, not during the aura – the attending physician warned me about this. You can also take a second triptan tablet two hours later if the first dose doesn’t work.

Diagnostics and treatment of headaches – recommendations of the National Institute for Health and Continuing Education, Great Britain

Triptans should not be taken too often, otherwise you can get abusal pain caused by frequent use of painkillers. It is a good idea to keep a diary so you know how many medications you have taken this month.

How often can you drink painkillers for migraines

Eduard Yakupov

Doctor of Medical Sciences, Head of the Department of Neurology, Neurosurgery and Medical Genetics, KSMU

The risk of developing an abusal headache differs for each drug.On average, it is better not to drink triptans more than twice a week. The doctor indicates the maximum frequency of taking each medication that he prescribes. If these are combined anesthetic drugs, where there are several medicinal substances in the composition, then they look at the content of each of them and calculate the dosage.

Before triptans were prescribed, I took Ketorol, Nimesulide, Pentalgin, Citramon. Sometimes there was a positive effect, but more often nothing helped.

Now, if my head hurts slightly or I do not feel nausea, then according to the doctor’s prescription I take Nalgezin – this is a non-steroidal anti-inflammatory drug, one pack costs about 300 R.If after that the pain does not go away, then I add triptan and antiemetic – “Cerucal” or “Domperidone”.

Painkillers that I take for a mild attack. Source: Eapteka

Triptans work well for me, but not all. From the first generation drug – Sumatriptan – I experience unpleasant side effects: weakness and dizziness, I immediately want to lie down, and it is better to sleep at all. It does not begin to act immediately, you have to wait 30-60 minutes. Relpax and Zolmitriptan are more modern medicines.They have less pronounced side effects, and they also cope with pain faster for me, even if you take the pills not at the very beginning of the attack.

At first I bought only Sumatriptan, it costs about 170 R for two tablets. Then in the hospital I was advised to try “Relpax” – it is more expensive, about 700 R for two tablets.

1000 R

per month I spend on average on triptans

At the last appointment, the doctor prescribed Zolmitriptan, now I only take it, a pack of 10 tablets costs about 500 R.For a month, two packs of 10 tablets are enough for me, that is, I spend an average of 1000 R.

All of these are prescription drugs, but I am rarely asked to show the recipe. I tried to buy drugs from different manufacturers, but I did not notice the difference.

The prices for triptans differ, but they are selected not according to cost, but according to whether they help or not. Source: “Eapteka”

How are migraines treated

What medications are taken to prevent migraine attacks


Prevention of migraine with medication is prescribed if attacks occur more than four times a month.For such prevention, drugs are often used that were originally intended to treat other diseases not associated with headache, such as depression. These can be magnesium preparations, some antidepressants, antiepileptic drugs, drugs that lower blood pressure, and others. All of them are used for other purposes, but have been shown to be effective against migraines.

Migraine treatment – Mayo Clinic blog

Pharmacological prevention of episodic migraine in adults – American Academy of Neurology guidelines

Prescribe prophylactic drugs by the selection method, observing what will have a positive effect.

The first doctor prescribed me the drug “Vasobral” for prophylaxis – it improves the blood supply to the brain, dilates blood vessels. It did not help me, only I felt sick from taking the pills, I had to cancel after a month.

I also went to see two neurologists on VHI. They ordered several examinations, which, as I later realized, I did not need: ultrasound, X-ray, blood tests. And they also recommended two drugs that relax the muscles: “Midocalm” and “Sirdalud”. These medications did not help me in any way, and I also quickly refused to take them.

Later I was prescribed “Magnet B6”, I still drink it – there is some evidence that it is effective for the prevention of migraine.

When migraine prevention is needed

Eduard Yakupov

Doctor of Medical Sciences, Head of the Department of Neurology, Neurosurgery and Medical Genetics, KSMU

Prevention is needed if frequent migraine attacks occur – from 10 per month, it becomes chronic. In this case, you cannot use only drugs that relieve headache attacks, otherwise a person begins to take them too often.Preventive treatment helps to reduce the frequency and intensity of migraine attacks, and reduce the amount of pain medication taken. This reduces the risk of having an abusal headache or other side effects.

How are migraines treated

How I treated migraines with botulinum toxin injections


Already at the second appointment, a neurologist from the polyclinic advised me to try botulinum therapy and offered to send an application by e-mail to the National Medical and Surgical Center named after N.I. Pirogov. Doctors from this center themselves send information to polyclinics that they are being treated for migraine under compulsory medical insurance.

Botulinum therapy is one of the methods of migraine prevention. These are botulinum toxin injections that relax the muscles and thus help reduce the frequency and severity of headache attacks. For migraines, injections are given in the muscles on the head and neck.

Chronic migraine – Uptodate

Expected Result: Reduced seizure frequency by 3 to 9 months.During the first year, you need to do one procedure every 12 weeks, and in subsequent years – every 6 months.

When botulinum therapy is used for migraines

Eduard Yakupov

Doctor of Medical Sciences, Head of the Department of Neurology, Neurosurgery and Medical Genetics, KSMU

Botulinum therapy is prescribed if there are 10-15 migraine attacks per month, and previously tested preventive drugs did not help. It does not help all patients, like other preventive measures, but it can be a way to improve the quality of life in case of severe migraines.

Botulinum therapy for migraines can be treated privately, but you only need to contact neurologists, not cosmetologists. For one session, you will need about two bottles of the drug: from 155 to 195 units. The doctor selects the dosage individually. One bottle contains 100 units, its price – from 17,000 R. The whole procedure costs 39,000 rubles and more per session. In my case, everything was free of charge under compulsory medical insurance.

39 000 R

Botulinum therapy costs if it is paid for

To get to botulinum therapy, I wrote to the e-mail at the N.I. Pirogova, attached a diary from “Migrebot” and a certificate with a diagnosis from a doctor. They answered me the next day: the doctor of the clinic agreed that such treatment was shown to me, and sent a list of documents for hospitalization. According to the conditions of the clinic, it is imperative to go to the hospital for a day, since the compulsory medical insurance does not include outpatient treatment.

All analyzes and examinations I did according to compulsory medical insurance, except for a smear for coronavirus, for which I paid 2300 R. The list of necessary ones included:

1. Blood tests for HIV, syphilis, hepatitis B and C.
2. Certificate of attachment to the state polyclinic with a seal.
3. Complete extract from the medical card about neurological diseases. This certificate is issued by the therapist.
4. Referral for hospitalization. He is also given by the local therapist.
5. A measles antibody certificate or vaccination certificate that provides information on measles vaccination. I was tested for antibodies, I had enough of them.
6. Fluorography of the lungs.
7. PCR test for coronavirus.

I collected documents for almost two months. You can do it faster: my roommate, for example, did everything in two weeks. The most difficult thing is to explain to the district doctor why all these certificates are needed. In my clinic, no one has heard of such treatment. At first, they tried to examine me completely, before sending me for tests, I had to struggle.

After collecting the documents, I came to the center, and on the same day I was injected with 195 units of Botox. They made injections in the forehead, between the eyebrows, temples, neck – three or four injections for each zone.It hurt, but bearable. The whole procedure took about 15 minutes. A slight numbness was felt at the injection sites. By the end of the day it had passed, and I had no more unusual sensations.

The doctor warned that within five hours after the procedure, you cannot lie on your side or back, you can only lie down. Also, you can not lean your hands on the injection sites and generally touch them until the morning, so as not to worsen the effect. For two weeks it was not recommended to go in for sports and go to the bathhouse. There were no other restrictions.

A couple of hours later, a physiotherapist came to the ward, we went to do exercises for the back and neck. Nobody touched me anymore. For lunch, dinner and breakfast, they were fed hospital food, it was very much an amateur. In the morning they brought a sick leave, and I went home.

Usually, after botulinum therapy procedures, a cosmetic effect is also noticeable. After a couple of days, the crease in my eyebrow disappeared, although I could still frown. The eyebrows were also not raised as high as they could, and there were no wrinkles on the forehead.In general, my facial expressions did not suffer in any way.

Migraine returned to me a week after botulinum therapy, but the total number of attacks decreased by about 30%, the intensity of pain decreased, I drank pain relievers less often. This can be seen from the diary: since January, there have been fewer severe attacks, although they have not disappeared.

I made a schedule of seizures by month: in January I underwent botulinum therapy. The green bars represent the number of days with mild headaches that I did not take pain relievers.Red bars – severe attacks, triptan days

I made a schedule of seizures by month: in January I underwent botulinum therapy. The green bars represent the number of days with mild headaches that I did not take pain relievers. Red bars – severe attacks, triptan days

During the injections, I was warned not to wait for a miracle right away: first, the frequency of attacks and their intensity should decrease. The effect of the treatment should increase with each procedure. If, after the second session, the result is not noticeable, then there is no point in continuing botulinum therapy.

The second time I went to botulinum therapy for a fee three months later in another clinic, since the NMHC named after N.I. Pirogov no longer provided such assistance under compulsory medical insurance. It was not possible to make an appointment with them for a fee – the doctor was on vacation.

In a private clinic, things were different. Firstly, I paid 3,500 RUR for a preliminary appointment with a neurologist and 39,500 RUR for the procedure itself. When paying, I presented a TIN and a passport so that I was given a certificate for tax deduction. Secondly, the injections took longer, more painful and not directly in the same places.I was not forbidden to lie down, like last time, but I was strictly ordered not to wash my hair today, not to drink anything hot or cold for the next five days, not to take a bath and not to play sports.

It took more than an hour for the injections, they suggested to me at the same time to prick my forehead and between the eyebrows for cosmetic purposes, but I refused – I still like to actively move my eyebrows. After the procedure, I went home, I didn’t need to spend the night in the hospital.

Now I will watch how my state will change in the future.If my head starts to hurt less often in the next three months, then I will try to sign up for botulinum therapy again for free – it is possible that in the summer at the N.I. Pirogov, there will again be an opportunity for treatment under compulsory medical insurance.

If it doesn’t get better, that is, after three months the number of attacks will not decrease by another 50%, I will not continue and will switch to monoclonal antibody therapy.

90 080 During the year I spent 60 203 R on migraine treatment


Treatment	Cost
Botulinum therapy in a paid clinic	39 500 R
“Relpax”, 7 packs	4203 R
Sumatriptan, 18 packs	3566 R
Reception of a neurologist at a paid clinic before botulinum therapy	3500 R
Zolmitriptan, 5 packs	2329 R
PCR for coronavirus	2300 R
Unnecessary VHI examinations with payment of 20%	1359 R
“Vazobral”, 1 pack	1055 R
Reception of neurologists on VHI with payment of 20%	692 R
Magne B6, 1 pack	511 R
“Nalgezin”, 1 pack	429 R
“Midocalm”, 1 pack	390 R
“Sirdalud”, 1 pack	246 R
“Cerucal”, 1 pack	123 R

Botulinum therapy in a paid clinic

39 500 R

“Relpax”, 7 packs

4203 R

“Sumatriptan”, 18 packs

3566 R

Reception of a neurologist in a paid clinic before botulinum therapy

3500 R

Zolmitriptan, 5 packs

2329 R

PCR for coronavirus

2300 R

Unnecessary VHI examinations with payment of 20%

1359 R

“Vazobral”, 1 pack

1055 R

Reception of neurologists on VHI with payment of 20%

692 R

“Magne B6”, 1 pack

511 R

“Nalgezin”, 1 package

429 R

“Midocalm”, 1 pack

390 R

“Sirdalud”, 1 pack

246 R

“Cerucal”, 1 pack

123 R

An office in a paid clinic.I sat in the chair during the injections

How monoclonal antibodies help in the prevention of migraine attacks

There are already such drugs in Russia, for example, Irinex and Ajovi. Irinex is administered once a month. The cost of one dose is approximately 13,000 R, and the course requires four ampoules. “Ajovi” is more expensive – about 34,000 R per injection, it must be injected every three months during the year.

The effect of treatment is different for everyone. After the effect of the drug is over, you will need to do the injections again.They are used only as directed by a doctor, the drugs have side effects. I have not tried such treatment yet.

Preparations of monoclonal antibodies are expensive, they are prescribed only by a doctor. Source: “Eapteka”

Remember

1. If the headache is accompanied by nausea, phobia and sound, it is most likely a migraine.
2. Migraines cannot be cured, but they do not die of them, although migraines with aura can be dangerous to health.
3. To relieve a migraine attack, special drugs are most often used – triptans, which are sold by prescription.
4. If headache attacks are repeated more than 10-15 times a month, prophylaxis with drugs or botulinum therapy is needed.
5. Lifestyle influences the course of migraines, it is helpful to keep a headache diary and eliminate triggers that provoke attacks.
6. Doing ultrasound, X-ray and MRI is most often pointless. Start your treatment by finding a good neurologist.

Have you also had an illness that affected your lifestyle or attitude? Share your story.

causes, symptoms, appointment with a doctor in Yekaterinburg

Migraine is a complex disease that is accompanied by various symptoms. For most people, the main symptom of a migraine is a severe, throbbing headache that is felt in the front of the head or to the side. Other symptoms include visual disturbances, sensitivity to light, sounds and smells, nausea and vomiting. The intensity of the migraine symptoms is such that the patient needs to lie in bed in a dark room, away from any noises until the attack is over.

Different people have different symptoms of migraine, but even the same patient may have different symptoms during different attacks. A migraine attack usually lasts 4 to 72 hours; in the interictal period, most patients have no symptoms.

Types of migraine:

• Migraine with aura

  A headache involving an aura is a kind of warning sign that patients feel 5-60 minutes before the onset of an attack. Aura symptoms may include visual disturbances such as blurred vision, blemishes, or a sharp narrowing of the field of vision.Also, the aura can be accompanied by impairment of other types of perception, for example, difficulty speaking and loss of coordination.

• Migraine without aura

  Headache that is not accompanied by an aura but includes symptoms such as nausea and sensitivity to light, sounds, and odors.

Episodic and chronic migraine.

A person with episodic migraine experiences a headache or migraine less than 15 days a month.This is a very common disease, observed in about one in five women and one in fifteen men.

However, in some cases, infrequent headaches and migraine attacks can transform into a very serious illness known as chronic migraine.

Chronic migraine is defined as a series of headaches that a patient experiences for at least 15 days each month, with migraine attacks occurring at least 8 days a month. This disease has a significant negative impact on the lives of patients who are suffering physically and psychologically.

Chronic migraine is a widespread disease that occurs in almost every 10th patient in Russia.

If you have frequent headaches or migraines but are not sure if the condition is a chronic migraine, keep a diary and record each episode of headache and migraine. A completed migraine diary, taken to the doctor, will help you accurately describe the symptoms and frequency of attacks, which will allow you to choose the most effective treatment. The diary must indicate:

• every day that you have a headache and the intensity of the headache;
• every day you have a migraine;
• every day when you do not have a headache or migraine;
• taking medications for headache

Examples of drugs that may be prescribed to you to prevent migraine attacks:

Oral preparations (short-acting)

• Anticonvulsants
• Antidepressants
• Antihistamines
• Beta blockers
• Anti-inflammatory drugs

Injectables (long-acting)

• Chronic migraine only: botulinum therapy (injections of a botulinum toxin preparation according to a registered regimen)

It doesn’t matter how long you live with a migraine.It is important that the treatment effectively relieves the symptoms so that you can live a normal life.

Keep a migraine diary and note all symptoms and triggers, and also write down all the nuances associated with treatment.

If you are concerned about the severity or frequency of headaches and migraine attacks, remember that you do not have to fight the disease alone.

You should consult a headache specialist.

Treatment of headaches and migraines

Each person periodically experiences a headache, which is associated with various external factors and quickly disappears without requiring any treatment. But about 15% of people suffer from frequent, sometimes severe headaches and need examination and treatment.

In most cases, the headache is primary, i.e. is not a manifestation of any disease. Primary headaches include migraines and tension headaches.

But in 10% of cases, the headache can be secondary, arising as a consequence of other diseases, such as hypertension, infections, tumors, pathology of the cerebral vessels and eye diseases.

Tension headache is the most common type of headache. Infrequent attacks can last from half an hour to several days. In chronic forms of the disease, the frequency of attacks exceeds 15 times a month. During such attacks, the pain is pressing, without clear localization, with a feeling of pressure all over the head.The attacks are mild and can be relieved with conventional pain relievers, but frequent and severe attacks require constant preventive treatment.

In the center “Matzpen” tension headache is treated by a combination of drug treatment with psychotherapy and physiotherapy methods.

Migraine is the second most frequent treatment after tension headache. Migraine attacks are usually severe and require treatment. The frequency of seizures is influenced by various factors such as lack of sleep, dehydration, noise, nutrition, fatigue, and overall physical condition.Migraine tendencies can be hereditary. The attacks usually last from several hours to several days. According to statistics, women suffer from migraines 2 times more often than men, since there is a connection between attacks and the menstrual cycle.