Migraine

Migraine is the most frequent diagnosis of headache, which is characterized by attacks of pulsating pain in the head lasting from several hours to several days, mostly in one half of the head, more often in women, as well as in young and adolescents.

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How common is a migraine?

The etiology of this disease remains a mystery to this day, as well as its pathogenetic mechanisms. The result of studying the centuries-old information sources, including the ancient ones, has become quite extensive and detailed statistical data. Debuts disease at a young age, usually up to 20-25 years. Even small children can suffer from headache attacks. One of the reasons that may explain the lack of knowledge of migraines is the later recourse to medical care - only 15% of all migraine sufferers receive timely treatment and supervision of qualified doctors. Everyone else tries to cope with unbearable pains on their own. Treatment with conventional analgesic drugs gives a temporary effect and provokes resistance of the body to therapy with similar means. Migraine is a serious ailment that significantly reduces the quality of life and work capacity of the patient. In the WHO rating, which identifies the most disastrous diseases, it ranks 12th among female diseases and 19 among men.

Migraine occurs in 38% of people, more often women than men (3: 1). It is inherited by the dominant and less often by the recessive type.

Migraine ranks second in frequency after a tension headache. Its prevalence ranges from 11% to 25% in women, and between 4% and 10% in men. Usually migraine first appears at the age of 10 to 20 years. Before pubertal, the prevalence of migraine is higher in boys, then it increases more rapidly in girls and remains significantly higher in women than in men, even after 50 years.

After 50 years, migraine is practically not an independent disease. However, in the literature there are references to the onset of typical migraine attacks at 65 years of age. In the vast majority of cases, migraine affects women; in the period from 20 to 50 years, the ratio of women and men is 3: 2 or 4: 2, and after 50 years, there is almost no difference in sex. Migraine is more common among the urban population, especially among people who have a sedentary lifestyle. In addition to age and sex, a certain role is played by hereditary factors, which are now undoubtedly proven: in migrant relatives, migraine is much more common than in the population. So, if migraine was in both parents, the risk of descendant disease reaches 60-90% (whereas in the control group - 11%); if migraine attacks were in one mother, the risk of the disease is 72%, if one father - 20%. The mechanism of the described phenomenon is not quite clear: some authors point to the predominance of the dominant type of inheritance, others - to recessive.

It is also believed that inheritance is not migraine itself, but predisposition to a certain type of response of the vascular system to various stimuli. At the same time, there are conflicting data that parents of migraine sufferers are more likely to have hypertension, although there are indications of an arterial hypotension.

Classifications and criteria of migraine

To date, ICGS-2 - the international classification of headache has established two forms: 1.1 - migraine without an aura (sensory, vegetative disorders). This form is characteristic of 80% of all migraine sufferers; 1.2 - migraine with sensory disorders, which has subtypes:

• Typical autonomic disorders with migraine pain;
• A typical aura with non-migraine pain;
• Typical sensory disorders without pain;
• SGM - familial hemiplegic migraine (with paralysis of the muscles in the affected half of the pain);
• Sporadic hemiplegic migraine (unpredictable, accidental seizures);
• Basilar migraine.

Symptoms and criteria for diagnosis should be carefully and carefully studied to completely exclude the pathological organics of the central nervous system. The criterion of hemicrania without sensory disorders is the character, and the localization of pain, migraine with autonomic disorders involves the study of the clinical manifestations of the aura itself. Also, the possibility of similarity of symptoms with a tension headache should be excluded. In addition, with some types of migraine, pain may be absent altogether, this type is called a "decapitated" migraine.

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How to differentiate a migraine?

Migraine, not having vegetative disorders - at least five episodes with seizures: 

• The pain lasts from 4 hours to 3 days; 
• Two obligatory signs of the following - one-sided pain, ripple, intense pain, pain arising during exercise, activity; 
• Obligatory one of the following symptoms - vomiting, nausea, irritation, provoked by sounds - phonophobia, light - photophobia; 
• There are no organic lesions of the brain.

Migraine with aura: 

• Two episodes with seizures; 
• Three obligatory signs of the following are a few (or one) symptom of vegetative-sensory disorders, development of an aura that lasts no more than one hour, a headache occurs after an attack or accompanies it; 
• There is no organic pathology of the brain.

Factors (triggers) that can trigger a migraine: 

• Hormonal factors (substitution therapy, contraception, ovulation, menstrual cycle); 
• Food factors (cocoa, nuts, eggs, dry red wines, starvation, chocolate, cheese and other products); 
• Psychogenic factors (anxiety, depression, stress); 
• Sensory factors (sunshine bright light, flashes of light - visual stimulation, smells, sounds); 
• External factors - meteorological dependence; 
• Regime factors - skipping meals, lack of sleep, insomnia; 
• Medication factors (histamine, estrogen-containing drugs, nitroglycerin, ranitidine); 
• Neurogenic factors - TBI (craniocerebral injury), overwork, both intellectual and physical; 
• Somatic factors - chronic illness in the anamnesis.

How is migraine treated?

The therapeutic strategy for the treatment of hemicrania is very individual and depends on the form of the disease, the symptoms, the duration of the period of the illness, and many other factors. The most effective drugs are widely used in practice and showed a good result: 

• 5-HT1 agonists are a group of triptans (zolmitriptan, sumatriptan, zolomigren); 
• Dopamine antagonists - aminazine, domperidone, metoclopramide, droperidol; 
• NSAIDs, inhibitors of prostaglandins.

How to prevent a migraine?

If a person has experienced a migraine attack at least twice a month, he needs to learn how to prevent this disease. Preventive therapy lasts at least two months and can last up to six months. Prevention is needed to solve one, the main task - to reduce the number of episodes of migraine. Also, preventive drug therapy helps minimize pain symptoms, increasing sensitivity to basic therapy. Prescribed, as a rule, drugs blocking calcium channels, β-blockers, antidepressants from the tricyclic group, antagonists of serotonin. Also, except for medicines, it is necessary to make a dietary diet and stick to it for six months. In the menu, it is strictly forbidden to include foods containing biogenic amine-tyramine. Special therapeutic gymnastics, psychotherapeutic sessions are shown. Migraine, despite its "mysterious" origin and average kurabelnost, is a manageable disease. Provided that you have a timely call to a doctor, and follow all therapeutic recommendations, including preventive ones, you can control migraine and maintain the quality of life at the proper level.

What is a migraine?

Migraine is a throbbing pain that can appear suddenly, paroxysmally, and, as a rule, affects half the head. Hence the name of the disease - hemicrania or "half of the skull" (in Latin hemi cranion). According to statistics, almost 20% of people suffer from it, regardless of race, country of residence and social status.

Attacks last from 4 to 72 hours, migraine often (but not always) one-sided, pulsating, amplified with tension and accompanied by autonomic symptoms (nausea, photophobia, phonophobia and hyperacosmia, as well as hyperosmia). Headaches can be preceded by flickering scotomas and other focal neurological disorders. The diagnosis of migraine is based on a characteristic clinical picture. For treatment, serotonin receptor agonists 1B, 1D, antiemetics and analgesics are used. Preventative measures include changing the lifestyle (sleep and nutrition) and taking medications for beta-blockers, amitriptyline, valproate, topiramate).

The headache is marked by considerable intensity, accompanied by nausea, sometimes vomiting, is characterized by hyperesthesia to sound and visual stimuli (poor tolerance of bright light, loud sounds), lasts from 1-2 to several hours and even up to 3 days. After an attack, as a rule, lethargy, drowsiness, sometimes sleep brings relief. Although usually every patient has a "favorite" side of the pain, however, it can change, and sometimes migraine seizes both halves of the head in the forehead, temples and temenia.

Migraine: historical information

Migraine was familiar to our ancestors, it was mentioned by chroniclers in ancient Egyptian papyri. Treated in those days, migraine rather exotic ways, as an example can be a method of applying to the sick half of the head crocodile skins or the skin of a young toad. More than five thousand years ago the Sumerian letters described in some detail the signs and symptoms of an incomprehensible disease, which periodically amazed both women and warriors. The cause of the headache, according to ancient rulers and healers, was the influence of evil, all-powerful spirits. Accordingly, lined up and therapeutic measures - fumigating the patient with aromatic substances and the use of magical amulets. Often used and more radical measures - something like trepanation Spirit, obviously, left the body of the sufferer and figurative, and literally words. Later a Greek healer, Aretei of Cappadocia, made a contribution to the description and study of the disease, who suggested that the headaches of this nature be called heterocrania - another, another head. The Greek physician Claudius Galen gave a more precise name to the disease, who identified the localization of pain in the name and called the disease "hemicrania". He was the first who suggested that the cause of seizures lies in spasm, change in the vessels of the head. Over time, migraine acquired the status of a "fashionable" aristocratic disease, which could only be afforded by representatives of the upper classes. In the XVIII century, migraines were treated with acetic solution, and the ladies carefully covered vulnerable fragile heads with exquisite hats, which in principle was correct, because a bright sun can provoke a migraine attack. Later, the doctors isolated several forms - menstrual, hemiplegic and ocular. More specific causes and clinical symptoms were also identified.

The nineteenth century was marked by a breakthrough in the therapy of headache paroxysms. Migraines began to be treated with a special medicine, named after its author - Govers medicine. It was a weak alcohol solution of nitroglycerin. Ingenious Dr. Hovers, in search of an effective method of therapy, did not hesitate to experiment with cocaine and marijuana. In Russia this period migraine was treated with a popular universal remedy - quinine. Only in the last century in the treatment of migraines began to use NSAIDs - non-steroidal anti-inflammatory drugs. In the middle of the XX-th century the revolutionary preparation - alkaloid ergotamine was synthesized. This group of medicines had many side effects and the scientific medical world sought to minimize them. At the end of the last century, absolutely new drugs appeared that gave a lasting therapeutic result and had virtually no contraindications. Triptans activate the serotonin inclusion zones in the vessels, as a result they narrow and have a blocking effect on the neurogenic inflammatory process. It can not be said that tryptane preparations completely cure migraines, but the pharmaceutical industry is working hard to create new, more sophisticated means to finally defeat the migraine.