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Migraine Hangover (Postdrome)
What Is a Migraine Hangover?
A migraine hangover, also called postdrome, is the last stage of a migraine. It can linger a few hours to more than a day after the headache goes away. Postdromes don’t always come, but experts believe that they happen up to 80% of the time.
There’s also no way to know how intense your postdrome will be. It isn’t necessarily linked to how severe your migraine is.
Symptoms of a Migraine Hangover
How do you know if you’re having postdrome? Symptoms vary, but you might be:
- Unable to concentrate
- In a general bad mood
- Drained or washed out
You might also notice physical symptoms, like:
Causes of Migraine Hangover
Researchers don’t think one single thing causes postdrome. It’s part of the migraine itself, as it affects systems all over your body.
Migraine Hangover Treatment and Home Remedies
A doctor who specializes in headaches can help you understand your migraines and find treatments that work.
Once you’re in postdrome, it’s important to practice what’s called good headache hygiene.
Drink plenty of water. Get some rest, too. Relaxing activities like yoga can be helpful. What works for someone else won’t necessarily work for you, so you might need to experiment.
Do you notice that your postdrome is worse when you look at a screen? Stay off your phone or laptop.
Do you find that caffeine eases your symptoms? Make a cup of tea.
You can also try:
- Ice packs
- Heating pads
It can be a good idea to keep a headache diary. On a notepad, on your phone, or in an app, keep track of:
- What your symptoms are
- How you’ve dealt with them
- Which things work or don’t work
This will help you in the future when you need to feel better.
Don’t ignore your symptoms or try to push through them and return to your regular life too fast. Let yourself recover completely from both the headache and the postdrome before you dive back into everything.
Migraine Hangover Prevention
During the earlier phases of the migraine — prodrome, aura, and headache — make sure you stay hydrated and try to do some light stretches if possible.
Avoid anything that makes your migraine worse, like overstimulation or trying to do too much too fast.
Of course, one of the best ways to prevent the postdrome phase is to avoid a migraine in the first place. How do you do that?
- Try to have good sleep habits.
- Eat healthy foods throughout the day.
- Make exercise a priority.
- Keep stress in check.
Migraine Stages & Symptoms: Prodromal, Aura, Attack, Postdromal
A migraine can be complicated, with symptoms that change over hours or even days. They tend to move through several stages:
- Prodromal phase (before the migraine)
- Aura phase
- Attack phase
- Postdromal phase (after the migraine)
Prodromal Phase: Early Warning Signs
Hours before the migraine begins — and sometimes even the day before — many people may feel:
- Either unusually energetic and excitable or depressed
- Cravings for specific foods
- Sleepy, with a lot of yawning
- The need to pee more often
In some cases, these symptoms before the headache can help doctors diagnose the problem as a migraine.
Aura Phase: Strange Feelings Start
About 1 in 3 to 1 in 4 people with migraines get an “aura” that begins before the headache or starts along with it. It may not happen with every headache, though.
An aura can include:
Changes in vision, such as:
- A flickering, jagged arc of light. It may have a complicated shape. It usually appears on the left or right side of your vision. Over a few minutes, it may get bigger.
- A blind spot in your field of vision. This problem — combined with the flickering lights — can make it hard to drive or focus your eyes on small objects.
- You might “see” images from the past or have hallucinations.
These symptoms may continue to get worse over the next several minutes.
Skin sensations. You might feel tingling or “pins and needles” in your body during an aura. It may also cause numbness. These feelings often affect the face and hands, but they can spread out across the body. They may continue to expand over the next several minutes.
Language problems. You may have a hard time communicating with others. Symptoms may include:
- Trouble expressing thoughts when you speak or write
- Trouble understanding spoken or written words
- Trouble concentrating
Attack Phase: The Headache Begins
The attack portion of a migraine can last from a few hours to several days. During this phase, you’ll probably want to rest quietly and find it hard to do your normal activities.
The pain of a migraine:
- Usually begins above the eyes
- Typically affects one side of the head, but it may happen to the entire head or move from one side to the other. It may also affect the lower face and the neck.
- Tends to feel throbbing
- May throb worse during physical activity or when you lean forward
- May get worse if you move around
Other symptoms that might happen during this phase:
Postdromal Phase: After It Stops
Following the most severe phase of the migraine, you may not feel well for up to a day. Symptoms of this post-migraine phase may include:
- Extreme tiredness
- Head pain that flares up when you lean over, move quickly, or get a rush of blood to the head
Your migraines may change over time, including how often they happen and how severe they are. Attacks may not always include all of these stages. Also, you may eventually get the migraine aura without having a headache. Since many of the symptoms found in these stages of migraines can also occur in very serious conditions such as stroke or seizures, seek immediate medical help for any new symptoms, or ones that have never been evaluated by your doctor.
Treatment of Acute Migraine Headache
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Migraine – Neurologic Disorders – Merck Manuals Professional Edition
Often, a prodrome (a sensation that a migraine is beginning) heralds attacks. The prodrome may include mood changes, neck pain, food cravings, loss of appetite, nausea, or a combination.
An aura precedes attacks in about 25% of patients. Auras are temporary neurologic disturbances that can affect sensation, balance, muscle coordination, speech, or vision; they last minutes to an hour. The aura may persist after headache onset. Most commonly, auras involve visual symptoms (fortification spectra—eg, binocular flashes, arcs of scintillating lights, bright zigzags, scotomata). Paresthesias and numbness (typically starting in one hand and marching to the ipsilateral arm and face), speech disturbances, and transient brain stem dysfunction (causing, for example, ataxia, confusion, or even obtundation) are less common than visual auras. Some patients have an aura with little or no headache.
Headache varies from moderate to severe, and attacks last from 4 hours to several days, typically resolving with sleep. The pain is often unilateral but may be bilateral, most often in a frontotemporal distribution, and is typically described as pulsating or throbbing.
Migraine is more than a headache. Associated symptoms such as nausea (and occasionally vomiting), photophobia, sonophobia, and osmophobia are prominent. Patients report difficulty concentrating during attacks. Routine physical activity usually aggravates migraine headache; this effect, plus the photophobia and sonophobia, encourages most patients to lie in a dark, quiet room during attacks. Severe attacks can be incapacitating, disrupting family and work life.
Patients with episodic migraine can develop chronic migraine. These patients have headaches ≥ 15 days/month. This headache disorder used to be called combination or mixed headache because it had features of migraine and tension-type headache. These headaches often develop in patients who overuse drugs for acute treatment of headaches.
Other, rare forms of migraine can cause other symptoms:
Basilar artery migraine causes combinations of vertigo, ataxia, visual field loss, sensory disturbances, focal weakness, and altered level of consciousness.
Hemiplegic migraine, which may be sporadic or familial, causes unilateral weakness.
Migraine | MedlinePlus
What are migraines?
Migraines are a recurring type of headache. They cause moderate to severe pain that is throbbing or pulsing. The pain is often on one side of your head. You may also have other symptoms, such as nausea and weakness. You may be sensitive to light and sound.
What causes migraines?
Researchers believe that migraine has a genetic cause. There are also a number of factors that can trigger a migraine. These factors vary from person to person, and they include
- Hormonal changes in women
- Bright or flashing lights
- Loud noises
- Strong smells
- Too much or not enough sleep
- Sudden changes in weather or environment
- Overexertion (too much physical activity)
- Caffeine or caffeine withdrawal
- Skipped meals
- Medication overuse (taking medicine for migraines too often)
Some people have found that certain foods or ingredients can trigger headaches, especially when they are combined with other triggers. These foods and ingredients include
- Aged cheeses
- Monosodium glutamate (MSG)
- Some fruits and nuts
- Fermented or pickled goods
- Cured or processed meats
Who is at risk for migraines?
About 12% of Americans get migraines. They can affect anyone, but you are more likely to have them if you
- Are a woman. Women are three times more likely than men to get migraines.
- Have a family history of migraines. Most people with migraines have family members who have migraines.
- Have other medical conditions, such as depression, anxiety, bipolar disorder, sleep disorders, and epilepsy.
What are the symptoms of migraines?
There are four different phases of migraines. You may not always go through every phase each time you have a migraine.
- Prodome. This phase starts up to 24 hours before you get the migraine. You have early signs and symptoms, such as food cravings, unexplained mood changes, uncontrollable yawning, fluid retention, and increased urination.
- Aura. If you have this phase, you might see flashing or bright lights or zig-zag lines. You may have muscle weakness or feel like you are being touched or grabbed. An aura can happen just before or during a migraine.
- Headache. A migraine usually starts gradually and then becomes more severe. It typically causes throbbing or pulsing pain, which is often on one side of your head. But sometimes you can have a migraine without a headache. Other migraine symptoms may include
- Increased sensitivity to light, noise, and odors
- Nausea and vomiting
- Worsened pain when you move, cough, or sneeze
- Postdrome (following the headache). You may feel exhausted, weak, and confused after a migraine. This can last up to a day.
Migraines are more common in the morning; people often wake up with them. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work.
How are migraines diagnosed?
To make a diagnosis, your health care provider will
- Take your medical history
- Ask about your symptoms
- Do a physical and neurological exam
An important part of diagnosing migraines is to rule out other medical conditions which could be causing the symptoms. So you may also have blood tests, an MRI or CT scan, or other tests.
How are migraines treated?
There is no cure for migraines. Treatment focuses on relieving symptoms and preventing additional attacks.
There are different types of medicines to relieve symptoms. They include triptan drugs, ergotamine drugs, and pain relievers. The sooner you take the medicine, the more effective it is.
There are also other things you can do to feel better:
- Resting with your eyes closed in a quiet, darkened room
- Placing a cool cloth or ice pack on your forehead
- Drinking fluids
There are some lifestyle changes you can make to prevent migraines:
- Stress management strategies, such as exercise, relaxation techniques, and biofeedback, may reduce the number and severity of migraines. Biofeedback uses electronic devices to teach you to control certain body functions, such as your heartbeat, blood pressure, and muscle tension.
- Make a log of what seems to trigger your migraines. You can learn what you need to avoid, such as certain foods and medicines. It also help you figure out what you should do, such as establishing a consistent sleep schedule and eating regular meals.
- Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle
- If you have obesity, losing weight may also be helpful
If you have frequent or severe migraines, you may need to take medicines to prevent further attacks. Talk with your health care provider about which drug would be right for you.
Certain natural treatments, such as riboflavin (vitamin B2) and coenzyme Q10, may help prevent migraines. If your magnesium level is low, you can try taking magnesium. There is also an herb, butterbur, which some people take to prevent migraines. But butterbur may not be safe for long-term use. Always check with your health care provider before taking any supplements.
NIH: National Institute of Neurological Disorders and Stroke
Migraine and Cluster Headaches | Mercy Health
Causes of migraines or cluster headaches
The cause of migraine appears to be linked to hormones, genetics or environmental factors, while the cause of cluster headaches is not fully understood. Research has linked cluster headaches to a nerve in the face that causes intense pressure around one of the eyes.
Triggers for migraines
- Alcohol use
- Relaxing after a stressful situation
- Hormone changes
- Food or food additives
- Intense physical activity or exertion
- Sensory or light stimuli
Cluster headaches typically recur in certain seasons, so they are often mistaken for seasonal allergies.
Risk factors for migraines or cluster headaches
Risk factors vary depending on if it is a cluster headache or migraine.
Migraine risk factors
- Age — migraines seem to start in adolescence and peak in a person’s 30s
- Gender — women are three times more likely to suffer from migraines
- Family history — if a family member suffers from migraines, you are also at higher risk of developing them
- Hormonal changes — some women experience migraines right before menstruation when hormone levels are high
Cluster headache risk factors
- Gender — men are more likely to suffer from cluster headaches
- Age — most people develop cluster headaches between 20 and 50 years old
- Smoking — if you are a smoker, you are more likely to suffer from cluster headaches
Symptoms of migraines or cluster headaches
Symptoms differ based on whether you have a cluster headache or migraine.
Symptoms of migraines
- Light sensitivity
- Temporary loss of vision
- Symptoms can last up to 72 hours
Symptoms of cluster headaches
- Severe pain on one side of the head
- Sudden onset of pain
- Watery eyes
- Runny nose
- Symptoms are shorter in duration than migraines but can recur frequently over a period of a few months
- Wakes you up in the middle of the night
Diagnosis of migraines or cluster headaches
A neurologist typically will diagnose your migraine or cluster headaches during a physical and neurological exam. During the exam, he or she will take a full medical and family history, evaluate your symptoms, and order other tests to confirm your diagnosis.
Testing may include:
- Blood tests — blood tests can rule out infections or toxins in the blood stream that are causing your symptoms.
- Imaging — MRI and CT scans can take detailed images of the brain to determine if you have other conditions such as a brain tumor that is causing your symptoms.
- Spinal tap (lumbar puncture) — a spinal tap may be performed to rule out an infection in the brain.
Treatment for migraines or cluster headaches
Because there is not a cure for migraines or cluster headaches, the goal of treatment is to prevent the attacks as well as decrease the severity of symptoms. Specific treatments will vary based on the type of headache.
Migraine treatments include:
Medications that relieve pain
Pain relief medications should be taken when an attack comes on to reduce the pain associated with the migraine. Mild migraines may be handled with OTC aspirin or ibuprofen, while severe migraines may need prescription medication. Other medications that may be used to relieve pain include Triptans, Ergots, Anti-nausea medication, pain medication and glucocorticoids.
Medications that prevent future attacks
Preventive medications are taken daily and can reduce the number or severity of migraines. Not all patients are candidates for prevention medication. Preventive medication is best for patients who are not finding symptoms relief on pain relief medications, who have four or more migraines a month, and have attacks that last longer than 12 hours. Common medications that are used to prevent migraine attacks include cardiovascular drugs, antidepressants, anti-seizure drugs, pain relievers or Botox.
Your doctor will determine the most appropriate medication for your case, taking into consideration your symptom severity, overall health and other medical conditions.
Cluster headache treatment needs to be fast-acting. Treatments include:
- Pure oxygen treatment
- Local anesthetics
Preventive treatments for cluster headaches can be recommended based on your case. Your doctor will determine treatment that is most effective for you.
Preventive treatments for cluster headaches include:
- Calcium channel blockers
- Lithium carbonate
- Nerve block
🥇 San Jose CA Migraine Headache Treatment
Typically characterized by a pulsing sensation or an intense throbbing, a migraine headache differs from a regular tension headache in that symptoms are more severe, sometimes predictive of attacks and often recurring. Migraines are also a type of headache that can return with equal or greater intensity if not treated. Due to the complex nature of this type of headache, treatment is personalized based on reported symptoms, frequency of episodes, and likely triggers.
It’s believed migraine headaches result from a combination of environmental factors and genetics, although there is still much that’s not fully understood about migraines. It’s difficult to conclusively identify genetic links since symptoms can vary greatly even among relatives. Migraines may be linked to changes within the brainstem.
There’s related research suggesting levels of serotonin, a chemical affecting the nervous system, drop during an attack, which may trigger the release of neuropeptides, substances that travel to the outer layer of the brain, possibly resulting in a migraine headache. Fluctuations in estrogen may trigger migraines in women with a history of such headaches.
Migraines are unique in that you may notice signs of an upcoming attack a day or two before it occurs. Episodes can result in pain that lasts anywhere from hours to days, although the average duration is 4 to 72 hours, with symptoms ranging from mild to debilitating. Just before an attack occurs, sensory warning (aura) symptoms that can include flashes of light, tingling in arms or legs, and blind spots may appear.
Since sensitivity to light is often associated with an attack, most sufferers are in the habit of finding a dark, quiet place to rest until symptoms ease. After an attack (postdrome), sufferers may feel drained or even mildly euphoric. Symptoms that may occur before or during a migraine include:
- Nausea and vomiting
- Heightened sensitivity to light and sound
- Tingling in arms or legs
- Pins and needles sensations
- Speech or language difficulties
- Blurred vision
Treatment for migraines can be focused on minimizing the actual symptoms when attacks are severe or preventative to reduce the occurrences of future headaches. If you have frequent attacks, treatment will likely include both approaches. Other than improving overall quality of life, there’s also an emphasis on identifying and reducing triggers to minimize migraine episodes.Acute treatment for migraines involves the use of pain-relieving medications, which should be carefully monitored with medication management techniques to reduce the risk of interactions or dependency. Preventative medications are usually taken daily to minimize episodes. Treatment options may also include:
- Migraine-specific medications
- Anti-nausea medications
- Psychotherapy to reduce stress
- Dietary modifications
There is no cure for migraine headaches. However, pain management tailored to your symptoms may help minimize episodes. How your migraines are managed depends on the severity of the headaches you experience, the degree of your disability when headaches occur, and any preexisting medical conditions. While migraines aren’t likely to completely disappear, comprehensive management that includes preventative measures benefits many sufferers.
If you suffer from migraines and need relief, Contact Allied Pain & Spine Institute today to schedule an appointment with one of our specialists.
90,000 Migraine therapy with monoclonal antibodies in Moscow: price, make an appointment
What is migraine
Migraine is a chronic neurological disease characterized by prolonged, throbbing headaches of high intensity. Women are more likely than men to suffer from migraines. As a rule, the first episodes occur in adolescence and adolescence and continue until the onset of menopause. However, the development of the first episode of migraine at any age is possible.Statistically, 70% of patients have hereditary migraines.
Migraines are characterized by pulsating, pressing, exhausting, usually one-sided headaches. The pain can be localized around the eyes, in the temporal region and in the forehead. Often a migraine attack is preceded by the so-called aura – visual, sound, tactile symptoms – lightning, flashes, tingling, numbness.
Mechanism of action of monoclonal antibodies
The most important and studied mechanism for the development of a migraine episode is the interaction of the fibers of the trigeminal nerve, which is responsible for vasodilation of the brain, and the CGRP protein (pain neuropeptide).As a result of this interaction, a specific inflammation is formed, which is responsible for the intensity and duration of headaches.
In 1982, scientists discovered the CGRP protein, and already in 1985, the connection between the protein and migraine attacks was traced and established. The next few decades in the scientific community were aimed at creating a substance that can “bind” and block the CGRP protein to disrupt the mechanism that triggers a migraine attack. Work was underway to create targeted (targeted) therapy.
Long-term scientific and clinical research in the field of migraine treatment yielded results in 2011. It was then that monoclonal antibodies to the CGRP protein were synthesized. Monoclonal antibodies are thus the CGRP protein blocking substance. In 2017, clinical trials were completed, 4 drugs from the group of monoclonal antibodies were registered with the FDA (Food and Drug Administration).
Currently, 7 drugs from the group of monoclonal antibodies for the treatment of migraine have been registered and successfully used in Europe, 4 drugs in Russia.
Who will benefit from monoclonal antibody therapy
There are clear indications for starting migraine therapy with monoclonal antibodies:
- In case of ineffectiveness of the use of “classical” migraine treatment regimens;
- Frequency of episodes over 8 per month
- If it is impossible to take prophylactic drugs due to the development of side effects or frequency of administration.
Efficacy of monoclonal antibody therapy
Monoclonal antibodies are injected by a neurologist subcutaneously once a month.The course of therapy is 6-12 months.
The results of clinical trials demonstrate the high efficacy and safety of monoclonal antibody therapy. Taking medications significantly reduces the intensity of pain and the frequency of migraine episodes. The risk of developing side effects is minimal. The drug acts pointwise, without affecting metabolic processes in the liver and without changing the state of the mucous membrane of the gastrointestinal tract. Thus, the systemic effect is minimized.
Treatment of migraine in FNKTS
The neurologists of our center are highly qualified specialists with many years of clinical experience in the treatment of migraines.
We use the most modern and most effective pharmaceuticals tested in the best clinics in the world.
Benefits of pain treatment in FNCC
The Pain Treatment Clinic is one of the key areas of activity of the largest multidisciplinary medical center at the federal level of the Federal Research Center for Clinical Center of the Federal Medical and Biological Agency of the Russian Federation. We combine in one place all the stages of pain treatment, from specialized diagnostics, identifying the causes and relief of pain syndrome, to complete elimination of pain and the reasons that caused it.
You can be sure that real professionals will work with you. Our doctors have been trained in the treatment of pain syndromes in leading clinics in Israel.
Pain can and should be fought. We know how and we know how to do it!
doctors of different specialties in one place
a consultation of several doctors quickly solves your problem
International level of treatment
our doctors studied and worked in Israel
we use the most modern techniques, equipment from the world’s leading manufacturers
Treatment of chronic pain of any level
We relieve pain in 30 minutes on the day of treatment
Calling an ambulance, if necessary, at any time of the day
Personal consultant who accompanies you during diagnostics, consultation
School of Pain Management
we conduct seminars and webinars for the patients of the Clinic
After treatment with us, you return to your normal life!
90,000 Migraine treatment
Migraine is a disease characterized by severe headache accompanied by nausea. During an attack, light and sounds are irritating. She worries women more often than men. In total, migraine affects 18% of the female population of the planet and only 6% of the male population. According to the World Health Organization (WHO), it is migraine that most often reduces performance in people from 15 to 49 years old.
Migraine – a disease characterized by severe headache, accompanied by nausea. During an attack, light and sounds are irritating.She worries women more often than men. In total, migraine affects 18% of the female population of the planet and only 6% of the male population. According to the World Health Organization (WHO), it is migraine that most often reduces performance in people from 15 to 49 years old.
Diagnosis of migraine
To diagnose migraine, it is enough to talk and examine the patient. In difficult cases, the doctor may order an MRI to clarify the diagnosis.
Prevention of migraine with the latest generation drugs
In “Scandinavia” there are drugs that prevent migraines – “Irinex” (erenumab) and “Ajovi” (fremanezumab).Their active ingredient is monoclonal antibodies, which act in a targeted manner on the cause of pain. One injection a month is usually enough to get rid of headaches and keep the usual pace of life. We are one of the first in St. Petersburg and Russia to use this method.
In every fourth patient, after a year of therapy, the manifestations of migraine disappear, and many feel symptom relief from the first weeks. Monoclonal antibody injections are well tolerated by patients and do not affect the cardiovascular system.
The therapy is based on the action of monoclonal antibodies against the calcitonin gene-related peptide (calcitonin gene-related peptide) protein and receptors sensitive to it. This protein is secreted and accumulated during migraine attacks. The more it is, the more acute the pain. Monoclonal antibody drugs interrupt the pain pathway in which CGRP is involved. Irinex (erenumab) blocks receptors on cells, which prevents CGPR from attaching to them.And “Ajovi” (fremanezumab) is stopped by the protein itself.
Who is suitable for
This treatment is intended for adults who have migraine attacks more than four times a month.
How many injections are needed
The duration of the course is from six months to a year, that is, for a stable effect, from 6 to 12 injections are needed. The first effects are assessed after three months. The injections are given once a month by the doctor or nurse at the clinic.In some cases, the doctor may prescribe one injection every three months, but in triple doses.
So far, monoclonal antibody therapy for migraines is not cheap. The reason is that pharmaceutical companies create them using living cells – a multi-step and very expensive process.
Introduction Irinex (Erenumab) for migraine
Introduction of Ajovi for migraine
Branch “Parade Quarter”
Migraine cannot be cured once and for all, but therapy can bring it under control – making attacks rare and mild.Take this opportunity. Just call +7 (812) 600-77-77 and we will tell you all the details.
The doctors of the “Scandinavia” clinic will do everything to reduce the intensity of pain and to have seizures less frequently:
pick up specialized drugs for the relief of seizures;
will conduct a course of preventive drug treatment according to indications;
prescribe non-drug treatment if necessary.
90,000 one type of headache, its causes, symptoms and treatment methods
Migraine is a type of paroxysmal headache of a pulsating nature that recurs periodically. It is characterized by the fact that I am localized in one half of the head.
Symptoms are recurrent pains felt in the forehead, temple and eye socket on the one hand, the pain has a pulsating character.Pain stimuli are bright lights, loud sounds, and strong odors. The duration of an attack can range from one hour to two days.
The main symptoms are:
- visual impairment, for example, flashing flies, observing light zigzags in front of the eyes;
- impaired speech function;
- increased drowsiness.
Causes of migraine
One of the reasons for the development of this disease is a hereditary predisposition.If both parents suffer from this disease, then the risk of developing the disease in a child is 60 to 90%, if only the mother suffers – up to 70%, only the father – 20%.
For the first time, a person can face manifestations of the disease at a young age. The peak of the disease occurs at the age of 35-45 years. A significant decrease in seizures occurs after age 60, and in women in menopause. After forty years, the disease begins extremely rarely.
A viral disease can cause migraine.Another cause of the disease is an increase in pressure in the circulatory system or allergic reactions in the sinuses of the head. The most common cause of migraine is still stressful conditions.
During childhood, migraine headaches can be caused by overstrain, such as prolonged TV viewing or excessive use of the computer.
For migraine attacks, analgesics are used to relieve the condition and reduce pain. Neurologists recommend using an analgesic in conjunction with antiemetic drugs.To achieve the maximum effect of drugs, it is recommended to use them at the beginning of the attack, before the onset of the peak of pain. In the state of a deployed attack, the effectiveness of drugs is sharply reduced. The abuse of analgesics can lead to disastrous consequences, namely, they can increase the number and severity of a headache attack. To determine an effective treatment tactics, it is necessary to consult a neurologist.
90,000 Modern approaches in the treatment of headache
Headaches are among the most common neurological diseases in the world.According to DALY data, headaches and migraines are today the third and sixth causes of maladjustment and disability of the population. Most often women complain of headaches – 99%, in the structure of their headaches 25% are allocated to migraine, and 88% of women to tension headaches. Unlike women, men suffer least of all from migraines; in the general structure of headaches (93%), only 8% of complaints are attributed to migraines.
The high incidence rate among the population, as well as the insufficient level of diagnosis and prevention of headaches, attracts more and more attention from the scientific community to the problem of studying headaches and developing methods that can improve the quality of life of a patient suffering from headaches.
“I am sure that the experience of colleagues presented at the conference has made it possible to significantly increase the level of knowledge of the participants in the scientific event,” said Grigory Roitberg, president of the clinic of JSC “Medicine”, Academician of the Russian Academy of Sciences.
Opening the conference, the director of the medical service of JSC “Medicine” (clinic of Academician Roitberg), Ph.D. N.I. Pirogova Zhanna Dorosh noted: “The choice of the topic – diagnosis and treatment of headaches is not accidental.On the basis of JSC “Medicine” there is a Center for the Treatment of Pain, which successfully implements all modern domestic and foreign methods and standards of treatment and uses a multidisciplinary approach. While compiling the conference program, we tried to take into account all aspects of the topic of headache diagnosis and treatment. We are grateful to the speakers for interesting reports. Despite the online format, the conference turned out to be very lively, active, the speakers were asked many questions. ”
In Russia, as in the rest of the world, more and more attention is paid to headache, its causes, and prevention, however, the problem of diagnosis and adequate treatment remains due to late treatment of patients, erroneous diagnoses and subsequent inadequate therapy.“Today in Russia there remains the problem of adequate diagnosis of primary headaches, and there is a tendency towards overdiagnosis of secondary (symptomatic) forms of cephalalgias. This leads to the overuse of additional research methods such as electroencephalography and neuroimaging and, accordingly, to the use of suboptimal patient management strategies. In our practice, we need to move away from the widespread diagnosis of secondary headaches and focus on the diagnosis of primary headaches, which is easy to determine based on the clinical picture of the disease – patient complaints, anamnesis and examination, ”says Guzel Rafkatovna Tabeeva, Ph.MD, Professor of the Department of Nervous Diseases of the First Moscow State Medical University named after M.V. THEM. Sechenov, President of the Russian Society for the Study of Headache (Moscow, RF).
According to the new definition of pain, approved by the International Association for the Study of Pain (IASP) in 2020, pain is viewed as “an unpleasant sensory and emotional experience associated with or similar to actual or possible tissue damage.” Pain is always subjective and largely depends on a person’s life experience.Pain is a personal experience that is influenced to varying degrees by biological, psychological and social factors. “It is not so much genetics and adversity in life that affect the severity and duration of chronic pain syndrome, but rather a person’s reaction, his attitude to what is happening, the severity of catastrophization,” says Mikhail Lvovich Kukushkin, MD, professor, head of the laboratory of fundamental and applied problems pain research Institute of General Pathology and Pathophysiology, head of the ROIB, editor-in-chief of the Russian Journal of Pain (Moscow, RF).
One of the most important effective tools for studying the dynamics of pain, as before, remains a pain diary, which a patient with migraine or tension headache should keep during the entire period of treatment. “In my practice, I attach great importance to this instrument and I may even not accept a patient if he came to an appointment without his pain diary. This technique allows you to track important moments for treatment, such as changes in the patient’s condition before the onset of pain and during pain syndrome, the nature of pain, its frequency and duration, the effect of the drug and the disappearance of symptoms – all this really helps the doctor to form a general picture of the disease in particles and select the most effective treatment, ”notes Zaza Katsarava, MD, professor of neurology, head of the neurology department at Unna Hospital, professor of neurology at the University of Essen, President of the European Headache Federation (Essen, Germany).
Considering the issues of migraine prevention, Marina Gennadievna Vasilenko, neurologist-algologist, head of the Pain Treatment Center of Medicina JSC (Academician Roitberg’s clinic), member of the Society of Neurologists and Neurosurgeons, the Russian Society for the Study of Pain, the Association for Interdisciplinary Medicine, the International Association for the Study of Pain noted that treatment should be prescribed if the frequency of intense migraine attacks per month is three cases or more, if the frequency of headaches is 15 episodes or more, if the migraine is accompanied by a severe and prolonged aura.“The duration of the course of treatment for migraine is usually 3 months, if during this time the number of days with headache decreases by 50% or more, compared with the period of no treatment, then the chosen method of prevention is considered effective. The course of treatment can be 12 months if the migraine is chronic. On average, it takes 4-6 months to prevent episodic migraines, ”says the expert (Moscow, RF).
According to the International Classification of Headaches, updated in 2018, the causes of secondary headaches can be head and neck injuries, vascular lesions of the brain and neck, non-vascular intracranial lesions, infections, homeostasis disorders, and mental illness.A common cause of secondary headaches is the excessive use of various pain relieving drugs, which leads to the formation of one of the most severe and difficult to treat types of cephalgia – abusal or drug-induced headaches (LIGB). “The criterion for drug abuse of painkillers is the number of days with drug intake per month. So, for simple analgesics or NSAIDs, this is an excess of 15 days a month, and for triptans and ergotamine derivatives, more than 9 days a month.This is a very serious problem for Russia today. The prevalence of LHB in the general population is about 7.1%. A similar situation is noted, for example, in Zambia. In specialized headache centers, the proportion of patients with LHB is very high and reaches 70% of the total number of all patients with cephalalgias. Today we observe a change in the structure of drug abuse in our country. Patients mainly abuse triptans, the consumption of which has almost doubled over the past 10 years. Therefore, it is necessary to competently treat not only patients with already formed LHB, but also to prevent its development by actively identifying patients at risk, ”notes Ada Ravilievna Artemenko, Ph.M.Sc. Associate Professor of the Department of Nervous Diseases of the Institute of Postgraduate Education of the First Moscow State Medical University. THEM. Sechenov (Moscow, RF).
Modest attention is paid to tension headache (HDN). Despite the fact that HDN is the most common form of headache, and the degree of maladjustment and socio-economic damage associated with it exceeds those in migraine, most of the world’s scientific studies and publications are devoted to migraine, and not HDN; drugs with the indication “treatment of HDN” do not exist at all.Emotional stress and postural tension are the leading causes of this form of headache. Common culprits in pain episodes include sedentary work, anxiety, low mood, low self-esteem, anger suppression, and loneliness. The development of HDN is especially susceptible to people who are not capable of psychological and muscle relaxation, as well as little sleep. “A particular problem for neurologists and cephalgologists is presented by patients with chronic HDN, when patients experience headaches 15 or more days a month up to the development of daily headaches.Due to the addition of emotional disorders (anxiety, depression, phobias) and the frequent abuse of painkillers, the treatment of patients with chronic HDN presents great difficulties for neurologists and cephalgologists, ”notes Vera Valentinovna Osipova, MD, professor, presenter Researcher of the Scientific and Practical Psychoneurological Center named after Z.P. Solovyova, neurologist (cephalgologist), University Headache Blade (Moscow, RF).
Today in Russia there is an overdiagnosis of secondary headaches and an insufficient diagnosis of primary headaches: migraines and HDN, which prevents the doctor from choosing the necessary treatment method.Favorite erroneous diagnoses or “masks” of primary headache are diseases such as vertebrobasilar insufficiency, osteochondrosis of the cervical spine, post-traumatic arachnoiditis, discirculatory (atherosclerotic) encephalopathy. Unreasonably often, patients who complain of headache are diagnosed with arterial hypertension and hypertensive-hydrocephalic syndrome. “The reason for erroneous diagnoses is most often – the excessive use of paraclinical methods, including expensive neuroimaging, as well as ignorance of the diagnostic criteria for primary headache.All this leads to a false diagnosis and, as a consequence, to erroneous treatment. It is important to understand that secondary headaches account for only 5-10% of the total headaches. Primary headaches prevail in clinical practice: HDN and migraine. Often, a patient may have a headache of a mixed nature, when the leading form of headache (more often primary) is combined with pains of a different type, in which case a combination therapy is needed – says Elena Glebovna Filatova, MD. Professor of the Department of Nervous Diseases of the Institute of Professional Education of the First Moscow State Medical University.IM Sechenova, neurologist at the Headache Clinic.
There is a type of primary headache, which experts define as a cluster headache, and patients characterize it as the worst in his life, from which “you can go crazy.” Most often, such a headache occurs in a person during sleep and brings him excruciating suffering. An attack of cluster pain lasts from 2 to 30 minutes, but later without treatment it can last longer — up to 180 minutes. This is a very intense one-sided pain that can occur from once every two days to 8 times a day and be accompanied by tearing, redness of the eyeball, and eyelid edema.“It is assumed that such pain is caused by pathological excitability of the neuronal structures of the thalamus, as a result of which the central mechanisms of pain control and the autonomic nervous system are disrupted. The greatest effect in relieving pain is achieved with oxygen inhalation, subcutaneous and intranasal use of triptans, and verapamil continues to be used to prevent cluster pain. Recently, non-invasive methods of neuromodulation have often been used, in particular, electrical stimulation of the vagus nerve or drugs with monoclonal antibodies, but the latter only help with episodic forms of cluster pain, ”notes Evgenia ViktorovnaMD, Professor, Head of the Department of Nervous Diseases of the Academy of Postgraduate Education of the Federal State Budgetary Institution FSCC FMBA of Russia, Leading neurologist of the Clinic for Headache and Autonomic Disorders, Academician A. Vein, member of the Committees on Headache, Facial Pain and Pain in Pediatrics of the Russian Society for the Study of pain; Member of the European Society for the Study of Headache; Member of the International Society for the Study of Headache; member of the All-Russian Society for the Study of Headache.
Patients with headaches are a special category of people that needs to be informed; it is necessary to carry out a lot of educational work with them in order to effectively treat this disease at the initial stage – this was the conclusion of the conference participants.
The conference was attended by 250 neurologists, algologists, general practitioners and therapists from 67 cities of Russia, Armenia, Ukraine, Moldova, Kazakhstan, Uzbekistan, Finland, Lithuania, Spain, Peru and Ecuador. The educational event was held within the framework of the continuing medical education program; the participants received 6 educational credits each.
90,000 Frequently asked questions about migraines
1. Are migraines inherited?
Yes. Studies show that people with migraine have a familial predisposition to the disease. Many of them have a relative who also has a migraine. According to surveys in the United States, 17 million women suffer from this excruciating disease. Therefore, the chances that your daughter will also experience migraines increase.You should also watch for symptoms in your son.
2. Sometimes the headache goes away after taking aspirin, and sometimes it doesn’t. Do I need to see a doctor?
Of course, yes. It is possible that you have a migraine. About 50% of people with migraine are unaware of their diagnosis. Some people mistakenly associate the occurrence of headaches with sinusitis or stress, or they simply do not think about the origin of the pain. Another study showed that the average patient first experiences headaches for about three years and only then goes to the doctor.If you are experiencing a headache, the type of pain and the cause of its occurrence should be determined together with your doctor.
3. I have debilitating pains only once or twice a year. Do I need to think about treatment?
Yes. Quite often, in people experiencing migraines, attacks are rare. You should consult your doctor as sudden lifestyle changes, hormonal changes, or other responses to triggers may increase migraine attacks.
4. I don’t want to take pills every day. Are there other treatment options?
Yes. Some drugs are taken as soon as symptoms begin, and non-pharmacological treatments (biofeedback) and prophylaxis (reducing triggers) can also be effective. In order to find the most appropriate treatment option, it is important to tell your doctor about your preferences.
5. There are many triggers of migraine headaches.How can I determine what exactly triggers headaches?
If provoking factors are not obvious to you, for example, you have a seizure every time you fly on an airplane, the only way to determine them is to keep a migraine calendar. The calendar should indicate when the headache begins, the strength and duration of the pain, possible triggers (food or drink), weather changes, the dates of menstruation and methods of dealing with pain that were ineffective.
6. When a headache happens, I don’t have an “aura” or any other vision problems. Does this mean that the headaches are not due to migraines?
No. Aura migraines are characterized by the appearance of neurological symptoms such as flashes of light, interference, or loss of vision 5-20 minutes before the onset of an aura migraine. This type of migraine occurs in only 20% of cases. The aura with migraine does not always occur.
7.I have such a crazy schedule that I just don’t have enough time to eat regularly. Could this affect headaches?
Yes. Some people with migraines can benefit from a diet that prevents low blood sugar (hypoglycemia), which can dilate the blood vessels in the head. This condition usually appears due to a long time spent without food: for example, overnight or if a person skips a meal.Treatment for headache caused by low blood sugar is to eat more often, but in small portions. A special diet may be prescribed to stabilize the body’s system of regulating blood sugar. For a similar reason, many experts advise migraine sufferers not to sleep too long on weekends, as normal blood sugar levels can be disrupted and headaches begin, although not necessarily a migraine.
8. How can you prevent a migraine attack?
Avoid headache triggers and follow basic lifestyle recommendations to help you control headaches and improve your overall health. Get up and go to bed at specific times, change your diet, start a healthy diet, and exercise more.
Treatment of migraine using monoclonal antibodies with drugs
What is the principle of action of monoclonal antibodies?
Monoclonal antibodies – special molecules – block the receptors of the CGRP protein (Erenumab) or the protein itself (Fremanesumab, Galkanezumab, Epinezumab) in the body that causes headaches, in other words, they block the “path of pain”.CGRP is an abbreviation for Calcitonin-related gene-related peptide, which in turn is one of the main mediators of migraine attacks in the trigeminal nerve system.
Monoclonal antibodies reduce the sensitivity of receptors to the effects of the protein, thereby reducing the likelihood of an attack onset.
How is treatment with monoclonal antibodies treated?
Injections of the drug based on monoclonal antibodies are prescribed exclusively by the attending physician, preferably a specialist in pain therapy.
Based on the results of the examination, the collection of anamnesis and, if necessary, additional studies, the doctor determines the duration of the course and the frequency of injections and the dosage. The drug is injected subcutaneously into the shoulder, thigh, or abdomen.
The decision to discontinue therapy must also be made by the attending physician.
How long can treatment take?
As a rule, the duration of the course of treatment with the use of monoclonal antibodies is from 6 months to 12 months, as a rule, this is enough to “bring the migraine under control.”
How quickly to wait for the effect?
Treatment can be considered effective if, after a 3-month course of therapy, the duration of headache attacks is at least halved. To assess the effectiveness of therapy, patients are encouraged to keep a headache diary to help your healthcare provider adjust treatment.
Clinical studies have shown that the majority of patients who respond to therapy, the effect occurs within 3 months.
Who can take monoclonal antibody medications?
Therapy with Irinex / Ajovi preparations is indicated for patients with a confirmed diagnosis of migraine, who have no contraindications to this method of treatment. The presence of contraindications is determined by the attending physician.
What to consider before starting treatment?
A group of drugs based on monoclonal antibodies has a strict temperature storage regime, violation of which can lead to the loss of medicinal properties.Therefore, one should seek treatment with such drugs in specialized institutions, where there are all conditions for their safe storage and administration.
90,000 Scientists have traced the path from light to migraine
Every tenth person suffers from migraine
Scientists from Harvard University have discovered the mechanism of formation of migraine in people hypersensitive to light.
The study involved two groups of blind people with migraines.
It turned out that light triggers a reaction in a part of the brain neurons, which, after the cessation of the light exposure, remained electrochemically active.
Migraine headache is mainly localized in one half of the head and is accompanied by nausea and dizziness.
The duration of a migraine attack ranges from several tens of minutes to several hours, and sometimes days. This headache can be aggravated by any stimulus, including light, sound, and odors.
Scientists have noticed that even blind people prone to migraines can experience hypersensitivity to light. This observation was followed by the conclusion that the increase in pain is somehow related to the light signals that enter the optic nerve through the retina.
Wakefulness and sleep mode
In the course of the study, the reactions of two groups of blind people were studied. The first includes completely blind people who have lost the ability to see due to retinal cancer or glaucoma.
They did not have the ability to distinguish objects or feel light, so their normal wakefulness and sleep patterns are disturbed.
Patients from the second group are considered blind due to degenerative processes of the retina, such as, for example, pigmentary dystrophy.
Although they could not distinguish between individual objects, they nevertheless sense light and are able to maintain normal wakefulness and sleep patterns.
During the study, patients in the second group reported increased pain sensations when a beam of light was directed at them, especially blue or gray radiation.
Leader of the research team – anesthesiologist and emergency medicine professor Rami Burstine from Boston – believes that this study “helped us understand that photophobia is definitely associated with the optic nerve, since in completely blind people the optic nerve is unable to transmit signals to the brain. ”
Scientists have also confirmed that recently discovered cells of the retina, containing the melonopsin protein, are involved in this process. These cells are known as light receptors, which are involved in the body’s biological functions, including those that control the flow of sleep and wake time.These are the only light-sensitive receptors that remain in people with retinal degenerative processes.
Migraines are thought to occur when the pia mater, adjacent to the surface of the brain and the central nervous system, is irritated.