Treatment of migraine

The text is presented for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: “Why not self-medicate?”. Migraine sufferers will never call their condition a normal headache. Painful sensations during an attack are so strong that they cause loss of consciousness, and in rare cases lead to acute cerebrovascular accident. Migraine is not an ordinary spasm, but a phase cyclic process of the reaction of cerebral vessels to any stimuli that can occur in adults and children. The duration of migraine attacks, unlike the usual headache, lasts from 3-4 hours to several days. Not everyone can withstand this test without painkillers. But are there methods by which you can get rid of seizures forever?

There is an opinion that it is impossible to completely cure migraine, especially if it is a family disease transmitted by 1 degree of kinship. However, to endure pain is also categorically contraindicated. But the question is: how to treat migraine? Are the popular Analgin and Aspirin suitable for pain relief, or will traditional remedies in this case only be harmful? How to save a person from a migraine attack and is it possible to fight the disease at home without the use of pills?

First aid

Migraine attacks can be with an aura (classic) or without it (usual). In the first case, patients, shortly before the onset of an attack, constantly feel certain warning signals from the body. On the one hand, the aura prolongs the period of feeling unwell even more, but on the other hand, it allows you to prepare for a future attack. A migraine without an aura is another matter: it starts unexpectedly at any time of the day.

Due to the short duration of the first phase of migraine, it is advisable to use analgesics and antispasmodics at the very beginning of the attack, until the onset of severe pain. An anti-migraine patch to relieve pain or a special nasal spray (Exenza, Imigran, Digidergot) will help prevent or alleviate an attack. Before using the drops, you should clear your nose.

If an eye (ophthalmic) migraine has begun – atrial (flickering) scotoma or an ophthalmoplegic form of the disease – there is also no need to panic. Visual disturbances will go away on their own after a while. In the meantime, the patient should lie down and calm down, take sedative and vascular drugs to improve blood flow. Painkillers from the group of non-steroidal anti-inflammatory drugs – antispasmodics or analgesics will help stop the headache.

If the initial time of the attack is missed, then taking one-component analgesic drugs will no longer be effective, and intramuscular, and in some cases intravenous, administration of painkillers will be necessary to provide assistance. In this case, the most commonly used solution is Baralgin or Ketorol. The advantage of injections is their quick response. In addition, 1 ampoule of Baralgin is able to replace 5 tablets of the popular Analgin. Ketorol acts even faster. Usually, 1 single injection of the drug is enough to significantly reduce the headache. If it is not possible to make a “saving” injection, then in the “height” of the attack, you can take a more effective combined analgesic, which is a combination of an analgesic with caffeine or codeine. If headaches are accompanied by nausea and vomiting, then rectal suppositories (Indomethacin, Voltaren or Cefecon D and antiemetic suppositories Domperidone or Metoclopramide) are suitable instead of tablets.

In addition to the drug therapy of the first stage, self-massage of the head, a warm bath or shower, staying in a darkened room, due to photophobia during an attack, is also recommended for stopping a migraine attack.

Another effective way for many is a cool wet towel, which should be placed under the neck and on the forehead. Many use a menthol pencil, an ointment with essential oils or an Asterisk balm, which lubricate the temporal zone. It is also important to adjust the sleep pattern: it should be the same on weekends and workdays. And of course, do not forget to exclude from the diet all foods containing tyramine (red wine, beer, aged cheeses, chocolate, canned meat), which is a trigger for a migraine attack.

If the attack lasts more than 3 days or this is the third attack in a week, and the patient’s condition worsens, medical attention is needed. Prolonged migraine increases the risk of stroke and other serious disorders. It is also better to immediately seek professional help if severe occipital pain is tormented. It could be occipital neuralgia.

Therapies

Proper migraine treatment has certain standards. It consists of relief of an attack and preventive treatment in the interictal period. It may consist of drug treatment, elimination of triggers, correction of the psycho-emotional state, diet and lifestyle of the patient. At this time, it is useful to relax in a sanatorium, undergo a course of physiotherapy. Relief of an attack is the elimination of pain syndrome with modern medicines.

Medication Therapy

Medical products (drugs, medicines, vitamins, medicines) are mentioned for informational purposes only. We do not recommend using them without a doctor’s prescription. Recommended reading: “Why can’t you take medications without a doctor’s prescription?”. Medication is the traditional treatment for migraine. The main requirements for modern means are efficiency, safety, speed of action. For mild and moderate attacks, paracetamol, acetylsalicylic acid and its derivatives, as well as combination drugs (sedalgin, pentalgin, spasmoveralgin) can be effective. Due to the short duration of the first phase of migraine, it is advisable to use analgesics and antispasmodics at the very beginning of the attack, until the onset of severe pain.

In addition to universal painkillers, there are special anti-migraine drugs. This group includes medicines collectively called triptans. The peculiarity of these drugs is that they do not just stop the pain, but act directly on the trigeminal nerve. To understand the principle of action of this drug will help some knowledge about the nature of migraine. So, pain in the head with a migraine occurs for a reason, but because of the specific substances secreted by the end of the trigeminal nerve. Tryptophan prevents this process. In addition, the drugs of this group bring dilated painful vessels of the brain to a normal state. By the way, triptans have been treating migraine for about 30 years and are still known as the best. The effectiveness of drugs is confirmed in 7 out of 10 cases of therapy.

The third group of drugs in the “arsenal” of migraineurs are drugs based on ergotamine derivatives. These are special analgesics that stop migraines. Their action is reduced to causing vasoconstriction of the brain, thereby also reducing neurogenic inflammation.

If we recall that in many cases a migraine attack occurs on a nervous basis, then the use of sedatives is fully justified. For people whose attacks begin due to muscle tension in the neck or back, muscle relaxant drugs (relax skeletal muscles), for example, Mydocalm, Sirdalud, will be useful.

But do not forget that a migraine is not only an intense headache. Attacks are often accompanied by severe nausea and vomiting. For this reason, antiemetic drugs should also be in the first aid kit.

The drugs listed in the table are drugs that have proven effective against migraine. But it would be a huge delusion to believe that all of the above should be contained in the medicine cabinet of a migraine sufferer. Let’s say more: some of these items can be taken only on prescription and only in case of very severe attacks. Also, do not immediately resort to the use of the strongest painkillers. Simple one-component drugs in many cases relieve pain well, but for this it is important to take them on time and in the right dosage.

Analgesics. Aspirin or acetylsalicylic acid (1-3 g per day, especially in combination with caffeine) has a similar analgesic effect as more expensive drugs from the triptan group. However, due to the pronounced aggressive action on the gastrointestinal mucosa, aspirin is contraindicated in those who have a history of gastritis, duodenitis or peptic ulcer. It is also important to understand that aspirin intended for cardio patients (Aspirin Cardio, Thrombo ass) is not suitable for relieving migraine pain, as it contains a very small dose of the active substance.

Analgin, Ibuprofen, Diclofenac are undesirable for frequent use. The most dangerous – on an empty stomach or in a very large dosage, also because of the negative effect on the gastrointestinal mucosa and the toxic effect on the kidneys with prolonged use. Diclofenac and Paracetamol are inferior in effectiveness to Aspirin, but they help some people with mild headaches. Alternatively, you can take 20 mg of Ketorolac or 600-800 mg of Ibuprofen, but you should also remember that a large number of non-steroidal drugs disrupt the functioning of the kidneys and liver. But Paracetamol is not recommended to eliminate a very severe headache.

Combined painkillers (Pentalgin, Citramon), although they eliminate pain attacks, some of them contain codeine and phenobarbital, which can cause dependence on these components. Such drugs can be drunk no more than twice a month. The same applies to caffeinated drugs.

Preparations containing ergotamine, although they are considered effective for stopping a migraine attack, they are contraindicated in people with diseases of the kidneys, liver, heart and blood vessels, as well as in adolescents, pregnant women, with hypertension and thyrotoxicosis.

Effectively relieve pain with medicinal mixtures consisting of the following drugs: Indomethacin, Analgin, Amidopyrine, Reopyrin and Voltaren. Many feel relief by taking Sedalgin or Pentalgin at the beginning of an attack.

Regardless of what type of analgesics a migraine sufferer chooses, the abuse of any of them sooner or later becomes addictive, or rather, becomes the cause of psychological dependence on pills and the so-called abuse or analgesic-dependent headache. This means that the body gets used to a certain concentration of an anesthetic in the blood, and as soon as the indicators decrease, the pain returns, even if there is no physiological reason for this. WHO experts believe that every 50th inhabitant of the planet suffers from abuse pain. In addition, there are almost 5 times more women on this list than men. But the most dangerous thing is that such addiction almost always ends with acute drug poisoning, most often manifested by acute kidney damage or acute peptic ulcer. To prevent this from happening, you should follow the rules: single-component analgesics can be drunk up to 15 days a month, and combined and drugs from the triptan group – up to 10 days.

Triptans. The drugs in this group are designed specifically for the relief of migraine and are effective in 7 out of 10 cases. But you can take them only as prescribed by a doctor. In addition, they are contraindicated in coronary disease, unstable blood pressure, varicose veins, thrombophlebitis, after a stroke or myocardial infarction. To relieve pain, it is important to have time to take a pill at the very beginning of an attack, but in no case at the aura stage (a pill will only prolong this painful period). Triptans are not used for basilar and hemiplegic migraine, and drugs from this group are prohibited for children, pregnant women and during lactation.

Each of the described drugs has its pros and cons, in addition, each organism is individual. For each person suffering from migraine, you can choose your own drug that effectively helps to cope with a headache. Effective painkillers can only be called those drugs that gradually relieve pain up to 2 hours after taking it, and by the fourth hour they completely relieve the attack. After a suitable remedy for the patient, the headache should not return the next day, and the remedy itself should be effective during each attack.

Ergotamine derivatives. These drugs constitute another pharmacological group of special anti-migraine drugs, which, however, are used with great caution in Western medicine. The fact is that these drugs can severely and dramatically constrict blood vessels, and in large doses they can even be life-threatening. In most cases, the help of ergotamine derivatives is resorted to when it is necessary to quickly stop a severe attack, and are never prescribed for regular use. These drugs are contraindicated in persons with concomitant diseases of the cardiovascular system, glaucoma, after a heart attack or stroke, during pregnancy and lactation. It is also strictly forbidden to take simultaneously vasoconstrictor derivatives of ergotamine and triptans.

Other groups of drugs. Proper anti-migraine therapy should not be limited to taking pain-relieving drugs. If the attacks are strong and often recur, the treatment program is reinforced with drugs from other groups. For example, antiepileptic drugs reduce the activity of the brain, and hence its response to trigger factors leading to an attack. The benefit of antidepressants for migraineurs is the ability to increase the level of the hormone serotonin, the lack of which is called one of the causes of migraines.

In particular, Alexander Amelin, Professor of the Department of Neurology at St. Petersburg State Medical University, for whom the etiology and complex treatment of migraine has been the main occupation of the last 20 years, is confident in the benefits of antidepressants for migraine sufferers. Lability of blood pressure and pulse can also result in a migraine attack. With a preventive goal for the treatment of migraine, as well as to maintain an adequate level of blood pressure and pulse, drugs from the group of beta-blockers are recommended. In migraine, they prevent the development of spasm of vessels containing beta-adrenergic receptors, which prevents the onset of pain. Calcium channel blockers for people with headache attacks are also needed for a preventive purpose. They prevent the penetration of calcium ions through the membranes of muscle cells of blood vessels, thus changing, blocking muscle contraction and spasm. In addition, such patients are usually prescribed pills to improve blood circulation in the brain (for example, Divaz), magnesium preparations that reduce the excitability of neurons, as well as dietary supplements containing fish oil and B vitamins, the deficiency of which is one of the migraine triggers.

If necessary, stop vomiting is usually used Seduxen, Pipolfen in combination with Suprastin or Diphenhydramine. The drugs are administered as an injection. For mild nausea, medications based on metoclopramide help.

One of the latest additions to the anti-migraine list is Fremanezumab, which is based on monoclonal antibodies that can prevent attacks of cluster pain and migraine. And researchers from Colorado believe that marijuana will help overcome migraines. Scientists even conducted a 4-year experiment with 121 volunteers. The effect of such treatment was positive, but a persistent side effect was acquired – drug addiction.

Most types of migraines can be treated at home, but only after consulting a doctor. The exception is migraine status, accompanied by severe vomiting and cerebral edema. Treatment of this disorder is carried out only in a hospital setting, and in many cases, emergency care will be needed in the intensive care unit.

Examples of taking drugs

To relieve pain at the beginning of an attack:

1. Antispasmodics: No-Shpa, Papaverine hydrochloride, Spasmoveralgin.
2. Triple injection: Analgin, Papaverine, Diphenhydramine.
3. Serotonergic (Relpax).

To alleviate the condition in the “heat” of an attack:

1. Ergot preparations: Rigetamine, Ergotamine hydrotartrate, Dihydroergotamine.
2. Caffeine with ergotamine (Cofergot, Caffetamin).
3. Analgesics (Efferalgan, Indomethacin, Naproxen, Piprofen, Acetylsalicylic acid, Diclofenac sodium).
4. Beta blockers (Propranolol, Vasocardin).
5. Triptan.
6. Antihistamines.
7. Sedatives.
8. Antiemetics.

In some cases, appoint:

• Phenobarbital;
• Difenin;
• Hexamidine;
• Valproic acid;
• Interleukin;
• Hormonal;
• Dehydration;
• neuroleptics (Triftazine, Trisedyl, Haloperidol).

Preventive therapy involves the use of such drugs:

• beta-blockers (Anaprilin, Vasocardin);
• serotonin antagonists (Sandomigran, Deseryl, Lisenil, Metisergide, Cyproheptadine);
• calcium channel blockers (flunarizine, verapamil, nifedipine, nimodipine);
• anticonvulsants (Antelepsin, Finlepsin, Difenin);
• benzodiazepines (Tezapam, Relanium);
• antidepressants (amitriptyline);
• herbal preparations: Sealex, Hedrix (sometimes erroneously called Hendrix).

For prevention, they are also sometimes prescribed:

• ergot preparations;
• Nicegrolin;
• Picamilon;
• Stugeron;
• Diakarb (a diuretic that affects liquorodynamics);
• alpha-2-adrenergic agonists (Gemiton, Katapresan, Clonidine).

In addition, physiotherapy is useful in the period between attacks:

• electrophoresis (using sodium sulfate, novocaine solution, vitamin B);
• galvanic collar (with calcium chloride solution);
• UFO;
• Exercise therapy;
• sitz baths;
• diademotherapy (device “Diadema”, developed by Israeli specialists, affects the paravertebral zone, the anterior cervical sympathetic chain, preventing pain);
• laser therapy;
• magnetotherapy (using the device Almag-01);
• acupuncture;
• darsonvalization (use of the Darsonval impulse massager);
• kinesio taping;
• balneotherapy.

For long-term treatment, apply:

• 3rd generation adrenergic blocker with vasoconstrictive effect Nebivolol (Nebilet) and Aspirin (taken daily);
• the drug Eltacin, which contains glycine, glutamic acid and cystine, which are useful for the brain (take courses);
• nootropics, Actovegin with cerebrolysin, mexidol, phenotropil, cortexin, neuroprotectors and B vitamins (drink courses).

Principles of drug therapy for certain types of migraine

menstrual:

1. Non-steroidal anti-inflammatory.
2. Gestagen preparations: Oxyprogesterone capronate, Progesterone, Primolyutin depot, Hormofort, Duphaston (use with caution, because in some cases, on the contrary, it provokes migraine).
3. With severe pain: Testosterone propionate, Bromkriptin, Parlodel, Danoval.
4. In some cases: combined oral contraceptives such as Jess, Angelica, Yarina.

Basilar:

1. Propranolol.
2. Ergot preparations.
3. Antiepileptic (Gexamidin, Difenin).

Beam (migraine neuralgia):

1. oxygen inhalation.
2. Ergotamine.
3. Verapamil, Lithium carbonate, Metisergide (optional).
4. sodium valproate.
5. Indomethacin.

Abdominal:

1. Belloid or Bellaspon.
2. Valeriana.

Any migraine with aura:

1. Validol or Corvalol.
2. Pain reliever

Neck:

1. Eufillin, Nicotinic acid.
2. Novocaine blockade.

Surgery

The surgical method of treating migraine at this stage in the development of medicine is a new phenomenon and many treat it with apprehension and distrust. The number of specialists and patients ready for such experiments is still small, but the number of those who have cured migraine with surgery is growing. For the first time, a possible surgical method for the treatment of migraine was discussed in 2000. It all started from the fact that American researchers drew attention to the fact that in some patients, after procedures during which Botox (botulinum toxin) was used, the headache disappears. After additional research, scientists found that botulinum toxin therapy relaxes the muscle through which the trigeminal nerve passes, and it is precisely its irritation that causes headaches. So experts came up with the idea to treat migraines by removing a muscle known as the frown muscle. When it contracts, a vertical crease forms between the eyebrows. After the operation, the person loses the ability to frown. This is perhaps the only side effect of such treatment. However, the secondary migraine that has arisen against the background of other pathologies is not treated by the surgical method. In all other cases, the researchers claim that the operation is beneficial: after surgery, patients take 76% less analgesics.

The surgical intervention is preceded by a thorough examination of the patient, as well as a trial injection of botulinum toxin at several points on the forehead. Injections with botulinum toxin are a kind of rehearsal for the operation: if the body responds adequately (within 2 months after the injection, the frowning muscle becomes numb and stops irritating the trigeminal nerve, and migraine symptoms decrease by 50%), only then will the patient be offered to “go under the knife”.

And more recently, experts from Case Western Reserve University, in the United States, made another statement about the effectiveness of migraine treatment by surgery. In particular, the researchers studied the medical records of 14 migraineurs. The average age of participants in a clinical study is 16 years. Each of the teenagers suffered from migraine attacks and did not respond to drug treatment. American doctors have determined that there are several nerve endings in the head and face of a person, which are also associated with migraine attacks. During the operation, the anesthetic was injected into the teenagers precisely at these points. After the procedure, scientists followed the teenagers for 3 years and found that five of them had completely recovered from migraines. In 8 subjects, the number of seizures decreased from 25 to 5 per month. And only in one patient the frequency of attacks did not decrease, although the pain did not become so intense.

Treatment with folk remedies

Folk remedies are not used to treat frequent, prolonged and severe attacks. If the diagnosis is established, and migraine attacks are not life-threatening, you can try to reduce the frequency and intensity of the headache with the help of folk remedies, in addition to the main drug therapy.

Folk healers at different times used herbal preparations to relieve a throbbing headache. One of the most popular remedies is an infusion of meadow clover (1 tablespoon per 1 cup of boiling water), which should be drunk half a cup three times a day. The same infusion can be prepared from dry Siberian elderberry flowers. The finished broth is taken in a quarter cup (possible with honey) three times a day 15 minutes before a meal. To prevent attacks, Caucasian healers advise replacing ordinary black tea with dogwood decoction in the daily diet. Also, an anti-migraine drink can be prepared from peppermint, oregano and narrow-leaved fireweed (1 tablespoon of the mixture per 300 ml of boiling water). Infused tea should be drunk as soon as the attack begins.

There are many medicinal herbs with anti-migraine properties. Most often, the recipes of healers mention such fees as oregano, St. also butterbur herb.

Another way to combat migraines is fresh raw potato juice (drink 50 ml with each attack), and for some a cup of strong coffee helps. If you suffer from chronic migraine, then folk healers advise cracking a raw egg in a glass and pouring boiling milk over it. This cocktail should be drunk for several days. Fans of lighter recipes can try drinking a glass of whey daily on an empty stomach. At the first symptoms of an attack, you can drink a tablespoon of black cumin oil and apply it on the temples and the back of the head.

To relieve pain, traditional medicine advises to attach leaves of cabbage or lilac to the temples and tie them tightly. A similar effect can be from a sauerkraut compress. It is applied to the area behind the ears and also wrapped with a towel around the head. An even simpler recipe is garlic oil mixed with vodka. With this remedy, healers advised to lubricate the forehead and temples during an attack of a throbbing headache. To prepare garlic oil, take 0,5 cups of chopped garlic and olive oil, insist on the sun for 2 weeks, filter and add 1 tsp. glycerin.

There are other ways. For example, some advise twice a day to eat a lump of sugar soaked in 10-15 drops of purified turpentine, or breathe in a mixture of ammonia and camphor spirits.

Many put compresses using fresh onion or beetroot juice. It is also useful to soar hands and feet in warm water with the addition of mustard. Some migraine sufferers are helped by valerian tincture and sleeping on pillows stuffed with fragrant medicinal herbs, and supporters of lithotherapy (stone treatment) claim that amber beads will help prevent a headache attack.

Which doctor to contact

In our society, migraines are not always taken with the necessary seriousness. Meanwhile, this is not the case when you can say: “It will hurt and stop.” With this disease, everything is just the opposite: the pain intensifies every hour and this can last for several days, and they most often seek medical help when they can no longer endure. Then ambulance doctors usually give the patient injections of Dimedrol, Baralgin or Relanium, but such treatment does not bode well, as it can provoke an increase in seizures. Also, you should not self-medicate migraine, because improperly selected drugs and their dosage can be ineffective at best, and at worst lead to disruption of the digestive organs, kidneys, central and peripheral nervous and cardiovascular systems, cause allergies or toxic damage to the body.

Some patients do not rush for medical help because they do not know which doctor treats migraine. In this case, the easiest way is to go to the therapist, and he will already redirect to a specialist. A neurologist deals with migraine problems, after a comprehensive examination, he can determine the type and variety of migraine, as well as select the most appropriate therapy. It is possible that before making a final diagnosis, the neurologist may suggest that the patient undergo a consultation with other specialists. It can be an ENT doctor, an ophthalmologist, an endocrinologist, a dentist, an allergist. This is done in order to exclude all possible other causes of headache, or to determine the factors that cause an attack. Indeed, for the effective treatment of any disease, it is important not only to eliminate discomfort, but to overcome the cause that provoked the pathology. And this is a hundred times more important when it comes to brain disorders. Fighting a migraine is no easy task. But if you choose the right method, it is quite real.

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