Migraine – more than just a headache
Migraine is a neurological disease that manifests itself in repeated, often very intense, headache attacks. It’s not just a “severe headache” – migraines affect everyday life, work and emotional wellness. Timely diagnosis and proper treatment can significantly reduce the frequency and severity of seizures.
How common is migraine?
- Migraine affects around 10-15% of the population in the world, but in Latvia as many as 23% of the population have experienced some of the migraine symptoms in the last 3 months. In women it is 2-3 times more common than in men
- It is more common to start at a young age or middle age, but can also appear in children in pre-school and older
- Migraine is one of the most common causes of chronic headaches in Latvia, often a long-term unrecognised and untreated disease
Migraine Classification
According to the International Headache Classification (ICHD-3) (3), migraines have two main forms:
aura-free migraine:
- characteristic unilateral, pulsed headache lasting 4-72 hours;
- nausea, vomiting, sensitivity to light and sound are often added;
aura migraine:
- aura – temporary and completely transient neurological symptoms: blink of vision, zigzag lines, numbness or tingling, speech disorders – appears before headaches;
- aura usually lasts up to an hour, followed by a headache phase.
Why does migraine occur?
Migraines are based on brain nervous and vascular interactions disorders:
- a preactive nervous system in the brain activates the trigeminal nerve and causes the release of neuropeptides (e.g. peptide associated with the calcitonin gene);
- this causes blood vessels to expand and inflammatory reactions that cause pain impulses.
- genetic factors also play a role — more than 40 genes have been discovered that determine the ability to perceive, manage and respond to pain impulses, and migraines are known to be often inherited in families.
Migraine attack symptoms
- Severe, pulsing headache (more common on one side of the head)
- Nausea, vomiting
- Sensitivity to light, sounds, odors
- Headaches worsen at little normal physical activity (e.g. climbing stairs or shaking your head, getting up from bed)
- Aura (blink of vision, numbness, tingling, speech difficulties) – found only in ⅓ migraine patients.
Treatment of migraines
Acute treatment (at onset of seizure)
Objective: to reduce pain and restore functional ability as soon as possible:
- analgesics (paracetamol, non-steroidal anti-inflammatory agents – ibuprofen, naproxen, dexetoprofen, etc. at an optimal and timely dose; do not exceed the daily dosage limit);
- triptanes – specific medicines to stop migraine attacks, they can be prescribed by any doctor involved in pain care;
- antiemetics (if nausea with or without vomiting, and abdominal or abdominal sensation)
- proper dosing and concomitant administration are essential for effective therapy.
Preventative treatment (to prevent recurrent migraine attacks)
It is recommended if:
- seizures are common (more than 4 days per month) or severe;
- acute therapy is ineffective;
- migraine significantly impairs quality of life.
is used for prophylaxis:
- recent biological therapies, monoclonal antibodies that affect the release of calcitonin gene-related peptide and significantly reduce the frequency of seizures;
- beta-blockers (e.g. propranolol);
- anti-epileptics (e.g. topiramate);
- antidepressants (e.g. amitriptyline);
- and others.
Non-medical treatment and lifestyle
The most important part of effective control of migraines that a patient can initiate before a visit to a doctor:
- regular sleep and diet;
- sufficient liquid intake;
- avoiding agents (stress, food, hunger, sleeping too long, etc.);
- regular physical activity (moderate, not excessive);
- relaxation methods (breathing exercises, meditation);
- maintaining a headache diary.
NeiroMed ASTRA clinic approach to migraine
- Advanced neurologists specialising in the diagnosis and treatment of headaches
- Contemporary exams (laboratory analysis, USG Duplex for head and neck vessels, echocardiography, ECG, headache diary analysis, and brain MRI in collaboration with Commonwealth clinics)
- Personalised treatment plan – acute therapy, prevention, lifestyle recommendations
- Use of up-to-date biological therapies to prevent migraines (monoclonal antibodies, onabotulin toxin therapy, various analgesic blockades, intravenous analgesic therapy)
- Education and monitoring of patients
