What is a migraine?
Migraine is more than just a headache, it is a chronic hereditary disorder that regularly causes bouts of an excruciating, throbbing headache. Migraine differs from ordinary headache in that, as a rule, the head hurts only on one side, the pain lasts from 4 to 72 hours (if you do not take an anesthetic drug) and is often accompanied by nausea, vomiting, fear of bright light and loud sounds, as well as requires rest.
Migraine attacks start suddenly and can occur under a variety of provoking circumstances. Naturally, there can be no question of any study or work during an attack. That is why migraine occupies a leading position among diseases leading to social maladjustment and affecting the quality of life.
According to statistics, about 15 percent of the world’s population suffers from migraine, and women are 3 times more likely than men. More often the disease occurs in women aged 25–45 years, while migraine can manifest itself at any age (including children). Migraine often begins in childhood and can accompany the rest of your life.
Doctors note that there is a genetic predisposition to the disease: if a close relative suffered from migraine, the risk of headache attacks increases. More often migraine is transmitted through the maternal line.
Depending on the frequency of attacks, the following are distinguished:
- episodic migraine (less than 15 days a month, more often 1-2 attacks in 1-3 months),
- chronic (more than 15 days per month for three months).
Causes of migraine in adults
The causes of migraine are not yet fully understood. The main triggers (provoking factors) of migraine include:
- mental and psycho-emotional stress;
- hunger, long break in food intake;
- lack of sleep, poor sleep, as well as excess sleep (the so-called “weekend migraine”);
- change of time zones;
- excessive physical activity;
- head trauma;
- hormonal changes (puberty, menopause, menstruation, COC use);
- smoking and alcohol;
- weather changes (changes in atmospheric pressure, sharp jumps in air temperature);
- long stay in a hot stuffy room, strong odors, bright light.
Migraine symptoms in adults
The symptoms of a migraine directly depend on its type: there is a migraine without an aura (simple) and a migraine with an aura (classic).
Migraine without aura occurs most often and usually presents as bouts of one-sided intense headache that is accompanied by nausea, vomiting, fear of bright lights and loud sounds, and requires rest.
In the case of classic migraine, the headache is preceded by an aura. In this case, several symptoms of the aura can replace each other. It is important that all manifestations of the aura are completely reversible and are usually noted for about 30-60 minutes, but sometimes they can last for several hours. In the classic case, the aura can manifest itself in the following ways:
- sensory disturbances in the form of numbness or tingling in half of the face, arm, and leg on one side, as well as disturbances of motor function in the arm and leg on one side;
- visual disturbances: flashes of light, glare, sparks, and flickering in front of the eyes, in rare cases, vision in one eye may deteriorate or even temporarily disappear;
- speech disorders in the form of difficulty in pronouncing words, impaired understanding of the addressed speech.
In some cases, there are variants of the so-called headless migraine or Fisher’s syndrome, when only symptoms of aura appear without a subsequent headache. These manifestations are more typical for patients over 50 years old. Sometimes, especially in children, a migraine attack is accompanied by abdominal pain, nausea, or vomiting.
The diagnosis of migraine, first of all, is made on the basis of complaints and examination of the patient. The neurologist will ask you to describe the symptoms, specify how often attacks occur, how long they last, collect a complete medical history and help identify triggers for headache attacks.
Additional examination, as a rule, is not required, but if necessary, the doctor can prescribe an MRI of the brain and cerebral vessels (to exclude vascular anomalies, pathology of the brain), EEG, duplex scanning of the neck vessels with an assessment of the venous bed, and also refer for a consultation to an ophthalmologist who will assess the condition of the fundus.
Migraine treatment in adults
For the treatment of migraine in adults, there is drug and non-drug therapy. Medical therapy includes direct treatment of a migraine attack to relieve pain and preventative treatment. If we are talking about analgesics, then it is preferable to use drugs that contain one active ingredient, such as aspirin, paracetamol, ibuprofen, naproxen.
Combined drugs should not be used (for example, citramone or pentalgin). If aspirin, paracetamol, or ibuprofen do not help, then you need to take triptans (sumatriptan, eletriptan, etc.) – drugs created specifically to relieve a migraine attack. Important: analgesics can be used in no more than 8-10 doses per month. If the need is higher, then there is a risk of developing another type of headache – drug abuse.
The course of prophylactic treatment of migraine is long-term: it is usually calculated for one year. The drugs used for this purpose are from different groups, including anticonvulsants, antidepressants, beta-blockers, as well as botulinum toxin (prescribed for chronic migraine), and modern targeted drugs – monoclonal antibodies.
Monoclonal antibodies block one of the main migraine mediators, the CGRP protein (calcitonin gene-related peptide) or receptors that are sensitive to this pethid, thereby reducing the likelihood of an attack onset. This group of drugs has proven itself well, showing the best efficacy in the prophylactic treatment of migraine. The drug is administered subcutaneously as directed by the attending physician. Clinical studies have shown that in most patients who respond to therapy, the effect occurs within three months.
The choice of treatment and dose is determined by the headache specialist (cephalgologist).
At the same time, non-drug therapy is also of great importance, including changing the patient’s lifestyle. For example, the doctor can establish the relationship between the development of migraine and certain lifestyle factors based on the diary of headache, which should be kept by patients with migraine. Very often, patients with migraine combine smoking, endocrinological diseases and depression, or increased anxiety. An insufficiently active lifestyle, poor diet, sleep disturbance, and stress affect the risk of developing a migraine attack, so you need to tidy up your daily routine.
Non-drug methods are to prevent triggers of migraine attacks. First of all, these are corrective recommendations regarding the patient’s lifestyle: reducing stress levels, switching to a healthy diet, giving up bad habits, etc. Another effective non-drug method of dealing with migraines is acupuncture. If the migraine is accompanied by depression, anxiety is additionally prescribed psychotherapy, cognitive-behavioral therapy.
The method of non-invasive neurostimulation of the first branch of the trigeminal nerve using portable devices and transcranial magnetic stimulation (TMS) also shows high efficiency. In severe cases, migraine surgery is considered.
Traditional methods of treatment
All our experts agree: traditional medicine methods can be used in the treatment of migraines and are quite effective. It is important not to self-medicate and be sure to follow your doctor’s recommendations. Therefore, no advice from the Internet, but make an appointment with a neurologist.
Prevention of migraine in adults at home
Migraine prevention is primarily aimed at reducing the risk of new attacks5. To do this, you need to pay attention to your lifestyle: avoid stress and anxiety, have adequate sleep, and rest during the day. A diet with the restriction or complete exclusion of certain foods (nuts, hard cheeses, alcohol, citrus fruits, canned food, fast food, etc.) is effective.
It is also possible preventive drug prevention of migraine, which includes taking antidepressants and anticonvulsants, monoclonal antibodies. Important: any medications are prescribed strictly in consultation with the doctor!
Why are migraines dangerous?
The main danger is the risk of developing vascular complications, which is especially high in patients with aura. The lack of specially selected therapy or self-medication threatens migraine stroke, and the abuse of analgesics – problems with the gastrointestinal tract, including gastritis and peptic ulcer disease, toxic hepatitis, as well as the development of drug abuse. Also, a migraine attack that has not been stopped in a timely manner can turn into a migraine status, when an intense headache is noted for more than 72 hours and often such patients need hospitalization.
Like any disease characterized by long-term pain syndrome, migraine is often accompanied by depression or anxiety disorders, which, in turn, aggravate the patient’s general condition and the course of the disease. It turns out to be a kind of vicious circle. Therefore, it is so important to see a specialist as early as possible.
According to recent Western studies, migraines can significantly affect sleep quality. This is especially true for chronic migraines. In addition to decreased sleep quality, migraines are associated with insomnia, somnambulism, bruxism, and other neurological complications.
The complex relationship between migraine and pregnancy. On the one hand, during pregnancy in the second and third trimesters, the headache worries noticeably less, but in the first trimester of pregnancy, as well as the lactation period, an increase in pain is possible. The management of patients with migraine during pregnancy is a separate story because during this period the possibilities of drug treatment are very limited and non-drug methods of therapy come to the fore.
What if the migraine is accompanied by a fever?
If an intense headache, similar to a migraine, is accompanied by an increase in temperature, it is necessary to see a doctor as soon as possible. This could be meningitis or subarachnoid hemorrhage.
What diet should be followed for migraines in adults?
For migraines, it is not recommended to eat the following foods: caffeine, alcohol, confectionery, hard cheese, blue cheese, processed cheese, canned food, smoked meats, nuts, semi-finished products, bananas. If a person suffers from migraines, his diet should include sea fish, lean meats, vegetable oils, stewed vegetables, low-fat dairy products. It is also necessary to increase fluid intake, this also has a beneficial effect on the course of migraines.
With migraines, it is recommended to eat fractionally small portions, there should not be a long break between meals. When eating small meals, the number of meals can be up to five per day. You should not allow starvation and overeating.