Migraine is a fairly well-known disease. It just so happens that in our society it is not customary to pay enough attention to it. And all this is because of the prevailing stereotypes. Many of us at the word “migraine” vividly imagine languid women from TV series with a compress on their heads. Where’s Donna Rosa? Oh, don’t bother her, she has a terrible migraine today! However, the disease is quite serious, and brings a lot of suffering. The problem is that it is often mistaken for a common headache and is unsuccessfully treated with conventional analgesics. Let’s figure out what a migraine is, what are its signs and how modern medicine offers to treat this ailment.
Headache is the most common neurological symptom. Depending on the reasons, it can be primary or secondary. Secondary headache is a symptom of a number of diseases – hypertension, atherosclerosis, infectious diseases, rhinosinusitis, osteochondrosis, and so on. Primary headache has no direct connection with any diseases, and sometimes occurs for reasons unknown to date. One of these diseases is migraine.
As a rule, migraine manifests itself with characteristic symptoms:
- Headache. Most often one-sided, bursting, throbbing. The expression ” the head splits into two parts” is the best way to characterize a migraine. It should be noted that sometimes the pain in migraines is also bilateral, which is why it is confused with a tension headache.
- Nausea, vomiting. A migraine attack can lead to vomiting. About half of the people who suffer from this disease report this symptom.
- Bright light, sound, smell worsen the condition. During an exacerbation of the disease, people tend to retire to a semi-dark room.
- Impaired motor activity – loss of balance, dizziness, paresis (decreased muscle strength).
- Sweating of the palms, numbness of the limbs, a feeling of” goosebumps ” on the skin.
- Speech disorder.
- Sometimes there is a feeling of cold hands and feet. Interestingly, this symptom, in addition to subjective sensations, is manifested by objective signs – redness of the skin of the fingers and toes.
Severe migraine pain, nausea, and other symptoms naturally affect the quality of life. And given that a migraine attack can last from several hours to three days, we can say that during the exacerbation of the disease, a person literally ” falls out of life” for a fairly long period of time.
What is the difference between a migraine and a headache?
People who have never experienced a migraine in their life treat this condition very lightly. Big deal, my head hurts! And if you take into account the fact that most often women suffer from migraines, and generally write off everything on the psyche. Meanwhile, the nature of migraine headaches differs from “normal pain ” in both duration and intensity.
Differences between migraines and headaches:
1. Localization. Headache due to overwork often has a diffuse or shingling character. Secondary headache is localized in the occipital, parietal, temporal region or in the projection area of the paranasal sinuses.
2. The nature of the pain. Migraines are characterized by intense, throbbing, excruciating pain. The intensity of migraine pain is comparable to toothache. When overtired, the pain is usually less intense. It is bursting, pressing. Pulsating pain occurs with high blood pressure, but it is bilateral and has a different localization.
3. Causes of pain. Secondary headache has a clear cause. Migraine develops without obvious somatic causes under the influence of external factors.
4. Duration of pain. The secondary headache goes away when the cause is eliminated. It is necessary to cure the disease – and its symptoms will go away. Episodic migraines last up to three days, and chronic migraines can last for weeks.
5. Reaction to analgesics. The “usual ” headache is relieved by standard analgesics. Aspirin, paracetamol, analgin-any pain medication that is in the home medicine cabinet will help. With migraines, not everything is so simple. We will talk about ways to treat migraines a little later.
Of course, competent doctors may object that the very wording ” the difference between a migraine and a headache”, to put it mildly, is not entirely correct. You are certainly right. Migraine is one of the forms of primary headache, it just has its own characteristics. For an ordinary person, it is important to understand the difference between a situational headache (due to nervous tension, for example) for migraines. The first can be stopped with a standard painkiller, and the second has special features of treatment, and requires the participation of a specialist.
Migraine is a neurological pathology, and it is treated by a neurologist, therapist, or family doctor.
Classification of migraines
According to the International Classification of Headaches, there are:
- Migraine with aura
- Migraine without aura
- Chronic migraine
- Complicated migraine
There is also an unofficial classification of migraine, which reflects the factors that provoke the disease:
- Visual migraine (synonyms – ophthalmic, ocular) – provoked by bright light;
- Cold migraine-develops as a result of a decrease in air temperature;
- Neurological migraine-caused by neurological disorders, stress;
- Tooth migraine-triggered by toothache;
- Weekend migraine – develops after nervous tension and lack of sleep on the weekend;
- Estrogen-associated migraine is associated with changes in the level of the female hormone estrogen.
Each form of migraine has its own characteristic signs.
Migraine clinic, depending on its form
Migraine with aura
Migraine with aura is otherwise called classical. It starts gradually and consists of four stages:
1. The initial stage. A couple of days before the attack, the first signs of migraine appear – fatigue, sharp mood swings from irritability to apathy, photosensitivity, noise intolerance, inadequate response to external stimuli.
2. Migraine harbingers or aura. This stage lasts from a few minutes to an hour. During this period, a number of neurological disorders are observed – dizziness, loss of balance, confusion, a feeling of “goosebumps” on the body and head, speech and vision disorders. Patients see flashes, circles, bright flies, and iridescent visions in front of them. At the same time, there may be spatial distortions – a change in the distance from a person to objects, an apparent decrease or increase in the size of the body in relation to other objects.
3. Clinical manifestations of migraine with classic signs of migraine.
4. Postdromal period – the final period after a migraine attack. This state is accompanied by a feeling of frustration and apathy.
Migraine without aura
Migraine without aura (simple form) proceeds without precursors. The attack is accompanied by a throbbing headache, fear of light, sounds, smells, and other symptoms of migraine.
This form of the disease is characterized by frequent attacks (more than 15 per month). At the same time, at least 8 of them should have classic signs of migraine.
Complicated migraine has an aggressive course and is accompanied by loss of consciousness and epileptic seizures. Prolonged vascular spasm can lead to oxygen starvation of the brain area and the development of a stroke.
There is a definite link between migraine and stroke. It is believed that migraines with aura are more dangerous in terms of the development of complications. It is worth noting that migraines do not always lead to a stroke. Some experts do not draw parallels between these two diseases at all.
Causes of migraines
There are many different theories of the origin of migraines, none of which is confirmed or disproved.
Migraine and social status
Migraine was called the disease of the aristocrats, considering that they have more sensitive blood vessels. However, the fact that physical laborers often suffer from this disease has shaken this dogma a little. The fact is that not everyone with a migraine goes to the doctor, not perceiving the headache as a reason for consultation. This is especially true for people who are employed in factories and industries. So there are certain stereotypes.
Migraines and intellectual abilities
For a long time, migraine was considered a disease of geniuses. Indeed, the list of great scientists, artists and prominent politicians who suffer from this disease is quite wide. Later it turned out that this is nothing more than a myth, and ordinary people are subject to the disease of no less brilliant people.
Migraine in women
Another reason for the incorrect explanation of the nature of migraines is the gender inequality that still exists in most countries. The fact is that migraines suffer mainly from women. And this is more likely due to female hormones, and not to neurological abnormalities, as many believe. It’s no secret that women’s headaches are the subject of sarcasm and jokes, and are not taken seriously. And in vain. We have already said that a migraine and a headache “from nerves” and emotional excitement are not the same thing.
In fairness, it is worth recognizing that there is still a certain connection between mental illness and migraines. This disease is a frequent companion of some mental disorders. At the same time, it is sometimes difficult to understand what is primary. Migraine itself can be a cause of depression and suicidal tendencies.
After studying the symptoms of migraine in women, experts came to the conclusion that this disease may be associated with fluctuations in the level of estrogens. Very often, the first migraine attacks occur in young girls during puberty. Then the disease worsens before menstruation, after childbirth and during menopause.
Migraine and serotonin
Migraine is clearly associated with the metabolism of the hypothalamus hormone serotonin. Serotonin transmits nerve impulses between neurons in the brain and affects the tone of blood vessels.
If for some reason the work of the hypothalamus is disrupted, then serotonin is not produced enough. The body has a mechanism for compensating for this deficiency. The strategic supply of serotonin is found in blood platelets. With a sharp release of this hormone, there is a narrowing of the blood vessels that feed the brain. The displaced blood dilates the carotid artery and causes a painful attack.
Migraine and heredity
It is noted that migraine can be transmitted through the maternal line, if the mother has a defect in certain genes. However, the probability of hereditary transmission of a predisposition to migraine is very small. Otherwise, there would be many more people suffering from this disease.
Migraine and osteochondrosis
Osteochondrosis of the cervical spine often leads to migraines. It is known that prolonged tension of the neck muscles provokes a headache. It can be either a tension headache or a migraine.
There are several other theories of the development of migraines. It is noted that migraine develops with a lack of magnesium, as well as with a violation of the metabolism of histamine, bradykinin, heparin and a number of other substances. The scientific literature describes studies that prove the connection between hypothyroidism (thyroid hormone deficiency) and migraine, as well as other facts that somehow affect the disease.
In any case, to date, no one has managed to put all the reasons together and explain exactly what happens to the blood vessels and other brain structures in migraines. That is why the list of medications for the treatment of migraines is quite wide, but none of them is universal.
Migraine triggers or provokers are external factors that can cause an attack. These include:
- Smells, sounds, lights;
- Stress, depression;
- Food and alcoholic beverages – cheese, nuts, fish, chocolate, coffee, red wine, champagne. These delicious foods combine the ability to stimulate the pleasure hormone serotonin;
- Hormones. We have already talked about the effect of female hormones on the development of migraines. For this reason, a fairly strong provoker of migraine is contraceptive drugs;
- Head and spine injuries.
Modern methods of migraine treatment
The lack of knowledge about migraine, the lack of a general understanding of the nature of this disease and the mechanisms of its development, make it difficult to find effective means to treat this problem. Here you can object, because there are drugs that relieve the symptoms of migraine! Yes. These funds are available. That’s just they do not help everyone and not always. Moreover, migraine is considered an incurable disease. The task of practical medicine today is to reduce the number and severity of attacks of the disease. And this is also important.
Let’s take it in order. Let’s start with the relief of an acute migraine attack.
First aid for migraines
1. Exclude provoking factors.
2. NSAIDs (non-steroidal anti-inflammatory drugs) – aspirin, paracetamol, diclofenac, ibuprofen, naproxen. These are classic painkillers, with proven effectiveness in migraines. It is worth noting that despite the fact that these drugs are included in the first line of treatment for migraines (according to international standards), these drugs relieve pain only in mild migraines, and most often they are useless.
3. Triptans – zolmitriptan and sumatriptan. Because of their ability to quickly relieve migraine pain, these drugs are mistakenly considered analgesics, but they have a completely different mechanism of action. They are competitors of serotonin and bind to its receptors. Thus, no matter how much serotonin is in the blood, it does not affect the blood vessels, since the receptor is “busy” with the drug. Naturally, the earlier a person takes the drug, the higher its effect will be.
4. Antiemetic drugs-metoclopramide, prochlorperazine. It can be taken together with triptans with severe nausea.
5. Ergotamine derivatives – medicines from ergot. This is a fungus that parasitizes the ears of cereal plants. In its structure, it resembles serotonin, dopamine and serotonin. Due to this structure, it has a number of effects on the body. In migraines, it is important that this drug acts as triptans on the one hand – it blocks serotonin receptors, and on the other hand reduces the effect of the trigeminal nerve on blood vessels. A significant disadvantage of ergotamine is its low bioavailability, only 5%. This means that out of 100% of the active substance, a small fraction of it will work.
6. Codeine-containing drugs they have a good effect, especially if a person has nervousness and irritability. These drugs have a big disadvantage – they are addictive.
It is important to remember that drugs for the treatment, or rather for first aid for migraines, are not harmless at all and have a number of side effects. They are especially dangerous for people with cardiovascular diseases. Therefore, doctors do not recommend taking them more than twice a week.
Preventive treatment of migraines
With frequent migraine attacks, severe attacks and with the ineffectiveness of emergency medications, preventive treatment is recommended. This is a complex therapy that is selected individually, depending on the specifics of the course of migraine and the presence of concomitant diseases.
Drugs with proven effectiveness for the preventive treatment of migraine
1. Antiepiteptic drugs (sodium valproate and topiramate) are used for certain neurological problems. There is an important nuance. These medications are not allowed for pregnant women, as they cause birth defects. Everything is so serious that women of childbearing age are simultaneously prescribed reliable contraceptives.
2. Beta-blockers (metaprolol, propanolol) are effective for high blood pressure, tachycardia and anxiety.
3. Antidepressants (amitriptyll).
The preventive treatment of migraine with these drugs has significant disadvantages. The fact is that the treatment is quite long. The first effect can be discussed only after 8 weeks of regular pill intake. In some cases, the therapy is extended from 6 months to a year. Studies have shown that only 20% of people can survive such long-term treatment. And it’s not just about the need to take medication regularly. Not everyone can withstand the side effects of drugs. And they have a lot of them. Just look at the instructions to make sure of this.
In addition, not all patients understand what these torments are for. A good result is a reduction in the duration and intensity of migraine attacks. But this does not always suit people. After all, everyone’s desire is to get rid of unpleasant migraine symptoms forever.
Fortunately, if you are intolerant to standard medications, there is an alternative treatment for migraine with the use of new medications.
Treatment of migraine with botulinum toxin
Onabotulotoxin A, aka Botox, is used in medicine relatively recently. It may seem strange to you that a neurotoxin, which is essentially a toxic substance, is successfully used to treat certain diseases.
About 10 years ago, doctors noticed that women who regularly use Botox for cosmetic purposes, significantly reduced the number and severity of migraine episodes. This issue has been actively studied. And in 2010, a new indication appeared in the instructions for Botox – chronic migraine.
Botulinum toxin is a nerve agent. It is a muscle relaxant and an anesthetic. That is, it is able to relax the muscles and relieve pain.
What is the mechanism of action of Botox in migraines? The mechanism of migraine development is associated with tension in the muscles of the head and neck. This is a standard problem for people who spend most of their time in the office at the computer. From prolonged forced posture, incorrect posture, stress and nervous tension, the muscles contract the nerve endings and blood vessels that feed the brain.
In addition, spasmodic muscles constantly send pain signals to the brain, which leads to its oversaturation of these impulses. As a result, a painful focus is formed in the brain and the head begins to ache.
Botox for migraines has a complex effect-relieves muscle spasm and neurogenic inflammation, providing relaxing and analgesic effects.
However, one Botox injection is not enough to solve the problem. Experts recommend a course of 10 procedures.
Despite the fact that botulinum toxin has a better tolerance compared to other drugs for the treatment of migraines, it can not be called a panacea. This drug acts only on one of the mechanisms of migraine development, and does not solve the problem with serotonin, for example. Therefore, it is not universal.
Science does not stand still, and several new migraine medications are currently undergoing clinical trials. In addition, the disease itself is being actively studied. And this gives hope to many people. Perhaps in the near future, people will be able to overcome migraines and forget about this disease forever.
Be healthy, and let the headache never bother you!