Frequently Asked Questions About Migraine Treatments

Migraine is a health disorder that is distinguished by intense headaches that reoccur. The typical signs of this type of headache disorder are a pulsating nature of pain and its long duration from a couple of hours to several days. Besides, such symptoms are commonly accompanied by increased sensitivity to light, loud sounds, intensive smells, and other irritants. Severe migraines can be also paired with nausea and even vomiting.

People who suffer from this disorder also may have an aura which is a short-lasting vision impairment that foregoes the headache.

The precise causes of migraines are not entirely understood. But it’s important to distinguish them from the headaches that occur as a result of other diseases, vessels spasms due to coronary diseases, infectious diseases, and injuries. Migraines are classified as headaches that are the result of a conjunction of environmental and genetic factors. It means that an important role in their occurrence plays heredity and the environment, your working conditions, and so on.

Statistic says that nearly 15% of the total population suffers from the disorder. It usually develops during puberty and worsens in the middle age. The manifestations can be less intense during gestation or menopause. Women are statistically more prone to disorder development.

Most often, migraine begins between the ages of fifteen and twenty-four years old, the highest frequency of attacks is observed in patients aged 35–45 years. Among children, migraine occurs in approximately two percent of children aged seven years and 4% of children aged 7 to fifteen years, with the prevalence of the disease being somewhat higher in boys before puberty. In adolescence, migraine is more inherent for girls, this ratio is also maintained in older adults and among elderly patients - women suffer from migraines twice as often as men. In women, migraine without aura is observed more often than with aura, while in men both types occur with equal frequency.

During premenopause, the symptoms often worsen and after the menopause, their severity may decrease. Symptoms are resolved in approximately two-thirds of elderly patients remaining in only 3–10%.

The risk groups prone to the onset of the disorder are:
– People who have family members with the history of migraines;
– People who suffer from any neurological or vascular diseases;
– People who are exposed to the negative effects of the environment.

Currently, doctors and scientists believe that migraines occur as a result of different factors combination:
– Heredity (It is considered that genetic predisposition means rather not the disease transfer but a certain reaction of the vascular system to the triggers);
– Environmental factors;
– Hormone levels change.

According to the statistics, almost anyone at least once in their lifetime had suffered a migraine attack or something similar. But it doesn’t mean that the diagnosis should be made.

Migraine refers to the manifestations of dysautonomia (a condition in which the autonomic nervous system does not work properly). The frequency of occurrence of migraine ranges from 4 to 20%.

Migraine is a disease that is clinically manifested by recurring bouts of headache. So if you have had one intense headache it doesn’t mean that you have migraines. But if the headaches reoccur, you should get checked and receive appropriate treatment.

Migraines have typical clinical manifestations that are maximally manifested during an attack.

The main symptoms are:
– Intense headaches, usually localized in the forehead and temples area;
– A usual predeceasing aura that is manifested in vision impairment, hallucinations of flashes of light, flicker, certain odors, etc;
– The character of the pain is pulsing and bursting;
– During an attack, a sensitivity to different irritants increases, for instance, to bright light, noises, odors, etc.;
– Paleness of the skin, changed sweating (increased or decreased), rapid heartbeat, chills, nausea, vomiting, and other accompanying symptoms.

In kids, the disease can also have a number of migraine attacks that follow one after another and very badly respond to therapy.

For the diagnosis of migraine, besides the patient’s survey that includes the complaints of a patient, questions about the family history of the disease, frequency of symptoms, and so on, the following diagnostic tests are made:
– X-ray examination of the skull, which reveals an extended venous pattern;
– Rheoencephalography, which is most informative at the time of the attack and detects asymmetric blood supply in different hemispheres;
– Genetic counseling;
– Study of the function of the vestibular apparatus by various methods;
– Ophthalmoscopy.

The lack of therapy of the disorder is fraught with the occurrence of the following complications:
– Neurosis;
– Psychosomatic diseases;
– Depression;
– Constant difficult to stop headaches;
– Ischemic stroke (the risk is high in migraine with aura).

Migraine with aura is considered a serious danger factor for ischemic stroke. It is especially relevant for young women who use oral contraceptives and are smokers. There is no proven risk of the complication related to migraine without aura.

To prevent the development of such complications it is important to seek medical assistance and follow your doctor’s recommendations on the diet, physical activity, as well as have at hand the prophylaxis, preventive medicines or painkillers for acute attacks.

When you first encounter a migraine, you should try using simple painkillers such as ibuprofen, aspirin, Diclofenac, paracetamol, and other NSAIDs.  Worth noting, painkillers are the most useful at an early stage of an attack. The frequent use of certain medications can cause the development of abuse headache, which is characterized by increased intensity and attacks frequency. It can develop if you receive analgesics, especially opioids. In this regard, conventional analgesics are encouraged to be taken less than three days a week.

If the above-listed medicines help, you don’t need to use any other more potent formulations. If you also suffer from nausea, you can take over-the-counter anti-nausea pills.

If the headaches are intense and cannot be stopped by these regular drugs, special medications such as:
– Triptans (Sumatriptan by Sun Pharma) are effective for almost 80% of patients. But they are not advised for use in patients with cardiovascular risks. The medications activate receptors in the carotid artery system, it causes their narrowing without affecting the cerebral blood flow. Their dilatation and edema of these arteries are considered the cause of migraine. In addition, they inhibit the activity of the trigeminal nerve;
– Ergotamines are used along with triptans. They may cause vessels spasm, including coronary spasm, and are prohibited for patients with coronary artery disease;
– Anticonvulsants such as Depakote (Divalproex) by Aventis Pharma are used for the preventions of migraines as they are able to lower the response to triggers;
– Serotonin receptor antagonists are used for prophylaxis of migraines;
– Intravenous or intramuscular injections of analgesics are used in emergency care for migraines attacks.

In case a patient also suffers from elevated blood pressure, the correction of it is also prescribed.

Therapy of severe cases:
– Surgery for the relaxation of the nerves in the head and the neck;
– Non-invasive or implantable neurostimulators are used for the treatment of intractable chronic migraine and give encouraging results in severe cases.

Alternative treatment methods with no statistically proven effectiveness include:
– Acupuncture;
– Massage;
– Physiotherapy;
– Meditation practices;
– Behavioral therapy;
– Butterbur;
– Dieting.

The prophylaxis of migraines is based on:
– Treatment of underlying diseases if they are present;
– Control over arterial pressure;
– Avoidance of triggers such as bright light, stress, loud noises, foodstuffs that can trigger a headache (beans, pickles, spices, nuts, avocados, plums, chocolate, coffee, alcohol, and others) and so on;
– Use of medicines to prevent migraines such as Depakote (Divalproex), serotonin receptor antagonists, topiramate, propranolol and metoprolol, and timolol. The medicines must be chosen by a doctor.

The use of prophylaxis medications is indicated for individuals who suffer from migraines more than twice a week and do not tolerate analgesics used for acute attacks or have severe attacks. In the most severe cases, surgery can be performed if there are indications. The surgery implies the decompression of some nerves in the head and neck.

Unfortunately, today there is no cure for migraines and no prophylaxis measures that can guarantee the complete prevention of migraines.

Therefore, a complex approach and following of your doctor recommendations is highly advised.