How are IBS and migraines connected. What causes the link between these two conditions. Can treating one condition help alleviate symptoms of the other. What strategies can improve both IBS and migraine symptoms.

Understanding the Connection Between IBS and Migraines

Irritable Bowel Syndrome (IBS) and migraines are two distinct conditions that often coexist, significantly impacting the quality of life for those affected. While these disorders may seem unrelated at first glance, research has uncovered intriguing connections between gut health and brain function.

Dr. Roderick Spears, a neurologist and headache specialist at Penn Medicine in Philadelphia, emphasizes the importance of seeking proper diagnosis and treatment for both conditions, stating, “Even though these conditions are benign in the sense that they don’t lead to death, they cause a lot of disability and can negatively impact your quality of life.”

Defining IBS and Migraines

IBS is a chronic gastrointestinal disorder characterized by:

• Abdominal pain or discomfort
• Diarrhea, constipation, or both
• Other symptoms such as fatigue, muscle pain, and sleep disturbances

Migraines, on the other hand, are a neurological disease typically causing:

• Recurrent headaches
• Nausea and vomiting
• Sensitivity to light, sound, touch, and smell

The Correlation Between IBS and Migraines

Studies have consistently shown an increased prevalence of migraines among IBS patients and vice versa. This correlation suggests a shared underlying mechanism, although the exact nature of this relationship remains unclear.

Is there a direct causal link between IBS and migraines? According to Dr. Spears, “If you have migraine, it seems you’re more likely to have IBS, and vice versa, but they don’t seem to cause one or the other.” This suggests a more complex interplay between these conditions rather than a simple cause-and-effect relationship.

Potential Mechanisms Linking IBS and Migraines

Several theories attempt to explain the connection between IBS and migraines. Understanding these potential mechanisms can provide insights into more effective treatment strategies for both conditions.

Genetic Factors and Nervous System Sensitivity

Research published in Current Pain and Headache Reports suggests that a “genetically sensitive nervous system transformed into one that is hypervigilant” may be at the root of both IBS and migraines. This heightened sensitivity could explain why individuals with one condition are more prone to developing the other.

The Mind-Gut Connection

Dr. Maxwell Chait, a gastroenterologist at the ColumbiaDoctors medical group, emphasizes the importance of the mind-body connection in understanding these conditions. “This mind-body connection is real and can greatly influence health,” he states. Stress, in particular, plays a significant role in exacerbating symptoms of both IBS and migraines.

The Role of Serotonin

Serotonin, a neurotransmitter found in both the brain and the gut, appears to play a crucial role in both conditions. Dr. Chait explains, “Serotonin is a major neurotransmitter of the gastrointestinal tract that plays a relevant part in IBS as well as migraine.” This shared neurochemical pathway may explain why treatments targeting serotonin can affect both conditions simultaneously.

Distinguishing Between IBS and Migraine Symptoms

While IBS and migraines may share some common ground, it’s essential to understand the key differences in their symptoms and presentation.

Duration and Frequency of Symptoms

How do the gastrointestinal symptoms of migraines differ from those of IBS? Dr. Spears notes, “The GI symptoms of migraine are typically associated with head pain, and the person is usually disabled by the attack — they’re missing work or social activities.” He adds that migraine-related GI symptoms tend to be shorter in duration compared to those of IBS.

IBS symptoms, on the other hand, are often more chronic and persistent. “IBS is more chronic in most cases. People are having either diarrhea, constipation, or abdominal bloating going on most of the time, and they can cycle between those different phases,” explains Dr. Spears.

Impact on Daily Life

While both conditions can significantly affect quality of life, their impact may differ in nature and intensity. Migraine attacks often lead to complete disability during episodes, whereas IBS symptoms may be more constant but potentially less acutely debilitating.

Treatment Considerations for Comorbid IBS and Migraines

Managing both IBS and migraines can be challenging, but understanding their interconnected nature can lead to more effective treatment strategies.

Medications and Their Dual Effects

Dr. Spears highlights an important consideration when treating patients with both conditions: “Any medication prescribed to improve migraine that targets serotonin — and that’s typically an antidepressant — may have a positive or negative impact on the IBS.” This bidirectional effect means that treatments for one condition may inadvertently influence the other.

How do medications typically affect both conditions? According to Dr. Spears, “Very often, the effects of the medication track together; that is, both conditions will improve, or both conditions will worsen, as a result of the drug.” This observation underscores the importance of a holistic approach to treatment, considering the potential impacts on both IBS and migraines.

Lifestyle Modifications

Dr. Bethany DeVito, a gastroenterologist at Northwell Health, emphasizes the role of stress management in treating both conditions. She advises patients to:

• Identify and address sources of stress
• Avoid unhealthy coping mechanisms like smoking or excessive alcohol consumption
• Maintain a healthy diet
• Ensure adequate sleep
• Exercise regularly
• Stay hydrated

Natural Approaches to Managing IBS and Migraines

In addition to conventional medical treatments, several natural approaches may benefit individuals suffering from both IBS and migraines.

Acupuncture

Can acupuncture effectively treat both IBS and migraines? Dr. Spears reports positive experiences among his patients: “I’ve had patients who have successfully used acupuncture to help with migraine and IBS.” This anecdotal evidence is supported by research, with the American Migraine Foundation recognizing acupuncture as a valuable treatment option for some migraine sufferers.

A review published in the World Journal of Gastroenterology also found that acupuncture “exhibits clinically and statistically significant control of IBS symptoms.” These findings suggest that acupuncture may be a promising complementary therapy for individuals dealing with both conditions.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) has shown promise in managing both IBS and migraines. This psychotherapeutic approach helps patients identify and modify thought patterns and behaviors that may contribute to their symptoms.

How does CBT benefit patients with IBS and migraines? By addressing stress, anxiety, and pain perception, CBT can help reduce the frequency and severity of symptoms in both conditions. It also equips patients with coping strategies to better manage their symptoms when they do occur.

The Gut-Brain Axis: A Key to Understanding IBS and Migraines

The concept of the gut-brain axis has gained significant attention in recent years, offering new insights into the relationship between IBS and migraines.

Defining the Gut-Brain Axis

The gut-brain axis refers to the bidirectional communication system between the central nervous system and the enteric nervous system of the gastrointestinal tract. This complex network involves neural, endocrine, and immune pathways.

Implications for IBS and Migraines

How does the gut-brain axis influence IBS and migraines? The interconnected nature of this system may explain why disturbances in gut function can lead to neurological symptoms and vice versa. For example, gut inflammation or dysbiosis (an imbalance in gut bacteria) may trigger or exacerbate migraine symptoms in some individuals.

Conversely, stress and anxiety, which are common triggers for migraines, can also affect gut motility and sensitivity, potentially leading to IBS symptoms. This bidirectional relationship underscores the importance of addressing both gut and brain health in managing these conditions.

Emerging Research and Future Directions

As our understanding of the relationship between IBS and migraines continues to evolve, new areas of research are opening up exciting possibilities for improved diagnosis and treatment.

The Role of the Microbiome

Recent studies have begun to explore the potential role of the gut microbiome in both IBS and migraines. The microbiome, which consists of trillions of microorganisms living in our digestive tract, plays a crucial role in various aspects of health, including immune function and neurotransmitter production.

How might the microbiome influence IBS and migraines? Alterations in the gut microbiome composition have been observed in both IBS and migraine patients. These changes may contribute to inflammation, altered pain perception, and other symptoms associated with both conditions.

Targeted Therapies

As research progresses, more targeted therapies may become available for individuals suffering from both IBS and migraines. These could include:

• Probiotics or prebiotics designed to modulate the gut microbiome
• Nutraceuticals targeting shared pathways in both conditions
• Novel pharmacological agents that address both gut and brain symptoms

Personalized Medicine Approaches

The complex and varied nature of both IBS and migraines suggests that a one-size-fits-all approach to treatment may not be optimal. Future research may focus on developing personalized treatment plans based on an individual’s specific symptom profile, genetic factors, and microbiome composition.

How might personalized medicine improve outcomes for patients with IBS and migraines? By tailoring treatments to each patient’s unique biological and symptomatic profile, healthcare providers may be able to achieve better symptom control and improved quality of life for those affected by both conditions.

Practical Strategies for Living with IBS and Migraines

For individuals dealing with both IBS and migraines, managing day-to-day life can be challenging. Here are some practical strategies that may help:

Dietary Considerations

While dietary triggers can vary widely between individuals, some common approaches include:

• Keeping a food diary to identify potential triggers
• Exploring low-FODMAP diets, which have shown benefits for some IBS patients
• Avoiding known migraine triggers such as aged cheeses, processed meats, and alcohol
• Maintaining regular meal times to stabilize blood sugar levels

Stress Management Techniques

Given the significant role stress plays in both conditions, implementing effective stress management strategies is crucial. Some options to consider include:

• Mindfulness meditation
• Progressive muscle relaxation
• Regular exercise, such as yoga or tai chi
• Journaling or expressive writing

Sleep Hygiene

Poor sleep can exacerbate symptoms of both IBS and migraines. Improving sleep hygiene may help manage both conditions. Some tips include:

• Maintaining a consistent sleep schedule
• Creating a relaxing bedtime routine
• Limiting screen time before bed
• Ensuring a comfortable sleep environment

Support Systems

Living with chronic conditions can be isolating. Building a strong support system can make a significant difference. Consider:

• Joining support groups for IBS and/or migraines
• Communicating openly with friends and family about your conditions
• Working with a therapist or counselor to develop coping strategies

By implementing these strategies and working closely with healthcare providers, individuals with both IBS and migraines can improve their quality of life and better manage their symptoms. As research continues to uncover the complex relationships between these conditions, new and more effective treatments may become available, offering hope for those affected by this challenging combination of disorders.

The IBS and Migraine Relationship

If you have symptoms of irritable bowel syndrome (IBS) and migraine but are trying to “tough it out” without a diagnosis or treatment plan, it’s time to reconsider.

“Even though these conditions are benign in the sense that they don’t lead to death, they cause a lot of disability and can negatively impact your quality of life,” says Roderick Spears, MD, a neurologist and headache specialist at Penn Medicine in Philadelphia.

IBS is a common chronic disorder characterized by abdominal pain or discomfort, and diarrhea, constipation, or both. But for some people, other symptoms are connected as well.

“Many IBS patients, especially women, also report symptoms unrelated to digestion, such as fatigue, muscle pain, sleep disturbances, and sexual dysfunction,” says Bethany DeVito, MD, a gastroenterologist at Northwell Health in Great Neck, New York.

Migraine is a neurological disease that usually causes recurrent headaches, but migraine attacks frequently include other symptoms, including nausea, vomiting, and extreme sensitivity to light, sound, touch, and smell. For many people with migraine, these attacks are debilitating.

The Relationship Between IBS and Migraine

The relationship between IBS and migraine would be described as a correlation, says Dr. Spears. “If you have migraine, it seems you’re more likely to have IBS, and vice versa, but they don’t seem to cause one or the other,” he says.

Numerous studies have found an elevated incidence of migraine or headache among people who have IBS, and an increased incidence of IBS among people with migraine:

There are a few possible reasons many people have both conditions. A study published in Current Pain and Headache Reports that explored the connection between migraine, IBS, and celiac disease traced the link to a “genetically sensitive nervous system transformed into one that is hypervigilant,” which can, over time, lead to chronic pain diseases like IBS and migraine.

Stress also factors into the connection between the head and the gut. “This mind-body connection is real and can greatly influence health,” says Maxwell Chait, MD, a gastroenterologist at the ColumbiaDoctors medical group in Hartsdale, New York.

GI Symptoms of Migraine and IBS Have Key Differences

“The GI symptoms of migraine are typically associated with head pain, and the person is usually disabled by the attack — they’re missing work or social activities,” says Spears.

Another difference is that the GI symptoms of migraine typically don’t last as long as the GI symptoms in IBS, he adds.

“IBS is more chronic in most cases. People are having either diarrhea, constipation, or abdominal bloating going on most of the time, and they can cycle between those different phases,” says Spears. “The nausea and vomiting that some people experience with a migraine attack would not be all the time; even in chronic migraine, you wouldn’t have a lot of patients in that category,” he says.

Chronic migraine is when a person has 15 or more headache days per month.

Neurotransmitter Serotonin Is Prominent in Both Migraine and IBS

One specific player in both migraine and IBS is the brain chemical serotonin. “Serotonin is a major neurotransmitter of the gastrointestinal tract that plays a relevant part in IBS as well as migraine,” Dr. Chait says.

Because of that common denominator, “any medication prescribed to improve migraine that targets serotonin — and that’s typically an antidepressant — may have a positive or negative impact on the IBS,” says Spears. “This would work the other way around, too: If someone has IBS and is put on a medication with a serotonin target, it would have an impact on migraine,” he says.

Very often, the effects of the medication track together; that is, both conditions will improve, or both conditions will worsen, as a result of the drug, says Spears.

Strategies to Improve Migraine and IBS

As stress and anxiety increase, so do episodes of IBS and migraine, Dr. DeVito says. To help reduce stress, try to identify and defuse its sources, such as finances, work, or relationships. Avoid unhealthy coping mechanisms like smoking, drinking alcohol, using drugs, and overeating. Instead, eat healthfully, get enough sleep, exercise regularly, and drink plenty of water.

There are also some natural options that can sometimes benefit both disorders, says Spears. “Often people who have both may try these approaches with their migraine and find that their IBS responds, too,” he says.

Acupuncture

“I’ve had patients who have successfully used acupuncture to help with migraine and IBS,” says Spears.

The American Migraine Foundation states that acupuncture can be a valuable treatment option for some people with migraine.

A review published in the World Journal of Gastroenterology found that acupuncture “exhibits clinically and statistically significant control of IBS symptoms.”

Cognitive Behavioral Therapy (CBT)

Many studies, such as one published in 2017 in Psychology Research and Behavior Management, have shown that cognitive behavioral therapy (CBT) — a type of short-term psychological therapy that focuses on modifying behaviors and altering dysfunctional thinking patterns — can have significant and lasting symptom improvements in IBS.

A type of therapy called mindfulness-based cognitive therapy for migraine (MBCT-M), which integrates cognitive and behavioral therapy techniques with mindfulness-based intervention strategies, was found to be a promising treatment for people with episodic and chronic migraine in a study published in September 2019 in the journal study published in September 2019 in the journal Headache.

Yoga

A study published in December 2015 in the European Journal of Integrative Medicine found that one hour of yoga three days a week for 12 weeks significantly improved symptoms for people with IBS.

Research suggests that many types of yoga can help improve headaches as well. A review published in July 2015 in the Journal of Physical Therapy Science found that yoga may be beneficial for some types of headaches, including tension-type headaches.

Peppermint Oil

“I’ve had patients use peppermint oil during a migraine attack and have it also help with gas and bloating,” says Spears.

Typically, diluted peppermint oil is massaged into the forehead and temples to relieve headache symptoms.

IBS Symptoms Should Be Considered When Choosing Migraine Medications

“When I have a person with symptoms that sound like IBS, I usually recommend that they see a gastroenterologist to be evaluated,” says Spears.

If you see two different specialists for your migraine and IBS, make sure to tell each doctor about the medications you are taking and the symptoms you are experiencing, he says. There are some medications used for migraine that may exacerbate IBS symptoms, such as constipation or diarrhea.

The treatment plan for migraine can depend on the symptoms of the IBS, says Spears.

“If constipation is a symptom, I’ll try to stay away from migraine preventives that are going to promote that, such as some of the tricyclic antidepressants or calcium channel blockers. If the person is prone to diarrhea and has a hard time keeping things down, I’ll stay away from certain antidepressants such as SNRIs [serotonin-norepinephrine reuptake inhibitors], which tend to speed the gut up,” he says.

Keep a Food Diary to Identify Food Triggers

For both migraine and IBS, foods and beverages can trigger symptoms.

“For IBS, dietary advice includes avoiding dairy products, fatty foods, caffeine, and gas-producing foods such as beans and cruciferous vegetables,” DeVito says.

For migraine, common triggers include meats and cheeses with added preservatives and the food additive MSG, according to the American Migraine Foundation.

Trigger foods can have a domino effect, warns Spears. “Often, if someone has IBS and consumes foods that trigger an attack — for example, spicy food — it will often lead to a migraine attack as well,” says Spears.

Keeping detailed records of what you eat and how you feel afterward will help you pinpoint food triggers of your migraine and IBS symptoms.

RELATED: Finding the Best IBS Diet: What to Eat and What to Avoid

Get Educated About IBS and Migraine

When it comes to controlling migraine and IBS, different treatments work for different people. As a first step toward finding relief for your IBS and migraine symptoms, talk to your healthcare professional.

You can also learn more about IBS online at the website of the National Institute of Diabetes and Digestive and Kidney Diseases and at AboutIBS, the website of the International Foundation for Gastrointestinal Disorders.

And you can learn more about migraine from the National Headache Foundation, the American Migraine Foundation, the Association of Migraine Disorders, and Migraine Again.

Additional reporting by Ashley Welch and Becky Upham.

Migraines and gastrointestinal problems: Is there a link?

There may be a link between headaches and the gut. Nausea and vomiting are often associated with migraine attacks. And research suggests that people with frequent headaches may be more likely to develop gastrointestinal disorders.

In young children, several syndromes that cause gastrointestinal symptoms are also associated with migraines. These syndromes can cause episodes of vomiting (cyclical vomiting), abdominal pain (abdominal migraine) and dizziness (benign paroxysmal vertigo). They’re often called childhood periodic syndromes or episodic syndromes that may be associated with migraine.

Although these syndromes usually aren’t accompanied by head pain, they’re considered a form of migraine. In many cases, childhood periodic syndromes evolve into migraines later in life.

Research has shown that people who regularly experience gastrointestinal symptoms — such as reflux, diarrhea, constipation and nausea — have a higher prevalence of headaches than do those who don’t have gastrointestinal symptoms.

These studies suggest that people who get frequent headaches may be predisposed to gastrointestinal problems. Digestive conditions, such as irritable bowel syndrome and celiac disease, also may be linked to migraines. Treating these digestive conditions may help reduce the frequency and severity of migraines. However, more research is needed to understand these connections.

If you experience nausea, vomiting or diarrhea with your headaches, talk to your doctor about treatment options. Treating the headache usually relieves gastrointestinal symptoms.

However, in some cases, your doctor may recommend an anti-nausea or anti-diarrheal medication or a nonoral pain medication. Keep in mind that some pain medications, such as aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), may increase nausea.

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• Ocular migraine: When to seek help
• Migraine medications and antidepressants

Nov. 24, 2020

Show references

1. Lee SH, et al. Clinical implications of associations between headache and gastrointestinal disorders: A study using the Hallym smart clinical data warehouse. Frontiers in Neurology. 2017:8;526.
2. Gelfand AA. Episodic syndromes that may be associated with migraine: A.K.A. “the childhood periodic syndromes.” Headache. 2015;55:1358.
3. O’Brien H. Classification of migraine in children. https://www.uptodate.com/contents/search. Accessed Oct. 16, 2018.
4. Garza I, et al. Chronic migraine. https://www.uptodate.com/contents/search. Accessed Oct. 16, 2018.
5. Camara-Lemarroy CR, et al. Gastrointestinal disorders associated with migraine: A comprehensive review. World Journal of Gastroenterology. 2016:22;8149.
6. Bajwa ZH, et al. Acute treatment of migraine in adults. https://www.uptodate.com/contents/search. Accessed Oct. 16, 2018.
7. Hindiyeh N, et al. What the gut can teach us about migraine. Current Pain and Headache Reports. 2015:19;33.

See more Expert Answers

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[Migraine and irritable bowel syndrome]

The association between migraine and functional gastrointestinal disorders has been confirmed by many clinical observations and epidemiological studies. In most patients during the attacks of migraine, apart from various neurological and vascular symptoms, gastrointestinal disturbances occur including nausea, vomiting, abdominal pain or diarrhea. Functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), are reported in migraine patients in periods between the attacks as well. On the other hand 23-53% of IBS patients have frequent headaches. Migraine and IBS often coexist with fibromyalgia and other chronic pain syndromes and functional disorders. Migraine and IBS affect approximately 10-20% of the general population, usually young adults. Both diseases are more prevalent in women, perhaps due to the role of estrogen in their pathogenesis. Looking for the common pathogenetic mechanisms of IBS and migraine the role of the brain-gut axis, neuroimmune and neuroendocrine interactions are being considered. The influence of stress on symptom occurrence and severity seems to be associated with hyperactivity of the hypothalamic-pituitary-adrenal axis. The enteric nervous system as a source of numerous neurotransmitters and visceral reflexes is a plausible common pathogenic link between IBS and migraine. In particular serotonin being the main neurotransmitter of the gastrointestinal tract plays a relevant role in the pathogenesis of IBS as well as migraine. Nowadays, agonists and antagonists of serotoninergic receptors are the most efficacious drugs for IBS and migraine therapy. Some side effects of triptans, 5-HT(1B/D) agonists, used in migraine treatment may be connected with the influence of triptans on the gastrointestinal functions. A better understanding of the relationship between migraine and IBS may result in more effective treatment of both diseases.

Is this IBS? | The IBS Network

People with IBS frequently suffer from headaches, and backache, urinary symptoms, tiredness, and pain in many parts of the body.

IBS is an individual illness. People react with their own individual symptoms.

Other Symptoms that are Common in IBS:

• Lethargy

• Backache

• Urinary frequency

• Headaches

• Dizziness

• Muscle pains

• Indigestion

• Ringing in the ears

• Anxiety

• Depression

• Nausea

• Shortness of breath

People with IBS often have experienced symptoms in many other parts of the body. IBS overlaps with other unexplained illnesses.

Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) causes persistent fatigue (exhaustion) that affects everyday life and doesn’t go away with sleep or rest. 

CFS is also known as ME, which stands for myalgic encephalomyelitis. There’s some debate over the correct term to use for the condition, but we will refer to the condition as CFS.

CFS is a serious condition that can cause long-term illness and disability, but many people – particularly children and young people – improve over time.

It’s estimated around 250,000 people in the UK have CFS. Anyone can get the condition, although it’s more common in women than men.It usually develops when people are in their early 20s to mid-40s. Children can also be affected, usually between the ages of 13 and 15.

Fibromyalgia

Fibromyalgia, also called fibromyalgia syndrome (FMS), is a long-term condition that causes pain all over the body.

As well as widespread pain, people with fibromyalgia may also have:

• increased sensitivity to pain
• fatigue (extreme tiredness)
• muscle stiffness
• difficulty sleeping
• problems with mental processes (known as “fibro-fog”) – such as problems with memory and concentration
• headaches
• irritable bowel syndrome (IBS) – a digestive condition that causes stomach pain and bloating

The exact cause of fibromyalgia is unknown, but it’s thought to be related to abnormal levels of certain chemicals in the brain and changes in the way the central nervous system (brain, spinal cord, and nerves) processes pain messages carried around the body.

 Indigestion (Functional Dyspepsia)

Indigestion (dyspepsia) is a condition of impaired digestion. Symptoms may include upper abdominal fullness, heartburn, nausea, belching, or upper abdominal pain. 

Heartburn is when acid moves up from the stomach into the gullet (oesophagus) and causes a burning pain behind your breastbone.  

Indigestion and heartburn can occur together or on their own.

It’s a common problem that affects most people at some point. In most cases it’s mild and only occurs occasionally. People may also experience feeling full earlier than expected when eating.

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Diet Helps Both IBS and Migraine Symptoms • National Headache Foundation

15 Jan You Are What You Eat: Diet Helps Both IBS and Migraine Symptoms

Health care professionals and researchers have known for several years that a link exists between irritable bowel syndrome (IBS) and migraine disease, and a small recent study shows that food may play an important role in reducing symptoms in both disorders.

Researchers in Istanbul, Turkey, designed a study to evaluate the benefits of a diet in which patients eliminate foods that provoke an immune response and elevate Immunoglobulin G (IgG) antibodies. Such diets have previously proven beneficial for improving symptoms in both migraine and IBS.

When on the elimination diet, participants’ IBS symptoms improved, ranging from less severe pain and bloating to improvements in the severity of diarrhea and constipation. Participants also reported greater quality of life, including greater happiness at home and work. Concerning migraine symptoms, nearly 67% reported at least a 30% reduction in migraine days, and nearly 48% reported at least a 50% reduction in migraine days.

Specifically, the authors noted, the tailored elimination diets decreased lymphocyte proliferation responses, improved clinical outcomes and decreased the release of inflammatory agents.

When the offending foods were re-introduced into the diet, symptoms of both disorders increased, and patients who had improved relapsed.

The authors note that food elimination diets and food challenges are considered to be time-consuming for both patients and health care professionals, and require that patients be motivated and compliant with the dietary plan. For this reason, the authors do not recommend a general elimination diet, but encourage diets tailored to the individual and based on serum IgG antibody titers. The tailored-made diets are expected to be the easiest for patients to follow because they would most likely require removal of fewer foods than a general plan, thus leading to increased compliance and the most success.

The lead author of the study was Elif Ilgaz Aydinlar, MD, of the Department of Neurology at the Acibadem University School of Medicine in Istanbul, Turkey.

Gut-brain Axis and migraine headache: a comprehensive review | The Journal of Headache and Pain

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Steiner TJ, Stovner LJ, Vos T (2016) GBD 2015: migraine is the third cause of disability in under 50s. J Headache Pain. 17(1):104

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Frontiers | Migraine Associated with Gastrointestinal Disorders: Review of the Literature and Clinical Implications

Introduction

Migraine is a common headache disorder with a lifetime prevalence of 13% in men and 33% in women (1). There are ictal (migraine attack) and interictal periods. Migraine is a highly disabling disease with high personal and social costs (2). Migraine can be considered as a complex neurogenic inflammatory disorder (3–5) but the pathophysiology is still not fully understood (6). It is a disease of the brain, possibly of the brainstem and is associated with increased synthesis and release of calcitonin gene related peptide (CGRP). A migraine attack can be blocked with CGRP antagonists (3, 7, 8). The actual pain is generated by nociceptors of trigeminal nerve endings in the dura. Low serotonin levels may sensitize the nociceptors of trigeminal neurons (9). Existing data support that serotonin is low interictal but increased ictally in migraineurs (10, 11). Ictally serotonin agonist, like triptans and ergotamins, which decrease serotonin are associated with relief of acute pain (7–9). In contrast tricyclic antidepressants and selective serotonin and noradrenaline reuptake inhibitors, which are associated with increases in serotonin, are utilized for migraine prevention (11). Migraine attacks can be triggered by intrinsic cerebral factors (CGRP release), nitric oxide like tri-nitroglycerine, corticotrophin releasing hormone (stress), pro-inflammatory cytokines, and degranulation of mast cells located in the dura (1, 3, 8). Migraine has a genetic background, but the concordance in monozygotic twins is only 20%, indicating the importance of environmental factors in getting the disease (12).

An environmental factor that may play an important role is the gut microbiota. The number of bacteria in the human gut outnumbers the human cells by approximately 10:1 (13). Due to recent technical developments, studies of the gut microbiota are no longer dependent on culture techniques, but use high-throughput sequencing techniques to investigate the intestinal bacterial species. Over 25 different diseases are currently associated with alterations in the composition of the gut microbiota. At the moment, most attention has been given to inflammatory bowel diseases (IBDs), allergy, diabetes, and obesity (14). Besides gastrointestinal (GI) diseases, the gut microbiota as an independent factor can also contribute to systemic diseases. This can be caused by the migration of stimulated immune cells, by systemic diffusion of microbial products or metabolites, or by bacterial translocation as a result of decreased intestinal barrier function (15).

The brain and the GI tract are strongly connected via neural, endocrine, and immune pathways (16–18). The communication occurs in two directions, not only from the brain to the gut but also the other way around. This recent finding on the role of the gut microbiota in the gut-brain axis suggests that the gut microbiota can be associated with brain functions and neurological diseases like migraine. In this review, associations between migraine and GI diseases are studied and possible therapeutic consequences are hypothesized.

Headache and Gastrointestinal Symptoms

Not all observational studies are restricted to migraine. The HEAD-hunt study, for example, looked at the relationship between GI symptoms and headache, including migraine (19). The study was a questionnaire-based cross-sectional study among more than 51,000 inhabitants of a county in Norway. The study showed a higher prevalence of headaches among people who regularly experience GI symptoms compared to the control group without GI complaints. The association between headache and GI complaints increased with increasing headache frequency. All the GI complaints were as common among persons with non-migrainous headache as among migraine patients. So both migraine and other types of headaches are more common in people with GI complaints.

Migraine and Gastroparesis

Gastroparesis is a chronic disorder manifested by delayed emptying of the stomach. Gastroparesis is a relatively common complication of diabetes. In a population of patients with symptoms of diabetic gastroparesis, the patients with cyclic symptom patterns had a higher incidence of migraine headaches (47 vs. 20%, p = 0.02) compared to patients without cyclic vomiting pattern (20). Migraine attacks are associated with delayed gastric emptying (21). This migraine-associated gastroparesis is a problem for the treatment of the migraine with oral medicines, like oral triptans (22). Initially, delayed gastric emptying was found during migraine attacks, now there are also indications that in the interictal periods migraine patients have delayed gastric emptying. However, the studies done so far have been small and inconsistent in their results (23, 24), so further research in this topic is warranted.

Migraine and Colic

Infantile colic is a common cause of inconsolable crying during the first months of life. It is defined according to criteria by Wessel as crying and fussing for more than 3 h per day, more than 3 days a week, and for more than 3 weeks in an otherwise healthy and well-fed infant (25). It affects many infants, with incidence rates ranging from 5 to 19% (26). Infantile colic might be caused by abdominal pain, although other causes cannot be excluded. A few studies have used probiotics to treat or prevent colic, with variable effects (27, 28). Colic has also been suggested as an early life expression of migraine, as in a group of 154 infant–mother pairs the children with a mother with a history of migraine (28 in total) were 2.6 times as likely to have colic as infants without maternal history of migraine (29). Recently, it has been shown that infants with abdominal colic have a lower intestinal microbiota diversity and stability compared to control infants in the first weeks of life (30). Moreover, children with migraine are more likely to have experienced infantile colic compared with controls (OR ranging from 1.6 to 6.6 between different studies) (31–33). Although long-term prospective studies have not yet been performed, these different studies indicate the existence of an association between migraine and infantile colic.

Migraine and Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain, bloating, discomfort, and marked changes in bowel habits as described in the ROME III criteria (34). The exact pathophysiology of IBS is not understood yet. IBS and migraine are both 2–3 times more prevalent in women than in men (1, 35–37). IBS has been shown to be a disorder with an increased intestinal permeability and this permeability increases with more severe IBS symptoms (38).

A study among approximately 125,000 IBS patients, identified in a large national health insurance database, found a prevalence of migraine of 60 per 1000 against 22 per 1000 in a control population from the same database (39). After correction for gender and age, and stratification of the mean monthly total medical cost, the odds for being diagnosed with migraine were 60% higher for people in the IBS cohort compared to people in the non-IBS cohort (39). Also other studies with smaller sample sizes indicated that 25–50% of IBS subjects had migraine, whereas it was only 4–19% in controls (40, 41). A meta-analysis showed that overall IBS patients are at risk to have coexisting headache with an estimated OR of 2.7 (CI 2.3–3.1) (42). Although no distinction between headache and migraine was made in this study, this suggests higher prevalence of migraine in IBS patients.

A study in Korean migraine patients revealed high numbers of functional GI symptoms in migraine patients, of which IBS related symptoms were the most common (43). Unfortunately, these numbers were not compared with control subjects, also in the total population a large percentage of the people fulfill the Rome III criteria for IBS.

Experimental evidence for an association between IBS and migraine comes from a study in which an IgG-based elimination diet was given to migraine patients with IBS. Twenty-one patients were included in the double blind, randomized, controlled, cross-over clinical trial with usual diet, elimination diet, and provocation diet (44). Compared with baseline, the elimination diet was associated with a significant reduction in migraine attack count, duration and severity. Also a significant reduction in IBS complaints was observed, demonstrating an association between the two diseases.

Migraine and Celiac Disease

In patients who suffer from celiac disease, the immune system develops an autoimmune reaction against gliadin, the main protein in gluten. This inflammatory reaction is associated with intestinal damage, including dysfunction of the tight junctions resulting in an increased intestinal permeability (45–49). Celiac disease has been associated with migraine headache in case–control studies (50, 51). In one study, 14 out of 111 celiac disease patients (12.6%) reported migraine (50). The prevalence in controls was much lower, only 12 out of 211 controls (5.7%). In another study, migraine was present in 40 out of 188 celiac disease patients (21%), compared with 13 out of 178 controls (7%) (51). Conversely, there are also some indications that celiac disease is more frequent in migraine patients. One study showed that out of 90 adult migraine patients, 4 had celiac disease (4.4%), as opposed to only 1 out of the 236 controls (0.4%) (52). A second study in 72 pediatric patients with migraine showed four cases (5.5%) of elevated transglutaminase IgA antibodies. The transglutaminase IgA antibody level is a reliable indicator for the presence of celiac disease. Elevated transglutaminase IgA antibodies were found only in 1 out of the 147 controls (0.6%) (53). Another study among 87 pediatric migraine patients showed 1 child with celiac disease (1.1%), compared to 2 out of 543 controls (0.04%) (54). However, in another study no difference was found in the presence of celiac disease in 100 children with migraine and 1500 controls, being 2% for both groups (55). The association between migraine and celiac disease seems to be stronger in adult patients compared with children, although a direct comparison has not yet been investigated.

Only one study suggests that migraine in celiac disease patients may be relieved by treating celiac disease. Until now, the primary treatment for celiac disease is a gluten-free diet (56). The effect of a gluten-free diet was investigated in a small study with four patients with both migraine and celiac disease (52). In one patient migraine completely resolved. In the other three patients, a reduction in migraine frequency, duration, and intensity was reported. This suggests that a gluten-free diet used by celiac disease patients with migraine may give relief in both celiac disease and migraine. However, it should be noticed that only four patients were included in this study. Larger, well-designed studies to confirm these results are warranted.

Migraine and Inflammatory Bowel Disease

The two main forms of IBD are ulcerative colitis and Crohn’s disease (57). These diseases are characterized by defects in the barrier function of the intestinal epithelial layer and the mucosal immune system (46, 57). Factors that may trigger IBD are antibiotics, non-steroidal anti-inflammatory drugs, stress, and infection. All these factors decrease the mucosal barrier integrity, modulate the immune response, and change the luminal microenvironment, providing the susceptibility to inflammation (58).

Data about possible correlations between migraine and IBD are scarce. To our knowledge, only two studies investigated the comorbidity between migraine and IBD. In the first study done by Ford et al., 100 patients with Crohn’s disease or ulcerative colitis were selected from the Gastroenterology clinic at the University of North Carolina (59). The prevalence of migraine in the IBD patients was 30%. This prevalence rate is higher than the US population basal rate of 18.2% for females and 6.5% for males. In the Crohn’s disease patients migraine was more prevalent (36%) than in the ulcerative colitis patients (14.8%) (59). In the second study, 111 patients with IBD were questioned in a survey (51). Prevalence of self-reported migraine was higher in these subjects compared with controls (OR 2.66, 95% CI 1.08–6.54). No reports in the literature were found showing a reduction in migraine frequency or severity with improvements of inflammatory bowel symptoms.

Role for Gut Barrier Function in Migraine?

This overview of the literature suggests the existence of a rather strong relationship between GI disorders and migraine. One of the links between inflammatory diseases and migraine are enhanced pro-inflammatory immune responses (60). In intestinal disorders characterized by an increased intestinal permeability like IBS, IBD, and celiac disease enhanced pro-inflammatory immune responses have been reported (48, 61, 62). Enhanced levels of pro-inflammatory cytokines like tumor necrosis factor alpha and interleukin 1β in serum of migraine patients have been found during migraine attacks (63). These cytokines can act on the nociceptors of the trigeminal nerve, causing migraine. Also statistical significant associations have been reported between migraine and a wide range of inflammatory disorders like asthma, obesity, metabolic syndrome, allergies, and GI diseases (4, 5, 64–70). A strong trigger of pro-inflammatory immune responses is the leakage of lipopolysaccharides (LPS) from the intestinal lumen into the circulation. Enhanced levels of LPS can enter the circulation when the intestinal permeability is increased (leaky gut, Figure 1). Depending on genetic susceptibility, pro-inflammatory responses can occur in different parts of the body, e.g., in case of migraine on the nociceptors of the trigeminal nerve.

Figure 1. The microbiota-gut-brain axis.

Gut permeability and inflammation are bidirectional related, increased permeability can cause inflammation, but inflammation can also cause increased gut permeability (71). An increased gut permeability, and thereby increased translocation of LPS can be caused by multiple factors, like medicines, exercise, mast cell activation, high fat diet, stress, etc. (72). The most used method to measure epithelial barrier function is with the lactulose/mannitol test. Mannitol is transported via the transcellular pathway whereas lactulose is absorbed through the paracellular pathway. In case of increased permeability, more lactulose passes the barrier and eventually ends up in the urine. Therefore, an increase in intestinal permeability is characterized by an increased ratio of lactulose/mannitol (38, 73). It can be hypothesized that reduction of the permeability of the intestine results in relief of migraine in the subgroup of patients in whom intestinal permeability plays a role in the disease. One specific group might be migraine patients with food allergies. Subjects with food allergies have an increased intestinal permeability compared with healthy controls (74). The role of food allergens in migraine is controversial, as evidence linking avoiding suspected food triggers with improvement in migraine is still limited (60). In the 1990s and the first 10 years of this century, there has been almost no interest in studying the relationship between migraine and diet (75). However, some recent studies suggest a role for IgG-mediated food allergy in migraine (44, 76), a hypothesis that warrants further investigations.

Treatment of Migraine with Probiotics?

Probiotics are living microorganisms that have beneficial effects on the health of the host (77). The most used probiotics are lactobacilli and bifidobacteria. Effects of probiotics are dependent on the used species and strain. Certain probiotics have shown to be effective in gut-related diseases, like infectious childhood diarrhea (78), the prevention of antibiotic-associated diarrhea (79, 80), and necrotizing enterocolitis in premature infants (81). For other clinical conditions, like atopic dermatitis, IBD, and IBS the results from clinical trials have been inconsistent (82, 83). This can be due to multiple factors like study population, duration, end-points, etc. An important variable are the different probiotic strains which are studied, making it difficult to draw conclusions about probiotics in general for these conditions. One of the possible working mechanisms of probiotics in the treatment of GI disorders is strengthening of the intestinal barrier. In vitro as well as in vivo, probiotics have shown to be able to improve the epithelial barrier function via different mechanisms (84, 85). Most mechanistic work has been done in cell culture systems or in animal models. In a randomized double-blind placebo-controlled cross-over study in healthy adults, probiotics were able to enhance the epithelial barrier by changing the location of the tight junctions proteins in the epithelial layer (86).

As probiotics may play a role in maintaining or improving gut barrier function in human beings, they can have a beneficial effect in migraine patients with an enhanced intestinal permeability as well. So far, no clinical randomized controlled trials have been published where migraine patients received nutritional therapy with probiotics. An uncontrolled study reported the effects of a combination of different probiotics (Lactobacillus acidophilus, Lactobacillus bulgaricus, Enterococcus faecium, and Bifidobacterium bifidum) with vitamins, minerals, micronutrients, and herbs in 40 migraine patients (87). At the onset of this study, the participants had a mean quality of life score of 38 [Medical Outcomes Trust Migraine Specific Quality of Life (MSQ) Questionnaire] and after 90 days of treatment their mean quality of life score was risen to 76. Sixty percent of the migraine patients experienced almost total relief from migraine attacks and they reported quality of life scores between 80 and 100.

Conclusion

Next to migraine, other brain diseases have been suggested to be associated with increased gut permeability, including depression, autism, and stress (15, 88–90). There is growing interest in the role of the gut microbiota in these brain diseases. In this review, a possible route via an increased intestinal permeability is suggested. There is an accumulation of studies on both migraine and GI disorders (Table 1). However, the findings of some (small) studies are not supported yet by other independent studies. Nevertheless placebo-controlled studies in migraine patients using treatments directed at increased intestinal permeability are warranted. We have recently started a study in which permeability of the gut is measured in migraine patients as well as in controls. We also started a double blind, placebo-controlled trial to investigate the effect of a probiotic product on gut permeability as well as severity and incidence of migraine attacks. Hopefully, these studies provide an answer to the question if gut permeability plays a role in migraine patients.

Table 1. Summary of intestinal diseases associated with migraine.

Conflict of Interest Statement

Saskia van Hemert is employee of Winclove Probiotics. Winclove produces, markets, and investigates probiotics. Other authors declare that they have no conflict of interest.

Abbreviations

CGRP, calcitonin gene related peptide; GI, gastrointestinal; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; LPS, lipopolysaccharides.

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90,000 ischemic heart disease (coronary heart disease) – insufficient blood supply to the heart .: causes, complaints, diagnosis and treatment methods on the website of the clinic “Alfa-Health Center”
Pathological violation of the blood supply to the heart muscle, accompanied by attacks of chest pain, aggravated by stress and physical exertion, shortness of breath, dizziness, weakness.

Coronary artery disease (CAD) is the most common cause of death in developed countries. Russia is no exception here.The cause of coronary artery disease is coronary atherosclerosis, that is, partial or complete blockage of one or more coronary arteries (arteries that provide blood to the heart itself) by atherosclerotic plaques. However, IHD and coronary atherosclerosis are not synonymous. In order to diagnose ischemic heart disease, it is necessary to prove the presence of myocardial ischemia using the methods of functional diagnostics.

Often, the diagnosis of ischemic heart disease is made unreasonably, especially in old age. IHD and old age are also not synonyms.

There are several forms of coronary artery disease. Below we will consider the most common of them – exertional angina, unstable angina, myocardial infarction. Other forms of ischemic heart disease include ischemic cardiomyopathy, painless myocardial ischemia, microcirculatory angina pectoris (cardiac syndrome X).

IHD risk factors

The risk factors for coronary artery disease are the same as for atherosclerosis in general. These include arterial hypertension (persistent increase in blood pressure above 140/90), diabetes mellitus, smoking, heredity (myocardial infarction or sudden death of one or both parents under the age of 55), sedentary lifestyle, obesity, excess blood cholesterol …The most important part of the prevention and treatment of coronary artery disease is the impact on risk factors.

Symptoms

The main manifestation of myocardial ischemia is chest pain. The severity of pain can be different – from mild discomfort, feeling of pressure, burning in the chest to severe pain in myocardial infarction. Pain or discomfort most often occurs behind the sternum, in the middle of the chest, inside it. The pain often radiates to the left arm, under the scapula or down to the solar plexus area. The lower jaw and shoulder may hurt.In a typical case, an attack of angina pectoris is caused by physical (less often emotional) stress, cold, abundant food – everything that causes an increase in the work of the heart. Pain is a manifestation of the fact that the heart muscle does not have enough oxygen: the blood flow provided by the narrowed coronary artery becomes insufficient during exercise.

In typical cases, the attack is eliminated (stopped) at rest by itself or after taking nitroglycerin (or other fast-acting nitrates – in the form of tablets under the tongue or spray).It must be borne in mind that nitroglycerin can cause headaches and a decrease in blood pressure – these are direct manifestations of its action. You should not take more than two nitroglycerin tablets on your own: this is fraught with complications.

Complaints may be absent (this is the so-called painless myocardial ischemia), sometimes the first manifestation of ischemic heart disease is myocardial infarction or sudden death. In this regard, everyone who has risk factors for atherosclerosis and who is going to engage in physical education should undergo a stress test (see.below) – make sure that myocardial ischemia does not occur during exercise.

Interruptions in the work of the heart (extrasystoles) in themselves are not a sign of coronary artery disease. The reason for the extrasystoles most often remains unclear, and the extrasystole itself does not require treatment. Nevertheless, in patients with coronary artery disease, extrasystole is often encountered during exercise: if you conduct an exercise test and make sure that the extrasystole disappears during exercise, this indicates its benign nature, that it is not life-threatening.

Complaints in ischemic cardiomyopathy are characteristic of heart failure of any other origin. First of all, it is shortness of breath, that is, a feeling of lack of air during exertion, and in severe cases, at rest.

Exertional angina

Exertional angina pectoris is also called stable angina pectoris. Angina pectoris is considered stable if its severity remains constant for several weeks. The severity of stable angina pectoris may vary slightly depending on the patient’s level of activity, on the ambient temperature.

For the first time, angina pectoris is called, which arose a few weeks ago. It is a borderline condition between stable and unstable angina.

The severity of exertional angina characterizes its functional class: from the first (the lightest), when attacks occur only against the background of heavy physical work, to the fourth, the most severe (attacks with little physical exertion and even at rest).

Diagnostics

Resting electrocardiogram (or echocardiography) are NOT diagnostic methods for coronary artery disease.Sometimes these methods, however, allow diagnosing or detecting ischemic heart disease, for example, if it is possible to detect signs of a previous myocardial infarction, or if they are performed against the background of chest pain.

Also, Holter monitoring (ECG monitoring) does not serve as a method for diagnosing ischemic heart disease, although this method is used for this purpose unreasonably widely. ST segment depression, which is detected by Holter ECG monitoring, is often nonspecific (that is, they are false), especially in women.Holter monitoring only reveals

The main method for diagnosing ischemic heart disease is stress tests . The main types of stress tests: ECG tests with exercise and stress echocardiography, that is, performing echocardiography during exercise (or immediately after exercise) or against the background of the introduction of drugs that increase the work of the heart (for example, dobutamine). Myocardial scintigraphy (isotopic examination of the heart with stress) in Russia is performed in only a few centers and is practically inaccessible.

Based on the results of stress tests, a decision is made whether to refer the patient for coronary angiography. It is almost never necessary to begin an examination with a coronary angiography. It is the best method to visualize (examine) coronary artery lesions (atherosclerotic plaques), but coronary angiography is often unable to assess their functional significance (whether they cause myocardial ischemia or not).

Treatment

There are three main treatment options for exertional angina: medical, coronary stenting (angioplasty with stents) and coronary artery bypass grafting.In any case, treatment begins with an active influence on risk factors: with a low-cholesterol diet, with smoking cessation, with normalization of blood pressure, etc.

Each patient who is diagnosed with coronary artery disease should, in the absence of contraindications, take at least three drugs: a beta-blocker (for example, metoprolol, bisoprolol, nadolol), an antiplatelet agent (most often aspirin) and a statin (for example, atorvastatin, rosuvastatin).

It should be borne in mind that neither coronary stenting nor coronary artery bypass grafting generally prolongs life.There are only select groups of patients for whom this is not true. So, bypass grafting lengthens life in patients with lesions of several vessels in combination with diabetes mellitus, with a greatly reduced general contractile function of the heart, with damage to the proximal (initial) parts of the left coronary artery.

Stenting for stable angina pectoris also has a limited set of vital indications, and in general serves to improve the quality of life (that is, eliminate symptoms), and not its duration.It should be borne in mind that the stented artery, although it looks like normal in the images, in fact is not. Stents (expanded metal springs) are prone to thrombosis and other complications. Therefore, after stenting, for a long time, it is necessary to take not only aspirin, but also another antiplatelet agent, clopidogrel, and this, in turn, increases the risk of bleeding.

In any case, the decision on the method of treatment should be made together with the attending physician, therapist or cardiologist, and not with the angiographer and not with the cardiac surgeon – those who perform stenting or bypass grafting.

Unstable angina and myocardial infarction

These two life-threatening conditions are caused by the fact that at some point the atherosclerotic plaque in the coronary artery becomes unstable (its membrane is broken, it ulcerates). Unstable angina pectoris and myocardial infarction constitute the so-called acute coronary syndrome, which requires immediate hospitalization. In almost half of cases, acute coronary syndrome is not preceded by angina pectoris, that is, it develops against the background of visible health.

Symptoms

Most often, acute coronary syndrome is manifested by severe unbearable pain in the chest (behind the sternum or below – in the solar plexus region, “under the spoon”).

Diagnostics and treatment

The modern tactics of treating such patients consists in immediate delivery to the hospital, where it is possible to perform emergency stenting of the coronary artery in which the catastrophe occurred. We must act immediately: about half of those who die from myocardial infarction die in the first hour after the first signs appear.

Unstable angina is distinguished from myocardial infarction by the reversibility of myocardial damage: with an infarction, a part of the myocardium supplied with blood from the affected artery dies and is replaced by scar tissue, with unstable angina this does not happen.

In myocardial infarction, there are characteristic changes in the electrocardiogram, growth, and then a decrease in the level of several proteins – markers of myocardial necrosis, impaired contractility of several segments of the left ventricle according to echocardiography.

Anterior myocardial infarction has its own complications, while the lower one has its own. So, with anterior myocardial infarction, cardiogenic shock, pericarditis (the so-called episthenocarditis pericarditis), rupture of the left ventricle, false and true left ventricular aneurysms, dynamic obstruction of the left ventricle, left bundle branch block are much more common. For inferior infarction, transient atrioventricular conduction disturbances, mitral insufficiency, rupture of the interventricular septum, and damage to the right ventricle are characteristic.

After a period of hospitalization, rehabilitation is carried out: a mode of physical activity is developed, drugs are prescribed for constant intake. Everyone who has had myocardial infarction should, in the absence of contraindications, constantly take at least four drugs: a beta-blocker (for example, metoprolol, bisoprolol, nadolol), an antiplatelet agent (most often aspirin), a statin (for example, atorvastatin, rosuvastatin) and an ACE inhibitor ( enalapril, lisinopril and others). Before discharge from the hospital or immediately after it, it is necessary to carry out an exercise test (preferably stress echocardiography) and decide on the advisability of coronary angiography.

90,000 what you need to know before an ambulance arrives?

Who among us would dare to say that we will not be able to be in the place of a patient with coronary artery disease (IHD – ischemic heart disease. – Ed.)? Disease is a manifestation of our ignorance, and knowledge gives the strength to overcome. Among all socially significant diseases, diseases of the circulatory system are in the first place, and among diseases of the circulatory system, the most important disease is coronary heart disease. Please tell me ischemic disease is just heart disease?
Grigorenko Elena Aleksandrovna, Chief Freelance Cardiologist of the Health Committee of the Minsk City Executive Committee, Associate Professor of the 3rd Department of Internal Diseases of the Belarusian State Medical University, Candidate of Medical Sciences:
Certainly not.Ischemic disease in the broadest sense of the word is a disease of any organ that experiences ischemia – a lack of blood supply. Neurologists are familiar with ischemic brain disease and cerebrovascular disease. Gastroenterologists are faced with ischemic bowel disease or abdominal ischemic disease. In fact, any insufficient blood supply to an organ can lead to the development of its ischemic disease. It is another matter whether this form of ischemic disease is defined in a nosological form (a nosological form is a separate, independent form of the disease.- Approx. Ed.), but the nosological form is only coronary heart disease.

What diseases does ischemic disease include?

Elena Grigorenko:
IHD is a rather large and diverse group. We attribute to ischemic heart disease such forms as sudden coronary death, angina pectoris, myocardial infarction, postinfarction cardiosclerosis, heart failure, arrhythmia. The All-Russian Scientific Society of Cardiology has recently referred to IHD as painless myocardial ischemia.Therefore, perhaps due to the heterogeneity of this group, we have so many problems with the diagnosis of coronary artery disease, with prevention and with therapeutic measures.

Heart attack is perhaps the most common reason for calling an ambulance. And it is right. In the classic version, this is a burning sensation, squeezing or pain behind the breastbone.

Olga Evtukh, head of the outpatient department of the GKTs UZ ‘2nd City Clinical Hospital’ of the city of Minsk:
The term ‘heart attack’ itself means not just pain in the heart, but this is already a more formidable event. This is either myocardial infarction, or pre-infarction, as patients say, or, as doctors say, unstable angina.

What can be done before the doctors arrive? First of all, don’t panic.

Olga Evtukh:
Relatives are more worried, sound the alarm, cry, rush.

Almost all heart attacks are accompanied by a feeling of fear of death.

Olga Evtukh:
Even if this pain is very intense in nature, it is alarming, makes you think that something has happened.

This color of pain syndrome is a very good protective component. It is by its presence that doctors can quickly differentiate a heart attack.

Olga Evtukh:
Sometimes the pain falls below the chest, is localized in the iliac region and sometimes can cause associations with an exacerbation of a peptic ulcer, some kind of stomach problem.So, if pain occurs during movement, it is necessary to completely prevent any motor activity, because any movement increases myocardial oxygen demand.
Olga Evtukh:
In principle, the gold standard is taking a nitroglycerin tablet. Nitroglycerin is placed under the tongue, its side effect can cause headaches, but this is not a dangerous action.

Therefore, it is better to sit the patient in a chair or lay in a horizontal position, placing a high pillow or roller under his head.

Olga Evtukh:
You need to know the specifics of taking nitroglycerin. It is a drug that causes rapid vasodilation. Therefore, it can cause hypotension.

In addition to nitroglycerin, the patient should be given aspirin, which should be chewed and washed down with a glass of water.

Olga Evtukh:
This must be done in order to prevent the onset of thrombus formation.

If possible, measure the patient’s pressure level and closely monitor his condition.If the patient develops weakness, shortness of breath and sweating, he should raise his legs.

Olga Evtukh:
Increase central hemodynamics in order to prevent pressure from completely decreasing. To do this, raise your legs.

If after 5-7 minutes the pain persists, the patient should be given another nitroglycerin tablet, but with great care.

Olga Evtukh:
Facilitates the side effects of nitroglycerin taking validol.But validol is not required at all. In order to relieve headache, validol is a venotonic, that is, it increases the tone of the cerebral vessels of the veins, and due to this, the headache is slightly relieved.

In total, the patient has only 3 attempts to take nitroglycerin with a break of 5 minutes. Otherwise, narcotic analgesics should be administered to relieve pain, but this is already on the part of ambulance doctors. And one more nuance, when nitroglycerin cannot be given.

Olga Evtukh:
If the pain syndrome is accompanied by symptoms of cerebrovascular accident, that is, speech is impaired, weakness in the arm, leg, vision impairment, some viscosity of speech appears, then one can suspect that the patient develops in parallel with heart attacks the same stroke.

In addition, it would be nice for others to remain cool when calling an ambulance in order to clearly and briefly describe the essence of the problem and give the exact address. The rules are simple, but perhaps by observing them, you can save the patient’s life.

Are there any atypical signs of the manifestation of this disease? After all, not everything is so clear and so understandable even for a doctor.
Elena Grigorenko:
Unfortunately, according to the literature, the classic version that we talked about is quite rare, in 30% of cases.Pain syndrome can be blurred. Many patients do not regard these sensations as pain.
Are there other diseases that can also be confused with angina pectoris or myocardial infarction?
Elena Grigorenko:
This may be osteochondrosis of the spine. It could be a stomach ulcer. This may be an attack of gallstone disease. A number of diseases not only of the heart, but also of other internal organs can manifest themselves as pain in the chest. We often encounter patients admitted to the intensive care unit with myocardial infarction, who, during the initial communication, being on the bed in the cardiac intensive care unit, continue to say that the stomach hurts.Often the manifestation of a heart attack is an attack of suffocation, loss of consciousness, pain in the shoulder, in the tooth, in the jaw, in the elbow. And in this situation, there will also be a clear connection with physical activity and the effect of taking nitroglycerin. There are so-called brain forms, when the manifestation of ischemia is dizziness, syncope (fainting, short-term loss of consciousness, drop in muscle tone. – Ed.), General weakness. In any case, if a person belongs to a high-risk group for the development of coronary artery disease and has atypical complaints, he should be examined to exclude coronary insufficiency in order to subsequently receive adequate recommendations. What are the serious complications of coronary heart disease?
Elena Grigorenko:
Most complications are either fatal or disabling. Its most dangerous and threatening manifestation is sudden coronary death. And if you are a man, if you smoke, if you have a family history of coronary heart disease, then the probability that you will have sudden death onset of this disease is 40%. This is a catastrophic figure in the concept of a doctor who deals with issues of cardiology.Of course, a disabling complication or manifestation of coronary heart disease is myocardial infarction – heart failure.
What about the manifestation of heart failure? What is the experience of a person who suffers from heart failure?
Elena Grigorenko:
General weakness, feeling unwell, decreased exercise tolerance. In the future, shortness of breath, the appearance of a dry cough, often at night, the appearance of edema on the legs, an increase in the abdomen, a feeling of fullness, a feeling of heaviness in the right hypochondrium – all this is a manifestation of heart failure, join these complaints.

An interesting fact: there are many reasons for the development of ischemia. But the main thing is atherosclerosis.

Elena Ivanova, head of the organizational and methodological department of the GKTs UZ ‘2nd City Clinical Hospital’ of the city of Minsk:
Everyone knows about the development of atherosclerotic plaques, that is, cholesterol is deposited on the inner surface of the vessels.

This reason, alas, stems directly from bad habits.

Elena Ivanova:
The process of atherosclerosis in smokers is 10 times faster.

Nicotine damages the arterial wall and thus facilitates the deposition of ‘bad’ cholesterol in it.

Elena Ivanova:
Such an atherosclerotic plaque grows, enlarges, and over time it blocks the lumen of the vessel.

As a result, the nutrition of the heart is disrupted. Ischemia develops.

Elena Ivanova:
Nicotine has a direct toxic effect on the myocardium.

Women under 50 years old, as a rule, are slightly less susceptible to this disease.

Elena Ivanova:
Women have elevated estrogen levels that provide protection.

But today, protection more and more often does not work, as women smoke on a par with men, or even more. And then the pain signals the problem. But there are also more formidable situations.

Elena Ivanova:
If an atherosclerotic plaque is destroyed and thrombosed in this place of the vessel, this leads to a complete cessation of blood supply and leads to the development of necrosis, that is, the death of the organ that supplies this vessel.

In the case of coronary heart disease, this is myocardial infarction. In fairness, it should be noted that atherosclerosis is not the only cause of ischemia. But the percentage of such pathologies is quite insignificant.

Elena Ivanova:
As additional reasons, there may be abnormal development of coronary vessels, these are the vessels that supply the heart with blood, due to a congenital defect in the structure of these vessels. It can also lead to disruption of the blood supply to the myocardium, malnutrition, and ischemia.

Therefore, in most cases, the development of the disease is based on risk factors that a person is able to influence. For example, being overweight. Obese people have an excess of so-called bad cholesterol.

Elena Ivanova:
Good cholesterol is high density lipoprotein, bad cholesterol is low density or very low density lipoprotein.
So, high-density cholesterol prevents the deposition of fat in the walls of the arteries, while its antipode, on the contrary, is deposited in the form of plaques hated by the vessels.

Elena Ivanova:
If a patient has an elevated level of harmful low-density lipoprotein cholesterol, special treatment is required. Along with adherence to a hypocholesterol diet, drugs from the statin group are prescribed, which normalize the lipid composition of the blood.

Well, there is nothing to say about alcohol abuse. There is a tale among people that alcoholics have clean vessels, just a tale.

But diabetes mellitus is a reality that always accompanies atherosclerosis.

Elena Ivanova:
In patients with diabetes mellitus, due to carbohydrate metabolism, it is often accompanied by an increase in body weight and, in parallel, leads to a violation of the blood composition. Accordingly, the process of atherosclerosis in diabetics is faster.

But you can curb a sweet disease with discipline. Compliance with the recommendations of the doctor and diet. As, however, and hypertension, another companion of atherosclerosis. And here is the time to hit on physical inactivity. One shot at once to kill not two, but three birds with one stone.

Elena Ivanova:
European recommendations say that 30 minutes minimum is a daily load. Cycling, swimming, walking. Why are these types of loads? Because they are cardio workouts. They are accompanied by an increase in heart rate, they are accompanied by an improvement in metabolic processes in the myocardium, they increase vascular tone, and all this generally has a beneficial effect on the functioning of the cardiovascular system.

In addition, physical activity helps to better endure stress.It’s no secret that it is because of him that many cardiovascular disasters occur. And then no atherosclerosis is terrible for you.

By the way, about the reasons. Here, a man says: ‘I have always been absolutely healthy. Why did I get these plaques, which later led to the development of the disease? ‘
Elena Grigorenko:
The atherosclerotic process begins in early childhood. And his debut occurs precisely at this age. In the first ten years, we can detect certain lipid spots at the level of a large aortic vessel.If the arteries are examined at a later age, for example, in the third decade of life, then these will be single atherosclerotic plaques in the coronary arteries. In medicine, there is the concept of an ischemic cascade. And the paradox of coronary artery disease is that it begins to manifest itself clinically in a situation when the lumen of the coronary artery is narrowed by more than 50%. And often changes in the vascular wall at this stage are already irreversible. They require either invasive intervention or medication.And in this situation, medical intervention is lifelong. And we use the entire arsenal of our medications, and, unfortunately, we do not achieve the desired effect in relation to his complaints, in relation to his feelings, in relation to his ability to continue his ordinary professional life. Then, of course, we have to turn to interventional cardiologists for help. But in no way cancels the subsequent drug treatment. Shunts during coronary artery bypass grafting are also subjected to atherosclerosis, atherosclerosis develops after stenting on the coronary arteries.And the misconception of many patients is that most of them expect that surgery or manipulation on the vessel will lead to a cure. Unfortunately this is not possible.
Still, when a person found out that he has such a diagnosis, there are certain problems, should he change something in his life? What recommendations would you give to a patient with coronary artery disease? What should he do in the mode of life, nutrition, in relation to life?

Elena Grigorenko:
Of course, we very often tell patients that they should unite with the doctor against their illness, and not with the illness against the doctor.The whales of atherosclerosis are three factors: high cholesterol levels, high blood pressure, and smoking. The patient is able to influence 2 of these factors without pills. Quitting smoking is out of the question, changing the diet towards a diet that contains lower levels of cholesterol-rich foods. One should not be mistaken in this situation and go to extremes. Cholesterol is a component that is found in all cell membranes. And even if a patient with coronary heart disease is starving, cholesterol will be synthesized, because it is necessary for the synthesis of cell membranes, for the synthesis of sex hormones, a sufficiently large amount of cholesterol is contained in nerve cells, therefore it is necessary to limit those foods that contain the so-called bad cholesterol …

Let’s hit on atherosclerosis, and therefore on ischemia, with proper nutrition.

Elena Ivanova:
The key to health is a balanced diet, food rich in all nutrients, vitamins and minerals.

But first, a list of products that should be limited.

Elena Ivanova:
Fatty meats, egg yolk, fatty sour cream, butter, fatty dairy products.Undoubtedly, these are sausages, sausages, offal, salt.

They contain a lot of cholesterol and animal fats. Olive oil has a lower cholesterol content, so it is best used for cooking.

Elena Ivanova:
But you still need to limit so that your body weight does not increase.

Must-have foods: start the day with bread, preferably coarsely ground, or porridge.

Elena Ivanova:
With regard to carbohydrates, there is a reservation that difficult-to-digest carbohydrates should prevail, they are contained in cereals and cereals.

Breakfast can also start with fruits: they serve as a source of potassium, which is necessary for our heart. Lemons are especially useful for atherosclerosis. For our body, fractional nutrition is useful: 5-6 times a day.

Elena Ivanova:
Eating small portions leads to an even release of digestive juices, respectively, to better assimilation of food.

For lunch or afternoon tea, you can treat yourself to nuts. Unfortunately, they are too high in fat, so don’t go overboard with nuts.

Prepare lean meat for lunch, but always with a vegetable salad.

Elena Ivanova:
Only 30% of saturated fat, everything else should be polyunsaturated fatty acids.

And there are a lot of them in fish, moreover, fatty varieties.

Low-fat milk, yogurt or cheese is recommended for an afternoon snack. But sweets and sugar only harm a sick heart.

Elena Ivanova:
It is necessary to exclude easily digestible pure sugar, chocolate, some flour sweets.

Dinner should be light and 3 hours before bedtime. Mostly from boiled or baked dishes. And do not forget that the number of calories consumed should not exceed their consumption. This means that always remember about physical activity.

STB, 21 January 2013

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Angina pectoris

Angina pectoris is one of the most common forms of coronary heart disease (CHD). The disease is manifested by pain in the chest (in the middle of the chest) when walking (especially in cold or windy weather), climbing stairs, as well as other physical and emotional stress, against the background of increased blood pressure.The pains are of a squeezing nature (therefore angina pectoris was previously called “angina pectoris”), pressing or burning, given to the left hand or both hands, or to the lower jaw. Pains are often accompanied by shortness of breath, sweating, weakness. When you stop or stop the load, the pain behind the sternum quickly (3-5 minutes) disappears.

For stable exertional angina, recurrence of chest pain with the same physical activity is typical, the pains are of the same nature and quickly disappear when the load is stopped or nitroglycerin is taken under the tongue.Often, patients know that an attack occurs precisely when going out into the street in cold weather, accelerating a step, climbing a hill, and can even say exactly at what distance (for example, after 100-200 meters) pain appears.

If chest pains occur more often, become more intense, prolonged (lasting more than 10-15 minutes), are provoked by less exertion and occur even at rest (including at night), their character changes (especially if the pains become burning or tearing, sensation of “cola behind the breastbone”) and cease to be quickly stopped by nitroglycerin, these are symptoms of unstable angina.With an attack of angina pectoris lasting more than 20-30 minutes, the death of myocardial cells begins, that is, myocardial infarction is likely. In the acute period of myocardial infarction, there is a great danger of life-threatening complications (ventricular fibrillation, i.e. cardiac arrest, heart block, heart rupture). Therefore, if the pain behind the sternum could not be stopped within 15-20 minutes, then you should immediately call an ambulance, which will take you to a specially equipped cardiac intensive care unit, where observation and treatment will reduce the likelihood of myocardial infarction and its complications.

Why do chest pains occur?

To understand what ischemic heart disease and angina pectoris as the most common form of this disease, you need to remember your school biology textbook. In a simplified form, the development of this disease can be represented as follows.

If you remember, all living organisms, in contrast to inanimate nature, move. Organisms themselves move, their body parts, stomach and intestines, blood moves through the vessels. It takes energy to move.Energy in cells is produced by oxidation (this complex process can be rather conventionally called “internal combustion”). Oxidation requires oxygen. The simplest organisms (amoeba, bacteria, etc.) receive oxygen directly through the cell membrane. In complex organisms, there is a delivery system: in the lungs, oxygen is absorbed into the bloodstream and is carried through the vessels to all organs and tissues. The vessels that carry oxygen-rich blood are called arteries. Accordingly, there are arteries in all organs.The arteries that supply the heart are called coronary or coronary arteries (by the way, this is why coronary heart disease is also called Coronary Heart Disease (CHD) in English). Normally, the lumen of the artery is sufficient to ensure the flow of the required amount of blood through it In addition, when the demand for oxygen increases (for example, when running), the elasticity of the wall can cause the healthy coronary artery to expand (this is called coronary reserve).In atherosclerosis (and IHD is a variation of this process), cholesterol is deposited in the form of plaques under the inner lining of the coronary arteries. As a result, the lumen of the arteries in these areas narrows (just as the lumen of water pipes narrows in areas where rust and scale are deposited). In addition, calcium penetrates into the plaques and these areas become “cemented” and lose elasticity. As a result, the lumen of the coronary arteries narrows and the coronary reserve decreases. This process can last for years and not manifest itself in any way, i.e.because the physiological coronary reserve is quite high. But when the lumen of the artery narrows by more than 70-75%, then the oxygen supplied with the blood may not be enough (speaking in medical terms, myocardial ischemia occurs). Naturally, this happens primarily when the demand for oxygen is greater, that is, with physical exertion. In typical cases, with a speeding up step, walking uphill or going outside in cold weather, pain in the chest arises, which quickly stops when stopping (at rest, there is enough blood supply through the narrowed section of the artery).Pain behind the breastbone is an alarm signal, “cry of the heart” – “stop, I do not have enough oxygen,” and therefore “to endure it courageously” is wrong and very dangerous.

How to identify angina pectoris?

If you experience chest pain described above, you should consult a cardiologist, or, first, a general practitioner or family doctor. If you are a man over the age of 40, smoke, have arterial hypertension or diabetes mellitus, and your parents have had heart attacks or strokes, then it is very likely that chest pains are symptoms of angina pectoris.The disease is serious, so you need to be examined as soon as possible, temporarily postponing daily activities. Remember that if you leave this problem “for later”, hoping for “maybe”, then myocardial infarction may occur, from which people often die.

The diagnosis of angina pectoris is based on the analysis of patient complaints and examination data. Tests are carried out for the lipid spectrum of blood and indicators of the blood coagulation system (coagulogram). An electrocardiogram (ECG) is recorded at rest, which, if myocardial infarction has not been transferred, may be normal.But if you provoke an attack of angina pectoris with physical activity (stress test) on a treadmill (treadmill) or a bicycle ergometer, then the ECG can reveal signs of transient myocardial ischemia. If the stess test results are positive, coronary angiography (X-ray contrast study of the coronary arteries) is indicated, in which it is possible to reveal the nature of the lesion of the coronary arteries (multiple or single atherosclerotic plaques, stable or not, the severity of stenoses (narrowings), their localization and length.Depending on the symptoms, the cardiologist decides on the possibility of drug treatment of angina pectoris or the need for myocardial revascularization surgery – coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG).

What to do in case of angina pectoris attack?

The first thing to do when chest pain occurs is to stop exercising. If the pain appears when walking, then you need to stop. By itself, stopping the exercise can relieve (stop) the pain.But it is safer to take nitroglycerin under the tongue. I note that modern forms of nitroglycerin in the form of nitrospray in balloons (nitromint, nitropol, nitrocor spray, etc.) are more convenient in comparison with also effective tablets. You do not need to open the tube and pour the pills into your palm, take one of them, pour the rest back (and at this time it hurts in the chest, and if, in addition, the attack occurred on the street, you also need to take off and put on gloves, etc.). Nitrospray, unlike tablets, does not crumble into powder, which means that the dosage of nitroglycerin remains exactly necessary, it is protected from light and remains valid for 3 years.In short, if possible, it is more convenient and reliable to use nitrospray.

So, if there is pain behind the sternum, you need:

• Stop and take one sublingual dose of nitroglycerin (1 spray or one tablet).
• If possible, sit down. Nitroglycerin lowers blood pressure, and if the pressure drops abruptly, you may feel dizzy or even faint. That is why it is not necessary to take more than 1 dose of nitroglycerin at once.But attention! The danger of myocardial infarction when delaying an attack of angina pectoris is much more serious than these possible side effects of taking nitroglycerin, which, by the way, do not always occur, like a headache. If earlier when taking nitroglycerin there were pronounced headaches, then to reduce them take also 1 tablet of validol or any other tablet containing menthol (“halls”, “rondo”, “chill”, etc.). Attention! Taking only validol is not reliable compared to taking nitroglycerin and you can lose precious time to quickly stop the attack.The same applies to taking nitrosorbide under the tongue, it begins to act only after 7-10 minutes. Nitroglycerin remains the “gold standard” for relieving angina attacks. If, when taking nitroglycerin, severe headaches or dizziness nevertheless occur, then you can reduce a single dose for stopping attacks by switching to the use of “Kremlin drops” or Votchal drops or using an alcohol solution of nitroglycerin (drip 1-2 drops of it on a validol tablet and In an attack, take not the whole pill, but breaking it into 2-4 parts, although such a “blank” cannot be stored for more than several hours due to the rapid destruction of nitroglycerin).As a rule, chest pain is quickly relieved by taking 1 dose of nitroglycerin under the tongue.
• If the pain behind the breastbone does not stop after 3-5 minutes and there is no pronounced weakness and dizziness, then you need to take another dose of nitrospray or 1 tablet of nitroglycerin under the tongue. If after another 3-5 minutes the pain behind the breastbone still has not stopped, then again 1 dose (3rd in a row) of nitroglycerin is taken under the tongue.
• If after 15 minutes the pain behind the breastbone has not been stopped by taking nitroglycerin, then you need to call an ambulance.While waiting for the ambulance team, if there is no pronounced weakness and dizziness, you can re-take 1 dose of nitroglycerin under the tongue every 5-10 minutes and put a mustard plaster on the heart area. Considering that myocardial infarction is likely in such a situation, it is also necessary to take? aspirin tablets (250-325 mg).

Treatment of angina pectoris

If the diagnosis of angina pectoris is confirmed by examination, then treatment of this disease is necessary. The type of treatment depends primarily on whether the situation is stable or unstable.If unstable angina is diagnosed, hospitalization is indicated, treatment of stable angina is usually possible on an outpatient basis. With unstable angina pectoris or severe stable angina pectoris, coronary angiography is indicated and the decision on the need for surgical treatment – myocardial revascularization operations – coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) is indicated. If possible, they are limited to drug treatment.

Tasks of drug treatment

• slowing the progression of atherosclerosis,
• prevention of myocardial infarction,
• Reducing the frequency of chest pain.

Unfortunately, it is impossible to completely cure atherosclerosis and ischemic heart disease (do not believe the charlatans who advertise all kinds of means that have not been scientifically tested!), But you can significantly improve the prognosis and quality of life.

In principle, the treatment of angina pectoris includes:

• Correction of risk factors for coronary artery disease. There has been a direct relationship between smoking, arterial hypertension, hyperlipidemia, diabetes mellitus and morbidity and mortality from ischemic heart disease. It is necessary to eliminate or reduce the impact of these factors.
• Treatment of atherosclerosis. Ischemic heart disease is one of the forms of atherosclerosis, therefore, strict adherence to the diet and constant lifelong intake of statins (zokor, simgal, liprimar, lipostat, etc.) is necessary.
• Prevention of blood clots on atherosclerotic plaques. If the atherosclerotic plaque is “soft”, with a thin lining, then it can burst and a blood clot forms on it. A blood clot can block the blood flow through the coronary artery and then myocardial infarction occurs (see.section “Myocardial infarction”). To prevent the formation of a blood clot on an unstable plaque, all patients suffering from angina pectoris are prescribed antiplatelet agents – aspirin (its enteric form is called thromboASC) or Plavix.
• Optimization of the working conditions of the heart. If we compare our body with a cart that travels along the road, and the heart with a horse that drives it, then it will become clear why certain drugs are prescribed. Beta-blockers (atenolol, metoprolol, concor, etc.) slow down the work of the heart and lower blood pressure. As a result, we spare the horse (heart), so as not to drive it, and the carriage travels longer. Antihypertensive drugs (calcium antagonists (nifedipine retard, Norvasc, bendil, diltiazem), ACE inhibitors (enalapril, prestarium, monopril, etc.), diuretics (indapamide (arifon), hypothiazide), etc.) lower blood pressure if it is elevated , reducing the obstacle to the ejection of blood from the heart (improve the road on which the carriage travels). Cytoprotectors (preductal) improve the metabolism in the myocardium (comparable to lubricating the axles of the wheels of a cart).As a result, the use of drugs reduces the load on the heart, which reduces its oxygen demand and reduces the likelihood of angina attacks.
• Prevention of angina attacks. For this purpose, the above-mentioned beta-blockers are used, as well as calcium antagonists (they also dilate the coronary arteries) and long-acting nitrates (cardiket-retard, monochinque, monomac, nitrosorbide, etc.). Nitrates are used in the minimum required doses, as needed, depending on what time of the day angina attacks occur and how they are provoked.So, if chest pain occurs only in the first half of the day when going outside, then cardiket-retard is taken only 1 time a day in the morning, 20-30 minutes before the expected load. If, against the background of a selected adequate dose of beta-blockers and calcium antagonists, there is no pain behind the breastbone, then the intake of nitrates is not indicated.

Triptans

Triptans are a group of medicines specially designed to relieve migraine attacks. Currently, there are three triptans available in Russia – sumatriptan, eletriptan and zolmitriptan [3].Triptans are prescription drugs that are selected by a doctor taking into account concomitant diseases, contraindications, and a person’s lifestyle.

At the University Headache Clinic, we implement an international approach to headache therapy. According to the standard, the diagnosis of most types of headaches is made based on the results of a consultation with a neurologist, without additional tests and studies.

During the consultation, our doctors will select the drugs that are right for you for the prevention and relief of seizures.

How to make triptans work better

Triptans are effective in any phase of an attack, but the greatest effect will be when taken at the beginning of a migraine attack. It is ideal to adhere to the following rules for taking triptans [1]:

1. Take one tablet for mild to moderate headache.
2. A second dose of triptans can be taken after 2 hours.
3. Do not exceed two doses per day.
4. Do not use triptans more than two days a week.

Side effects of triptans

Side effects from triptans may include nausea, a feeling of tightness or squeezing of the neck, lower jaw, chest, palpitations, general weakness, tingling sensation in the limbs, burning sensation on the skin.
Although these side effects are common, triptans are a very safe class of drugs when used as indicated. And side effects are less common if triptan is taken early in an attack [3].

What is important to know about triptans

• are not effective for all people with migraines;
• Even if triptans are effective for you, they may not relieve all seizures;
• If one triptan is ineffective, you should try another – it may be more suitable for your migraine [2].

Contraindications

Triptans are contraindicated in patients with coronary heart disease, a history of stroke, uncontrolled arterial hypertension, and certain medications.Be sure to tell your doctor what drugs you are using to make sure the triptans are safe [4].

It is important to remember that triptans, like any other headache medication, must be taken only as directed by your doctor. Uncontrolled use of triptans on your own can lead to the development of complications, for example, to the occurrence of an abusal headache.

Literature:

1. Yu.E. Azimova (specialist of the University Headache Clinic), G. TabeevaP. “Triptans in the treatment of migraine: ways to increase efficiency.” // Pain: scientific and practical journal. – 2009. – N 2. – S. 28–32.
2. Amelin A.V. “Pharmacotherapy of a migraine attack.” // Handbook of the outpatient doctor. – 2007.- No. 9. – p.23-27.
3. Johnston M.M., Rapoport A.M. “Triptans for the management of migraine”. // Drugs. – 2010. –v.70. – p. 1505-1518
4. Loder E. “Triptan therapy in migraine”. // N Engl J Med.- 2010. – v.363. – p. 63-70
5. Rothrock J.F. Oral triptan therapy. // Headache. – 2006. – v.46. – p. 1038

Pain medications can cause headaches – Rossiyskaya Gazeta

In Russia, about 20 million people suffer from migraines.

This disease is not life threatening, but makes it painful. In most patients, headaches are so severe that people temporarily lose their ability to work.

When doctors carried out a comparative assessment of the quality of life in patients with migraine, coronary heart disease, hypertension and diabetes, it turned out that the worst of all the situation is with those suffering from headache.Even if migraine attacks occur only twice a month, then in a person of active age (between 15 and 45 years), at least two years are, as it were, deleted from life.

Therefore, it is no coincidence that in the list of diseases compiled by the International Headache Society (there is such a thing!), Migraine is in the first place, and the World Health Organization (WHO) included it in the list of 19 diseases that most violate the social adaptation of patients.

Although migraine has haunted humanity since the time of Julius Caesar and Pontius Pilate, who suffered from headaches, it is still shrouded in myths to this day, since doctors have not yet found the exact causes of the disease, or one hundred percent methods of healing.The most common myths are:

1 Migraine is an exclusively female disease, and if sometimes it affects men, then only genius ones. These headaches do affect women 3-4 times more often than men. And among the stronger sex suffering from migraines, there are indeed many big names – Peter I, Darwin, Chopin, Tchaikovsky, Tolstoy, Freud, Chekhov … But in general, the disease affects people of both sexes, regardless of their mental abilities.

2 Migraine starts from bad wine.The phrase “Chateau Migraine” has come to mean bad wine, allegedly contributing to the onset of migraine. But there is no scientific evidence linking migraine attacks to the quality of wine.

3 A migraine attack can be triggered by chocolate. Doctors did not find such a direct dependence. Although they recommend excluding cheeses, chocolate, nuts, fish, citrus fruits, smoked meats, bananas from the diet during the attack. More unambiguous factors that can cause migraines are stress, hormonal causes, certain medications (oral contraceptives, drugs that dilate blood vessels), changes in the weather, bright lights, loud noise.

4 Migraine haunts people with a bad character. It is difficult to say if there is a direct connection here. It is clear that regular pain attacks add few people to a good mood. Migraine sufferers are really distinguished by increased excitability, a tendency to depression, resentment, stubbornness, irritability.

5 There is no cure for migraine. Conventional analgesics really do not save you from these headaches. But some patients are helped by long-term (within 6-7 months) use of aspirin in small doses.But here you need to consult a doctor. And in general, the treatment of migraine should be carried out by a doctor, taking into account concomitant diseases. After all, special anti-migraine analgesics have already been created – triptans, which have an effective and safe effect. However, these drugs have a number of limitations. The drugs should not be used, say, in patients with severe ischemic heart disease (for example, angina pectoris or myocardial infarction), with arrhythmias, uncontrolled arterial hypertension.

Headache from analgin

Another common type of headache is the so-called “tension headache” (HDN). Doctors named it that way because for a long time it was believed that HDN was caused by fatigue and spasms of the frontal, temporal or occipital muscles. But in the end, research has shown that this is completely unnecessary. Often, muscle cramps are just a consequence of a headache. Therefore, it is so important not to endure, but to try to quickly get rid of it.

But try not to overdo it with medications.After all, oddly enough it may sound, drugs themselves can cause headaches. This even applies to pain relievers.

Medical sites warn: “drug-induced” headaches can provoke excessive doses of sodium metamizole (analgin), aspirin, triptans, etc.

Dangerous abuse of combined drugs that combine codeine with caffeine and paracetamol. They effectively suppress pain, but with frequent and excessive use, they stop relieving attacks and even intensify them.

Doctors advise not to get carried away with sedative drugs (Corvalol, Valocordin). Indeed, with constant overdoses, they are also capable of causing headaches in the truest sense of the word. And we have to wean the body from them already in stationary conditions, gradually canceling the drugs.

In untreated cases, the headache at first sharply aggravates (following the abolition of the medication), but after a month it passes.

Test

Physicians have compiled a short questionnaire that allows you to quickly understand whether a patient’s headache is a migraine.Try to answer whether your headache has been accompanied by the following symptoms in the past three months:

1. Nausea or vomiting?

2. Intolerance to light and sounds?

3. Did your headache limit your daily activities, work or school for at least one day?

If you answer “yes” to at least two questions, then with a probability of 93% it can be argued that your headache is a migraine.

Recommendations

Ischemic heart disease (IHD).Heartache. Examination and treatment

Our clinic has a wide range of diagnostic examinations of the heart and blood vessels. We are able to work with elderly patients and patients with coronary artery disease on the background of concomitant diseases (overweight, increased cholesterol, hypertension, diabetes, bronchial asthma, etc.). This is the careful and systematic management of each patient by the doctor. Our main task with you is to keep a healthy heart for a long time.

Watch our video about the diagnosis of the heart, blood vessels and respiratory function

Diagnosis of ischemic heart disease.Treatment in the clinic “Echinacea”

IHD is usually treated by a cardiologist or therapist . If we are talking about the treatment of several diseases at once, we usually recommend a therapist as the primary attending physician and a cardiologist as a consultant. To confirm the diagnosis, it is necessary to conduct a series of studies of cardiac activity.

Deposition of cholesterol in the coronary arteries feeding the heart muscle

Diagnosis of coronary artery disease (ischemic heart disease) is carried out as follows:

1. Electrocardiography (ECG) .Electrocardiography is the most effective, simple and well-known method for diagnosing coronary heart disease. The ECG records the electrical potentials of the heart, that is, how the excitation passes through the heart muscle. The ECG clearly shows in which part of the heart muscle there is not enough blood supply.
2. Daily ECG monitoring (Holter, Holter monitoring) is performed if the ECG results do not provide the necessary information. Holter ECG helps if the patient feels pain in the heart during periods when it is not possible to immediately take an ECG.
3. Bicycle ergometry is necessary when young patients come to us who have heart pain during or after physical exertion. At the time of physical activity on a stationary bike, the heart works more actively and hidden violations become apparent.
4. An echocardiogram (ultrasound, ultrasound of the heart) is done to see how the heart contracts and how the heart valves work. In areas of ischemia, where the heart muscle lacks blood supply, the heart contracts weaker, which can be seen on ultrasound.The amount of blood thrown out in one contraction may also be greatly reduced. The echocardiography shows the valves, any significant abnormalities and growths in the heart.
5. Biochemical blood test. Most often, coronary heart disease occurs due to the development of atherosclerosis. A biochemical blood test helps to see the ratio of “bad” and “good” cholesterol and provide effective treatment.
6. We carry out a blood test for muscle enzymes when myocardial infarction is suspected.

Coronary artery disease (CHD). Atherosclerotic plaque, impaired blood supply to the heart

Our experience shows that in some cases pain in the region of the heart is not associated with ischemic heart disease. Pain in the region of the heart can be the result of diseases of the nervous system, stomach, osteochondrosis of the spine, etc. If no heart problems are identified, a neurologist, gastroenterologist or other specialists come to the rescue.

Treatment of coronary heart disease

In our clinic, it is customary for a patient with coronary artery disease to have one attending physician who can be contacted in case of difficulties. Treatment is selected individually: the same medicine works differently in different patients with coronary artery disease. Cholesterol levels, blood clotting, heart rhythm disturbances, body weight, quality of night sleep are corrected, and attention is paid to general health and metabolism.

Treatment of ischemic heart disease (IHD)

• We will select drugs for relieving heart pain .
• Let’s select medicines that normalize cholesterol levels. This will inhibit the development of atherosclerosis and further vasoconstriction.
• If the results of the examination indicate that the only reliable way of treatment is surgery, we will refer you for coronary angiography of the heart . Under an X-ray, using contrast, a study is carried out to determine how the contrast fills the vessels of the heart muscle, the data are taken into account when deciding on the need for surgical treatment.

What is angina pectoris and myocardial infarction

Angina pectoris (angina pectoris, window disease) is a short (no more than 15 minutes) attack of pain behind the breastbone. It can occur due to stress or physical exertion. The pain usually radiates to the left arm, shoulder, lower jaw. Pain, in this case, occurs due to the fact that the myocardium does not receive the necessary blood supply. Lack of attention to this “alarm bell” can lead to a heart attack.

Myocardial infarction is an acute disease in which it does not receive nutrition and the part of the heart muscle that was poorly blood-sucked dies.