Neurological manifestations of migraine. Simple migraine Migraine neurology

An attack of hemicrania can be caused by various factors: depression, fatigue, strong smells or sounds, changes in atmospheric pressure. Some food products, such as smoked meats, red wine, chocolate, and cheese, can act as a provocateur.

Many people know how migraine manifests itself, but not everyone understands the pathogenesis of the disease. Most scientists are unanimous in the opinion that the main site of pain development is the blood vessels of the brain.

Therefore, it is obvious that the aura accompanying painful attacks is a consequence of vascular spasm and the development of cerebral ischemia. Cases of manifestations of focal neurological symptoms (dizziness, loss of consciousness, tremors of the extremities) may indicate the development of serious pathologies that require immediate treatment.

Main symptoms and signs of migraine: what kind of pain and how does it manifest?

Statistics show that women suffer from headaches more often than men. Migraines mainly occur in people over 35 years of age.

What kind of disease is this?

Migraine is a neurological disease that is accompanied by headaches. They can last a long time and repeat at regular intervals. In addition, the pain syndrome is accompanied by signs from the nervous system, as well as the gastrointestinal tract.

What kind of disease is this?

Migraine in the presence of neurological focal symptoms

Migraine is a complex of symptoms and phenomena that cause unpleasant consequences if the lesion is not eliminated in a timely manner. Migraine may have a good combination with focal neurological symptoms. In addition, it is necessary to distinguish between such concepts as migraine with aura, in which neurological disorders are present, and migraine without aura.

Main reasons

Paresis of the limbs, which can be partial or complete;
Nausea;
Vomiting and dizziness;
Hearing loss and decreased vision;
Impaired coordination of movements;
Amnesia.

A patient suffering from such a disease may experience intense pain that begins in the back of the head and spreads to the parietal region - to the forehead, temples, and neck. During this disease, when turning the head, a crunching or burning sensation may occur.

Headaches that occur in neurology are usually caused by severe compression of the occipital nerves; the pain itself has a shooting character. They can spread along the location of the nerves, and are also distinguished by the fact that they continue for a long time and constantly. If competent treatment is prescribed, it should bring the desired result, but often this does not happen.

Migraine– an attack-like disease characterized by repeated headaches from 4 to 72 hours, often accompanied by visual and gastrointestinal symptoms. It is an independent nosological form. The term " migraine"has an extraordinary linguistic destiny. To describe recurrent, one-sided pain, Galen coined the Greek word " hemicramia", which is later designated in Latin as Hemigranea And Migranea, and from the latter it was transformed into French Migraine. In the 13th century From French, this word has passed into many languages, including English and Russian. It later turned out that the term is inaccurate, since the attack begins with a unilateral headache in less than 60% of patients.

Frequency

18-20% of women suffer from migraines between the ages of 10 and 30, usually around the time girls get their periods.

Etiology and pathogenesis

Migraine attacks are accompanied by regional changes in cerebral blood flow due to dilation of intracranial arteries. Vasomotor changes are caused by episodic decreases in systemic serotonite concentrations. Prodromal symptoms may be due to intracranial vosoconstriction. One of the main factors of migraine is a constitutional predisposition to it, which is often hereditary. In hereditary anemnesis, migraine is present in more than two thirds of patients. There are currently two main theories of migraine: vascular And neurogenic. According to the vascular theory, migraine is considered as a suddenly developing generalized disruption of vasomotor regulation, manifested by lability of cerebral and peripheral vascular tone. Aura during migraine is caused by local spasm of cerebral vessels with the development of local cerebral ischemia and the appearance of focal neurological symptoms (scotomas, hemianopsia, dizziness, etc.). At the same time, an attack of headache is a consequence of excessive vodilation of the intracranial (meningeal) and extranial arteries, and periodic stretching of the vascular wall leads to the activation of pain receptors and gives the headache a pulsating character. Vascular malformations are often detected during cerebral angiography.

The neurogenic theory defines migraine as a disease with primary neurogenic cerebral dysfunction, and the vascular changes that occur during an attack are secondary.

The trigeminal-vascular theory assigns a major role in the pathogenesis of migraine to the trigeminal nerve system, which provides interaction between the central nervous system and intracranial and extracranial vessels. The key role is played by neurogenic aseptic inflammation due to the release of vasoactive neuropeptides (substance P, neurokinin A, calcitonin gene-related protein-CGRP) from the terminals of sensory nerve fibers in the vascular wall. These vasopeptides cause vasodilation, increased permeability of the vascular wall, sweating of proteins, spasms, blood cells, swelling of the vascular wall and adjacent areas of the dura mater, degranulation of mast cells, and platelet aggregation. The end result of this aseptic neurogenic inflammation is pain. As a result of the anatomical features of the trigeminal nerve, pain, as a rule, radiates to the fronto-orbital-temporal and is localized in the left or right half of the head. During a migraine attack, the level of calcitonin gene-related peptide increases many times in the blood of the external jugular vein, which confirms the role of activation of neurons in the trigeminovascular system.

Migraine is often combined (comorbidity) with diseases such as epilepsy, arterial hypotension, Raynaud's syndrome, mitral valve prolapse, angina pectoris, coronary heart disease, cranio-vertebral junction anomaly, constipation.

Clinical picture

There are three main forms of migraine. Migraine with aura (classic) occurs in 25-30% of cases. Its clinical picture consists of five phases developing one after another.

First phase – prodromal– appears several hours before the development of a headache and is characterized by mood changes, feelings of fatigue, drowsiness, fluid retention in the body, irritability, anxiety, bulimia or anorexia, increased sensitivity to smells, noise, bright light.
Second phase - aura- presents a complex of focal neurological symptoms lasting no more than 60 minutes. In the ophthalmic form of migraine, the aura is characterized by visual disturbances (flickering scotoma, photopsia, hemianopsia, visual illusions). In other forms of migraine, the aura manifests itself with neurological symptoms in accordance with the affected arterial system: hemiparetic, aphasic (carotid system), cerebellar, basilar.
Soon after the aura comes third phase - painful. It can last up to 72 hours and is manifested by a throbbing headache in the fronto-orbital-temporal region, usually unilateral, of moderate or strong intensity, aggravated by normal physical activity, accompanied by photophobia, sound fear, nausea, vomiting, and pale skin. In some cases, the headache is aching, bursting in nature and can spread to the other side. Sometimes the headache immediately has a bilateral localization. On the side of the headache, the vessels are injected, lacrimation and swelling of the paraorbital tissues are observed. In addition to swelling in the temporal region, swelling and pulsation of the temporal artery is observed. Patients often try to compress the temporal artery, rub their face, pull their head with a towel or squeeze it with their hands, try to retire to a dark room, and avoid loud sounds and bright light.
Fourth phase - permission. It is characterized by a gradual decrease in headaches, cessation of vomiting and deep sleep.
Fifth phase - restorative- can last several hours or days. It is characterized by increased fatigue, decreased appetite, gradual normalization of the functioning of the body's sensory systems (hearing, smell, vision), and increased diuresis.

Migraine without aura (simple migraine) is the most common form (up to 75% of cases). A migraine attack consists of three phases - prodromal, pain and recovery. The presence of a prodromal phase for simple migraine is not necessary. Often an attack begins without any warning, immediately with a headache. The clinical picture of the headache phase is similar to that described for migraine with aura. Migraine without aura is characterized by the presence of refractory periods, when the disease does not manifest itself for quite a long time after an attack, and during this period most patients consider themselves practically healthy. An objective study reveals in two thirds of them a syndrome of vegetative-vascular dystonia of varying intensity with a tendency to arterial hypotension and, rarely, arterial hypertension. Patients are characterized by increased sensitivity to distress. They are prone to anxiety-depressive reactions, emotional lability, and psychoasthenic manifestations.

Differential diagnosis

When analyzing the clinical picture of migraine, you should always remember the following symptoms, the appearance of which should alert the doctor, since they may be signs of an organic brain disease:

absence of change of side of pain, i.e. the presence of hemicrania for several years on one side;
progressively increasing headache;
the occurrence of a headache outside of an attack after physical activity, strong stretching, coughing or sexual activity;
increase or appearance of symptoms in the form of nausea, vomiting, temperature, stable focal neurological symptoms;
the appearance of migraine-like attacks for the first time after 50 years.

Migraine must be differentiated from headaches due to vascular diseases of the brain (hypertension, vegetative-vascular dystonia, vascular malformations, vasculitis, ischemic and hemorrhagic strokes with small foci, giant cell temporal arteritis - Horton's disease Tolosa-Hunt syndrome), as well as with tumors, infectious lesions of the brain and its membranes.

A special place in the differential diagnosis of migraine belongs to the so-called primary forms of cephalgia: cluster headache, chronic paroxysmal hemicrania and episodic tension-type headache.

Main reasons

Migraine with focal neurological symptoms can be caused by PA-vertebral artery syndrome. They, in turn, are located along the spinal column and pass through the canals, which are formed by the transverse processes of the cervical vertebrae. At the base of the brain stem, the vessel merges into an artery, which branches and at the same time supplies blood to the hemispheres. The cause of the pathology may be nothing more than cervical osteochondrosis. Migraine with focal neurological symptoms can be accompanied by a number of symptoms.

Paresis of the limbs, which can be partial or complete;
Nausea;
Vomiting and dizziness;
Hearing loss and decreased vision;
Impaired coordination of movements;
Amnesia.

A patient suffering from such a disease may experience intense pain that begins in the back of the head and spreads to the parietal region - to the forehead, temples, and neck. During this disease, when turning the head, a crunching or burning sensation may occur.

Seizures usually limit the patient’s ability to work and take him out of his usual routine of life. There are several main types of migraine with focal neurological symptoms - pharyngeal, facial, hemiplegic. The first is diagnosed less frequently than the others, and the second is represented by pain in the face, which affects overall well-being. The latter type of migraine is quite difficult to detect and diagnose; for this, a specialist must collect all the necessary data and make a diagnosis.

Causes of neurological symptoms

Vertebral artery syndrome and cervical osteochondrosis

Migraine with focal neurological symptoms can be caused by VA (vertebral artery) syndrome. The vertebral arteries (right and left) are located along the spinal column and pass through the canals formed by the transverse processes of the cervical vertebrae. At the base of the brain stem, the vessels merge into an artery, which branches out and supplies the cerebral hemispheres with blood.

The cause of pathological processes can be cervical osteochondrosis. Degenerative changes in the vertebrae and their spinous processes lead to compression of the spinal nerves, arteries and veins that supply blood to the brain. The neurological manifestation of osteochondrosis is the occurrence of vertebrobasilar insufficiency, manifested by the following symptoms:

Nausea and vomiting;
Decreased vision and hearing;
Dizziness;
Impaired coordination of movements;
Loss of consciousness;
Temporary amnesia;
Partial or complete paresis of the limbs.

The patient may experience intense pain, starting in the area of the occipital part of the head and the seventh vertebra, spreading to the parietal region, to the forehead, temple, ear and eyes. When you turn your head, you may feel a strong crunching and burning sensation in the neck area - the so-called cervical migraine.

Neurological headaches are usually caused by excessive compression of the occipital and facial nerves and have an intense shooting character. Painful sensations spread along the location of the nerves and are characterized by duration and constancy, lack of proper effect from the prescribed treatment.

Seizures can significantly limit performance and disrupt the usual rhythm of life. There are several types of migraine with focal neurological symptoms: facial, pharyngeal, hemiplegic.

Pharyngeal migraine

Much less often, specialists diagnose pharyngeal migraine. Pharyngeal migraine occurs as a result of damage to the sympathetic weave of the vertebral artery and is accompanied by sensations of a foreign body in the throat and a violation of the swallowing reflex.

In other cases, paresthesia (numbness, loss of sensitivity, tingling, crawling) and one-sided painful sensations involving the pharynx, hard palate, and tongue may occur. Chills, increased sweating, and spots in the eyes are also observed.

Any turn of the neck or change in head position leads to an increase in pain attacks. If you can find the optimal position of the head, the headache may weaken and disappear completely.

Facial migraine

Facial migraine is diagnosed as trigeminal neuralgia and is accompanied by neurotic reactions: strong excitement or vice versa, emotional numbness, aggression, hysterical state.

Shooting pain radiates to the area of the lower jaw or neck, sometimes to the area around the eyes. The attacks are difficult to stop and can recur several times a week, accompanied by accompanying pain in a certain part of the head.

Facial migraine with focal neurological symptoms can recur systematically. Cold wind or just communication is enough to cause unpleasant sensations.

Hemiplegic migraine

To establish a diagnosis, the doctor conducts a thorough medical history and prescribes a set of examinations to exclude other causes of attacks. Treatment of hemiplegic migraine consists of a complex of drugs and measures used for other types of the disease, and depends on the severity of the condition and the individual data of the patient.

Hemiplegic migraine can be divided into two forms: a disease without complications and a disease complicated by neurological manifestations with paresis of one half of the body. The disease can be considered as a hereditary autoimmune disease.

This is a rare severe form of hemicrania, characterized by attacks of headache with central paresis, temporary impairment of speech and sensitivity.

Paresis is manifested by difficulty in motor activity of the fingers, followed by spread to the corresponding side of the body and an increase in throbbing headache.

Such disorders can only in very rare cases reach the level of paralysis.

Unlike classic migraine, accompanied by aura, the first symptoms of hemiplegic hemicrania are paresthesia and headache, which are subsequently joined by reversible neurological symptoms: dizziness, double vision, short-term amnesia, fever, speech disorders.

In some cases, symptoms may be complicated by epileptic seizures.

Treatment, diagnosis

Migraine with focal neurological symptoms is difficult to treat and requires an integrated approach. The choice of methods and drugs depends on the origin of the migraine.

Diagnosis is based on collecting anamnesis and identifying characteristic complaints. In addition to collecting anamnesis, the specialist must conduct additional high-tech studies:

X-ray of the cervical or lumbar spine.
Dopplerography of the vessels supplying the brain.
MRI of the spine.
Blood test for cholesterol and lipids.

Neurologists treat hemicrania with focal neurological symptoms. If measures are started on time, then pain attacks can be quickly stopped or significantly minimized.

As a rule, treatment includes the use of ointments with active anti-inflammatory and analgesic components, medications that promote the regeneration of cartilage tissue, as well as:

Medicines that improve blood circulation, such as cinnarizine;
Anti-inflammatory and painkillers: nurofen, diclofenac, indomethacin nimesulide;
B vitamins;
Antispasmodics;
Neuroprotectors to protect the brain from hypoxia;
Triptan drugs: Sumatriptan, Sumamigren, Imigran spray;
Antidepressants - Cymbalta, Velafax;
Anticonvulsants.

Prevention

To correct the disease, consultation with a neurologist and comprehensive treatment are necessary. It is necessary to understand that therapeutic measures are intended only to relieve pain and relieve inflammation.

In order for the disease to bother you, you need to avoid stress as little as possible, lead a healthy lifestyle: play sports, take walks in the fresh air, eat a balanced diet.

Non-drug methods will help control the situation. Manual therapy, acupuncture massage, yoga classes are excellent disease prevention. It is very important to know the first manifestations of an attack and be able to stop them in time.

If the correct treatment is selected, then manifestations of migraine with focal neurological symptoms have a favorable prognosis - a decrease in the number of attacks and their intensity.

Facial migraine

The question of the existence of facial migraine as a special clinical form of the disease is controversial.

In the International Classification of Migraine, facial migraine is not specifically identified. In the famous American classification of headaches of 1962.

A. Prusnnsky (1979), suggesting that Horton's syndrome of the type “pain in the lower half of the head” and migraine of the same localization may occur, refers to earlier studies conducted by L. G. Erokhina (1973). She identifies facial migraine as a special form of facial sympathalgia and facial vascular pain.

Etiology. Vascular pain in the face may appear

as a component of headaches in vascular diseases or as isolated syndromes. The cause of facial pain of vascular origin is considered to be hyperthyroidism, atherosclerosis, arterial hypotension, migraine, migraine neuralgia, cerebral vascular aneurysms, temporal arteritis, venous circulation disorders. All pain disorders are usually localized in the fronto-orbital-temporal

Clinical picture. Facial migraine in most cases affects women 20-30 years old, many of them have family members burdened with migraine. Arterial dystonia of the hypotonic type and various kinds of autonomic disorders and neurotic reactions are often detected, especially in the period preceding attacks. There are no focal symptoms in the neurological status. Additional research methods (assessment of the condition of the fundus, craniography, etc.) usually fail to detect significant changes. Rare findings are moderate dilatation of fundus veins, narrowing of arteries, oxycephalic skull shape, or moderate signs of intracranial hypertension.

Factors that provoke an attack are overheating, cooling, fatigue, emotional influences, disturbances in sleep and nutrition, i.e., everyday factors, as with a regular migraine.

often they are localized in the temporal region, radiating to the orbit, upper jaw, and ear. With a prolonged attack of facial migraine, pain spreads to the entire face, teeth, then to the neck and upper shoulder girdle. In our opinion, this picture is no different from the localization and nature of pain in neuralgia of the pterygopalatine ganglion, as well as their development in some cases against the background of vegetative-vascular paroxysm.

In this regard, apparently, facial migraine is a form identical or close to neuralgia of the pterygopalatine ganglion.

The same should be said about general autonomic reactions during an attack (changes in facial coloring, swelling, Horner's syndrome, etc.), about the frequency of such phenomena as pulsation and pain in the superficial temporal artery, the branch of the ophthalmic artery at the inner edge of the eyebrow, bifurcation carotid artery, as well as the maxillary branches of the external carotid artery. As with cephalalgia, patients try to stop attacks by applying warm or cold to the face, as well as mechanical effects on facial tissue, teeth and gums. Usually they avoid exposure to noise, light, try to fall asleep, etc. In some cases, the pain is localized only in the teeth of the upper jaw, but the course of the attack and behavior

The patient's symptoms are typical, as with migraine, or the pain is localized first in the face, and then migraine attacks develop with headache, vomiting, and photophobia.

Differential diagnosis should be carried out primarily with carotidydynia, pulsating burning pain in the lower part of the face caused by damage to the periarterial plexus of the external carotid artery. In this case, tension, increased pulsation and pain on palpation of the external carotid artery are noted. The disease can affect both young people, often limited to one 2-3 week attack, and older people (usually women), in whom it has a chronic course, occurring with attacks of pain lasting several days, repeating with varying frequencies.

Treatment. Therapeutic measures for facial migraine are no different from those for other forms of migraine. Do they use drugs to stop and alleviate the attack itself? (ergotamine hydrotartrate tablets 1-2 mg sublingually or caffeamine, rigetamine), as well as analgesics. sedatives, vascular drugs, vitamins, physiotherapeutic procedures (see section 4.4.1).

Migraine - causes, symptoms and treatments

Most often, migraine is a painful headache and poor general health. The disease is characterized by various neurological disorders:

intolerance to loud noise;
vomit;
or nausea.

It is almost impossible to completely get rid of migraine symptoms, but they can be made less severe. Treatment also improves well-being and reduces pain in the skull.

Migraine is a chronic disease with exacerbation attacks. With the disease, pain is observed in the orbital-temporal region. Intense headache has periodic repetitions and is accompanied by general weakness and drowsiness. Patients suffer from phono and photophobia - they cannot tolerate loud sounds and light. The disease is complicated by psychological problems - patients are in constant fear that they are about to be overtaken by a migraine attack. It has been noted that the development of migraine can be triggered by the genetic characteristics of the body and heredity.

Causes of migraine

The disease is quite common, as medical practice shows. According to current medical statistics, about 14% of the world's population suffers from migraines. About 80% of people have experienced a migraine attack at least once. Representatives of the fairer sex most often complain of headaches. Doctors claim that pregnancy and hormonal changes in the body influence the occurrence of attacks. With the onset of menopause, migraines disappear for many women.

Some people have attacks more often, others less often. The development of migraine is highly individual. The mechanism of development of the disease is a strong spasm of blood vessels. With it, a large number of neuropeptides enter the bloodstream. The substances, together with serotonin, cause stretching of the vascular walls. Severe pain occurs in the frontal region and temples.

The main causes of migraine are:

pathology of the trigeminal nerve;
hereditary predisposition;
instability of the emotional background;
severe stress;
change in weather conditions;
improper diet;
the presence of chronic diseases.

Migraines can be caused by eating citrus fruits, foods high in sodium glutamate, chocolate, and caffeinated drinks. The feeling of hunger, as practice shows, also provokes headaches. You should not take a long break between snacks to avoid an attack.

In women, headaches can be caused by taking certain hormonal pills, as well as by the presence of menstruation. PMS is often the main cause of female migraines.

Headaches occur especially often in people who are prone to melancholy and have low resistance to stress. To overcome migraines, you should stabilize your emotional background and be a mentally stable person. Headache often occurs against the background of various neurological disorders, neurosis, and depression.

Symptoms of an attack

Migraines are usually preceded by a certain condition. Poor health is expressed in the flickering of flies before the eyes, the appearance of flashes of lightning. Sometimes visual hallucinations occur or vision is lost. General weakness of the body, a feeling of chills, goosebumps, and problems with speech occur. Vegetative symptoms include:

strong heartbeat;
dizziness;
spots in the eyes;
noise in ears;
sweating;
breathing problems;
tingling or burning in the extremities.

This condition is called “aura” in medicine. Such health problems are further accompanied by severe headaches. The attack itself occurs in several stages. Initially, a prodromal stage develops, after which an aura occurs, which is accompanied by a headache.

The prodromal stage of migraine can begin to develop a day before the acute headache. It also includes drowsiness, loss of performance, fatigue, changes in thought processes, and dizziness. All these neurological features indicate problems in the functioning of blood vessels. The symptoms are non-specific and therefore difficult to associate with an oncoming migraine. However, if the aura is repeated repeatedly and is accompanied by pain in the temporal part of the skull, then you should think about the approach of an attack.

Pain during a migraine can change its location. The disease is characterized by throbbing, excruciating pain. It can start in one temple and move to the forehead. Over time, the pain increases.

The main manifestation of the disease is the patient’s inability to tolerate high, loud sounds and bright light. They further intensify the pain in the skull and provoke a deterioration in well-being. Painful sensations are often accompanied by dry mouth, chills, fever, and difficulty urinating. In some cases, the patient may faint or experience lightheadedness. Health problems bring a lot of discomfort and discomfort to a person. The headache becomes very painful and can last for about 3 days.

Headache may also be accompanied by digestive disorders and stool disorders. Even after an attack, the body needs a lot of time to restore its functions and strength. Migraine is not only painful, but also has an extremely adverse effect on all human systems.

First aid for a migraine attack

When a headache begins to develop and weakness appears, you should sit comfortably in a soft, comfortable chair, relax and perform a light head massage. Massage your forehead, temples, back of your head, and neck. You need to place an ice bubble on the skull. Cold will help narrow dilated blood vessels. Place a crumpled cabbage leaf on the problem area. Its juice will help relieve pain. You also need to drink sweet, strong tea or coffee.

The above method is quite safe and can be used to eliminate migraines even during pregnancy. It is useful to learn some effective technique of complete relaxation and use relaxation during an attack. In a critical situation and persistent pain, you should take a headache pill. During pregnancy, you can use Paracetamol, which is non-toxic.

Treatment with physiotherapy

There are different approaches to treating headaches. Non-drug treatment includes:

physiotherapy (exposure to ultraviolet light, diadynamic current, circular shower);
laser therapy;
psychological trainings and psychotherapy;
massage;
correction of nutrition and regime;
acupuncture;
hirudotherapy;
pine baths.

Physiotherapy is of particular importance in eliminating migraine attacks. This approach has a beneficial effect on the patient’s entire body. Various methods are based on biocommunication. Physiotherapy helps stabilize the tone of blood vessels.

Hydrotherapy procedures in the form of various baths help eliminate migraines. Their therapeutic effect is to eliminate vascular spasm, completely relax the body, and calm the central nervous system. Baths for migraines should be used over a long period of time and procedures should not be skipped. You need to fill the bath with warm water – 38 degrees. It has a powerful antispasmodic effect. If you have a severe headache, you can take a bath, wash your hair and direct the shower stream onto your head, massaging it. You can add to the bath:

decoction of calamus rhizomes;
a decoction of cones and branches of pine or cedar;
sage;
motherwort;
nettle;
primrose;
seaweed;
lavender oil;
sea salt.

To prepare a bath, you need to prepare a decoction in advance. The raw material must be crushed and brewed with boiling water, let it brew, and then pour it into a bath of warm water. It takes about fifteen minutes to take the water procedure with complete muscle relaxation.

Massage and self-massage is another way to get rid of pain in the temporal and frontal parts of the head. If you intensively massage your fingers, the pain will begin to go away. You should start the movements with the thumb and end the massage with the little finger. You can also massage the “collar” area, back of the head, forehead, temples with circular smooth movements. Massage improves blood microcirculation and relieves vascular spasm.

Facial exercises help with migraines. It helps to relax the necessary muscles and relieve pain. Perform facial exercises for migraines as follows:

raise your eyebrows and relax them;
raise your left/right eyebrow alternately and lower it;
wrinkle your nose and then relax your nostrils;
yawn widely, slowly opening your mouth;
close your eyes and turn the apples of your eyes under your eyelids;
open your mouth and move your jaw;
make a face with a grimace.

After gymnastics you should completely relax. You can take a headache pill - the main thing is to remain completely calm. Various relaxation techniques and yoga help well with migraines.

If you have a headache, you can apply an ice compress or a warm heating pad to the problematic part. This will help relieve the spasm. Ice eliminates the rush of blood to the head vessels and stabilizes the blood flow.

Acupuncture is a technique that many people use to treat migraines. The procedure should be performed by a reflexologist. Acupuncture promotes complete relaxation of the necessary areas on the human body, which eliminates headaches. Stimulation of the body with needles is an effective method of treating psycho-neurological disorders and migraines. The needle stimulates nerve impulses, the central nervous system, and the production of endorphins and hormones. Acupuncture is not dangerous and brings great help to the human body, relieving nervous tension.

Hirudotherapy is a method that is often used for hypertension and headaches. Leeches stimulate blood production, change its composition and improve it by releasing beneficial substances into the bloodstream. After a course of hirudotherapy, patients note a noticeable improvement in their well-being, normalization of sleep and blood pressure, stabilization of the pulse, and disappearance of headaches. However, hirudotherapy should be used 2 times a year.

Laser treatment of migraines is carried out using a special device. Laser radiation neutralizes a paroxysmal attack, which is caused by a local disturbance of blood microcirculation in the head vessels. The laser affects certain areas and relieves pain. Irradiation of the cervical vessels helps eliminate blood congestion and stabilize the patient’s condition.

Drug therapy

Taking certain medications will help relieve headaches during an attack. For this they take:

agents – serotonin agonists;
ergot alkaloids;
non-steroidal anti-inflammatory drugs;
analgesics.

You should take the pill at the first sign of an attack. Directly when a headache develops, take Ibuprofen, Naproxen, Analgin. To eliminate nausea, take Cerucal, Metoclopramide, Domperidone. The combined drug Askofen includes caffeine, which is a good pain reliever. If the patient is vomiting, a rectal suppository with an analgesic is inserted into the anus. For this purpose, you can use Voltaren suppositories.

In situations where analgesics do not have the desired therapeutic effect, triptans are taken. These medications include:

Various preventive measures are used to prevent an attack and stabilize blood pressure. It is necessary to take adrenergic blockers, which stabilize blood pressure and prevent vasodilation. For this purpose, the doctor may also prescribe antidepressants, anticonvulsants, and calcium channel blockers. The following medications are used as adjuvant therapy:

The use of prophylactic medications should be kept to a minimum. The choice of the necessary medication in the treatment of migraine should be made by the attending physician. For unbearable headaches, medication and alternative treatment should be used in combination.

Folk remedies for migraines

There are several ways to reduce headaches:

Apply lemon or onion slices to the temples of your head. Hold until the pain disappears.

Place a cabbage leaf compress on the problem area and bandage your head.

Inhale a mixture of apple cider vinegar and water (bring the product to a boil and breathe in the steam for a few minutes).

Inhale the aromatic oils of lavender, pine, lemongrass.

At the beginning of an attack, drink raw potato juice.

Take a bath with valerian root infusion.

Make a hot mustard bath for your feet.

Place a tampon soaked in raw onion or beet juice into your ear.

To prevent an attack and deterioration of health, it is recommended to regularly take decoctions and tinctures of medicinal herbs. Medicinal plants have long been used in the treatment of migraines. Aristocrats and royalty did not neglect to treat themselves with these infusions. Some effective recipes for treating migraines with herbs have survived to this day.

Spinach and dandelion help get rid of headaches. The raw materials should be mixed in equal parts, brewed and drunk a third of a cup three times a day. The juice of blueberries, black currants and carrots helps to stabilize the functioning of blood vessels.

During a migraine attack, you can take the following remedy: break a chicken egg into a glass of hot milk, removed from the heat, and drink the resulting cocktail.

Daily use of coltsfoot decoction has a beneficial effect on the functioning of the blood vessels in the brain. The plant has the desired therapeutic effect and triggers the necessary mechanisms in the body to relieve headaches. To relax during migraines, use decoctions of valerian, lemon balm, viburnum, and clover. You can take a decoction of dogwood, rosehip and rowan.

Neurological migraine, its symptoms and treatment

Ivan Drozdov 02/15/2018 0 Comments

A migraine attack is a set of excruciating and painful neurological symptoms that significantly reduce a person’s physical activity and activity. The main cause of migraine development is pathological constriction of the blood vessels in the brain, provoked by poor diet, stress, overwork, the influence of tobacco and alcohol, as well as a number of neurological diseases. In the first case, it is enough to eliminate the impact of the described factors in order to reduce the number of attacks; in the second, it is necessary to treat diseases and pathologies that provoke the appearance of pain and unpleasant symptoms.

Where do neurological symptoms come from?

In most cases, migraine is accompanied by neurological symptoms, the cause of which is external factors (stress, fatigue, weather dependence) and serious pathological disorders. If focal neurological symptoms appear in aggravated form during migraine attacks, it is necessary to diagnose the causes of their development and begin treatment in a timely manner.

Vertebral artery syndrome and cervical migraine

A pathological disturbance of blood flow directed to the structures of the brain, which is caused by compression of the two main vertebral arteries, is called vertebral artery syndrome (VAS). The cause of these processes may be the presence of osteochondrosis, cartilaginous growths on the bone tissue of the vertebrae, intervertebral hernias, and muscle spasms. The vessels of the brain react with spasm to the decrease in blood flow, as a result of which a person experiences migraine pain.

Symptoms characteristic of cervical migraine or SPA are:

Headache developing from the cervical region and the back of the head, and spreading to the front of the head. The pain often occurs on one side constantly or in the form of regular attacks; its intensity increases with turning the head and moving the neck.
Attacks of nausea, often ending in vomiting.
Decreased motor coordination and memory concentration.
Dizziness.
Numbness of the limbs: complete or partial.
Temporary memory loss.
A burning or crunching sensation in the neck when moving the head.
Tinnitus.
Visual impairment.
Painful sensations when touching the scalp.

Exacerbation of SPA significantly limits physical and mental activity, while failure to take measures to treat the pathology only aggravates the condition.

Pharyngeal migraine

This type of migraine is a consequence of the development of spasm, but does not appear so often. Its occurrence is facilitated by pathological disorders occurring in the sympathetic plexuses of one of the vertebral arteries.

The main signs of pharyngeal migraine are:

Feeling of a “lump in the throat”, difficulty swallowing.
Chills, heavy sweating.
Light signs of a visual aura are flickering dots before the eyes.
Disappearance of sensitivity of the palate and tongue.
Unilateral numbness of certain areas of the pharynx and palate.
Increased pain when changing head position or neck movements.

Painful symptoms decrease or disappear with a certain position of the head and cervical region.

Facial migraine

The following signs indicate the presence of facial migraine:

Systematic attacks that occur several times a week lasting from 2-3 minutes to 1-2 hours.
Aching headache with periodic lumbago radiating to the cervical region, lower or upper jaw, or orbital area.
Pain in the carotid artery when touched and strong pulsation, swelling of the soft tissues, redness of the skin at its location.
Psycho-emotional instability during an attack - causeless hysterics, anger, nervous overexcitation, often giving way to apathy, indifference and numbness.

People aged 30-60 years are most susceptible to facial migraines. Common reasons that provoke the development of an attack are stress, prolonged exposure to drafts or cold, injuries and acute dental diseases. Due to the similarity of symptoms, facial migraines are often diagnosed as inflammation of the trigeminal nerve.

Hemiplegic migraine

This type of migraine is considered a rare illness with complicated neurological symptoms. There are two types of the disease: familial and non-familial. Hereditary predisposition and autoimmune pathologies are the main factors provoking hemiplegic migraine.

The headache that occurs with hemiplegic migraine is supplemented by the following pathological symptoms:

Aura in the form of neurological signs - dizziness, speech and visual disturbances, chills, short-term loss of memory and sensitivity.
Nausea, vomiting.
Drowsiness, mood changes.
Painful reaction to sound and light.
Unilateral numbness of the extremities, which can lead to impaired motor functions of the toes or hands with further spread of paresis over the entire half of the body.
Paralysis of limbs or body parts in complicated cases.

Rarely, an attack can develop into an epileptic seizure and result in a stroke.

Diagnosis and treatment of migraine with focal neurological symptoms

In case of obvious neurological focal symptoms, it is necessary to find out the cause of their origin. To do this, the neurologist examines the patient’s complaints and visual manifestations, after which he prescribes a number of the following diagnostic procedures:

radiography of the cervical and lumbar vertebrae;
MRI of the neck and brain;
Doppler ultrasound of the main vessels and arteries of the brain structures;
Clinical blood test for lipids and cholesterol.

After undergoing diagnosis, the patient is prescribed a comprehensive treatment to reduce the intensity of neurological symptoms, as well as the frequency and duration of migraine attacks. The therapeutic course of treatment may include a number of the following medications and drugs:

Anti-inflammatory and analgesic tablets (Diclofenac, Imet, Indomethacin, Nurofen).
A complex of B vitamins that has a positive effect on the central nervous system, metabolic processes, restoration of memory and mental activity.
Antispasmodics (Spazgan, Spazmalgon), aimed at relieving spasms of cerebral vessels and preventing migraines.
Tablets that improve blood circulation in the brain vessels (Cinnarizine, Cavinton).
Neuroprotective drugs (Glycine, Ginkgo Biloba, Thiocetam) have a restorative effect on nerve brain cells, improving their metabolism and protective functions.
Antidepressants and sedatives (Velafax, Aphazen, Persen) are indicated for prolonged depressive states and stress that provoke migraine attacks.
Anti-migraine tablets (Sumatriptan, Zomig, Ergotamine) are special medications with an effect aimed at relieving migraine attacks and eliminating additional symptoms.
Anticonvulsants (Epimil, Valproic acid) are prescribed if migraine attacks are aggravated by epileptic seizures.

Feel free to ask your questions right here on the site. We will answer you!Ask a question >>

To prevent attacks with pronounced neurological signs, it is recommended to undergo complex treatment regularly, without waiting for the exacerbation phase. For the effectiveness of drug therapy and as preventive measures, common alternative techniques should be considered - yoga, acupuncture, acupressure, manual procedures. Don’t also forget: proper nutrition and lifestyle are an effective measure to prevent migraine attacks caused by neurological causes.

Headache attacks - complicated migraine. Migraine of the lower half of the face

Migraine of the lower half of the face

L.G. Erokhina (1973) calls it facial migraine.

The nosological independence of this rare form has not been fully determined, and the pathophysiological mechanisms are not entirely clear.

In typical cases, we are talking about periodically recurring attacks of throbbing pain in the lower half of the face, which can spread to the orbital area, temple, neck and the entire half of the face.

The duration of the attack ranges from several hours to 1-3 days. The fact that the disease belongs to migraine is emphasized by many facts. In the family history of these patients there are indications of neurocirculatory dystonia or other vascular diseases. The disease begins more often in the first and second decades of life. As with migraine, it is possible to establish a number of factors that provoke an attack.

The behavior of patients during an attack is typical: they avoid bright lighting, loud sounds, try to go to bed and fall asleep. The attack is accompanied by nausea, paleness of the skin and pastiness of the face, and sometimes the mouth. It is possible to palpate the painful, tense branch of the external carotid artery on the face (Fig. 5.10), improvement occurs with treatment with antimigraine drugs. The combination of all these symptoms facilitates diagnosis.

However, if there is no corresponding family history, characteristic paroxysmalness and periodicity, if anti-migraine drugs do not help, then diagnosis causes great difficulties. T. Fay (1932) identified such vascular pain in the facial area as atypical facial neuralgia, vascular pain syndrome, and J.A. Higler (1949) proposed the name "carotidynia".

According to the observations of J.W. Lance (1978), carotidynia can manifest itself in 2 forms. In some cases, the disease begins acutely in young and middle age, the pain, initially pulsating, can become burning, the localization of pain corresponds to the distribution of the branches of the external carotid artery.

Typically, the most intense pain is limited to a smaller area: the cheek area, submandibular or zygomatic region. Palpation of the carotid artery is painful, especially near the bifurcation area, and can increase facial pain. The intensity of the pain fluctuates. Sometimes it lasts 2-3 weeks, and then gradually goes away and, as a rule, does not recur.

It is believed that this is a disease of an infectious-allergic nature, although it is not accompanied by fever and changes in the blood. The effectiveness of hormonal therapy has not been proven; symptomatic treatment with analgesics is usually carried out.

Another form of carotidynia occurs more often in old age, especially in women. Throbbing pain occurs in attacks that last several hours, less than 23 days, they are repeated with a certain frequency 1-2 times a week, a month, every six months.

At the beginning of an attack, throbbing pain is often localized in the lower part of the face, on the neck near the lower jaw; as the attack unfolds, the pain spreads to half the face, to the temporal region, and can become burning, similar to sympathalgia. The external carotid artery is painful on palpation, tense, and pulsates intensely. The soft tissue around it is swollen or pasty.

Electrical irritation of the carotid artery in the neck responds with radiating pain in the temple, eye, cheek, and sometimes the entire half of the head. The similarity with migraine affects not only the paroxysmal nature, frequency and nature of the pain, but also the effectiveness of anti-migraine drugs.

In the domestic literature, such facial pain is described under the name “carotic-temporal syndrome” [Geimanovich A.I., 1936; Wayne A.M., 1965; Erokhina L.G, 1973]. These authors explain the peculiarities of the pain pattern by damage to the carotid node, nerve and their connections with the autonomic nodes of the IX nerve. V.A. Smirnov (1976), emphasizing the sympathalgic nature of pain, suggests calling this syndrome vegetalgia or sympathalgia of the branches of the external carotid artery.

L.G. Erokhin, under the name “facial angioneuralgia,” describes vascular facial pain syndromes that develop after direct injury to the branches of the external carotid artery. The disease in these patients is manifested by periodic paroxysms of pain. According to rheography, dilatation of the arteries occurs during an attack. V.A. Smirnov does not see significant differences between carotidynia (carotic-temporal syndrome) and facial angioneuralgia [external migraine” according to L. Chavany, 1936].

Since facial angioneuralgia occurs after local injury to the branches of the external carotid artery, it can be assumed that any other hazard (chronic irritation, local inflammation, intoxication) can damage the periarterial plexus and cause vascular pain syndrome.

E.G. Filatova, A.M. Wayne

Department of Neurology FPPO MMA named after. THEM. Sechenov

URL

Migraine (M) has been known to mankind for more than 3000 years. In the papyri of the ancient Egyptians, descriptions of migraine attacks were found, as well as prescriptions of medications used to treat this disease. Despite this, much still remains a mystery in the pathogenesis of M. Practitioners and patients suffering from M do not have a clear idea of whether this disease is curable? What modern medications most effectively relieve a painful migraine attack? Do all patients with M need to be treated and how? Does M have any complications? What symptoms should you pay attention to in a patient with M so as not to miss another life-threatening disease (brain tumor, vascular aneurysm, etc.)?

Migraine is a paroxysmal condition manifested by attacks of pulsating headaches in one half of the head, mainly in the orbital-frontotemporal region, or bilateral localization. The attack is accompanied by nausea, vomiting, photo- and phonophobia. Characterized by recurrence and hereditary predisposition.

Epidemiology

Migraine affects 12 - 15% of the population. It is the second most common type of primary headache after tension-type headache (TTH).

Women experience migraine attacks 2 to 3 times more often than men, but in the latter the pain intensity is usually higher.

A characteristic symptom of migraine headache is its occurrence at a young age, up to 20 years. The peak incidence occurs between 25 and 34 years of age. With age, after the onset of menopause, in half the pain goes away, and in the rest, the pain intensity decreases somewhat. In some cases, M transformation occurs with age: the number of attacks increases, the intensity of pain often decreases, and a background interictal headache appears. Such transformed M acquires a chronic daily character. The most common reasons for this transformation include the abuse factor (abuse of analgesics and other anti-migraine drugs), as well as depression. There are known cases of M in 4-8 year old children (0.07% in the population).

There is a hereditary predisposition. If both parents had M attacks, then the disease occurs in 60-90% of cases, only in the mother - in 72%, only in the father - in 20%. Thus, M is more often inherited through the female line and the presence of a family history is an important diagnostic criterion for the disease.

The criteria for diagnosing migraine were defined by the International Headache Society in 1988.

Paroxysmal headache lasting from 4 to 72 hours.
A headache has at least two of the following characteristics:
- predominantly unilateral localization, alternating sides, less often bilateral;
- pulsating character;
- moderate to severe headache intensity (interferes with daily activities);
- increased during physical activity.
The presence of at least one accompanying symptom:
- nausea;
- vomit;
- phonophobia;
- photophobia.

To make a diagnosis of M without aura, there must be a history of at least 5 attacks that meet the listed criteria. For M with aura, there must be at least 2 attacks that meet these criteria.

Migraine classification

There are two main forms of migraine: M without aura (simple M) and M with aura (associated M). M without aura is manifested by attacks of pain that meet the listed criteria. This is the most common form, observed in 80% of cases. In M with aura, the pain attack is preceded by a migraine aura. An aura is a complex of focal neurological symptoms that precede an attack of pain or occur at the height of pain. The nature of clinical neurological manifestations depends on the involvement of the carotid or vertebral vascular system in the pathological process.

M with aura is characterized by: 1) complete reversibility of aura symptoms; 2) none of the symptoms should last more than 60 minutes; 3) the duration of the light interval between the aura and headache should be no more than 60 minutes. The greatest difficulties arise in the differential diagnosis of migraine aura with transient ischemic attacks (TIA). The frequency of migraine aura, its temporal characteristics, combination with typical migraine headaches and family history of migraine are of utmost importance.

M with aura is found much less frequently than M without aura (20%). Depending on the nature of the focal neurological symptoms that occur during an aura, several forms are distinguished: ophthalmic (classical), retinal, ophthalmoplegic, hemiparetic, aphasic, cerebellar, vestibular, basilar or syncope. More often than others, the ophthalmic form occurs, which is characterized by flashing bright photopsies in the right or left field of vision, possibly with their subsequent loss. The most severe form of M with aura is basilar or syncopal migraine. This form occurs more often in girls during puberty. Focal neurological symptoms are caused by the involvement of the vertebrobasilar vascular system in the pathological process. There is tinnitus, dizziness, paresthesia in the extremities, there may be photopsia in binasal or bitemporal visual fields, and syncope occurs in 30%, as a result of which this form is called syncope.

A special form of M is vegetative or panic migraine, identified by A.M. Wayne in 1995. In this form, a migraine attack is combined with a panic attack. The disease occurs in patients with affective disorders of an anxiety-depressive nature. The attack begins with a typical migraine attack, it provokes fear (panic), tachycardia, hyperventilation disorders, a possible rise in blood pressure, the appearance of chill-like hyperkinesis, general weakness or lipothymia, polyuria. Panic M is diagnosed when three or more panic-associated symptoms are present in any combination. Panic-associated symptoms are “secondary” in timing to the headache. Headache fully complies with the definition and diagnostic criteria of M. According to our data, the prevalence of “panic” M among other clinical forms of M is about 10%.

There are three phases during a migraine attack. The first phase: prodromal (in 50 - 70%), occurs in all forms of migraine in the form of changes in the emotional state, performance, etc. In M with aura, manifestations depend on the type of aura that is associated with the vascular basin. Second phase: headache with all its features and accompanying symptoms. The third phase is characterized by a decrease in headache, lethargy, fatigue, and drowsiness. Some patients experience emotional activation and euphoria.

"Danger signals" for migraines

They should always be remembered when analyzing a migraine attack and the criteria for its diagnosis. These include:

No change in the “painful side”, i.e. the presence of hemicrania for several years on one side.
A patient with M suddenly (in a fairly short time) develops other, unusual in nature, constant headaches.
Progradiently increasing headache.
The occurrence of a headache (outside of an attack) after physical exertion, strong stretching, coughing or sexual activity.
An increase or appearance of accompanying symptoms in the form of nausea, especially vomiting, temperature, stable focal neurological symptoms.
The appearance of migraine-like attacks for the first time after 50 years.

“Danger symptoms” require a detailed neurological examination with neuroimaging (CT, MRI) to exclude an ongoing organic process.

Factors that provoke a migraine attack

M is a hereditary disease, the course of which (the frequency and intensity of attacks) is influenced by a number of different external and internal factors.

The most important are psychogenic factors: emotional stress, release after positive or negative emotions. It has been noted that people with certain psychological characteristics suffer from M: they are characterized by a high level of aspirations, high social activity, anxiety, and good social adaptation. It is these personal qualities that allow people suffering from M to achieve remarkable success in life. It is known that many outstanding people suffered from M: Carl Linnaeus, Isaac Newton, Karl Marx, Sigmund Freud, A.P. Chekhov, P.I. Tchaikovsky and many others.

Patients with M often note increased meteosensitivity, and changes in weather conditions can provoke a migraine attack in them.

Physical activity, especially extreme physical activity and combined with emotional stress, is also a provocateur of M.

Irregular meals (fasting) or consumption of certain foods can initiate a painful migraine attack in people suffering from M. Approximately 25% of patients associate the occurrence of an attack with eating food rich in tyramine (cocoa, chocolate, nuts, citrus fruits, cheese, smoked meats, etc.). d.). The amino acid tyramine binds to the enzyme monoamine oxidase (MAO) and causes changes in vascular tone (angiospasm). In addition, tyramine competes with the precursor of serotonin, tryptophan, preventing its entry into neurons and thus reducing the synthesis of serotonin in the central nervous system. Alcohol (especially red wine, beer, champagne) and smoking are also provocateurs of a migraine attack.

The influence of female sex hormones on the course of M is well illustrated by the fact that in 60% of women attacks occur on premenstrual days, and in 14% they occur only before or during menstruation - menstrual migraine.

Deviations from the usual sleep formula increase the frequency of M attacks. The trigger can be either lack of sleep or excessive sleep. Patients who manage to fall asleep during an attack relieve headaches in this way. Special studies conducted by our employees have shown that there is a sleep migraine when an attack occurs during night sleep, namely in the most active phase of sleep - REM sleep. During this phase, a person dreams, which is accompanied by activation of vegetative parameters, biochemical and hormonal changes. M of wakefulness occurs in the most active stage of wakefulness - intense wakefulness. More than half of the patients experience M both during sleep and wakefulness.

Complications of migraine

Complications of M include status migraine and migraine stroke.

Status migraine is a series of severe, successive attacks, accompanied by repeated vomiting, with clear intervals of no more than 4 hours, or one severe and prolonged attack, lasting more than 72 hours, despite the therapy. Status migraine is a serious condition that usually requires hospital treatment.

The risk of stroke in patients suffering from M without aura is no different from that in the general population. In M with aura, this relationship is different: cerebral stroke occurs 10 times more often than in the population. In migraine stroke, one or more aura symptoms do not completely disappear after 7 days, and neuroimaging studies show a picture of an ischemic stroke. Thus, only with M with aura there is an increased risk of migraine stroke, which is why each attack of M with aura must be promptly and effectively stopped.

Pathogenesis of migraine

The pathogenesis of M is extremely complex, and many of its mechanisms are not fully understood. Modern researchers believe that cerebral mechanisms are leading in the occurrence of a migraine attack. In patients with M, it is assumed that there is a genetically determined limbic-stem dysfunction, leading to a change in the relationship between the anti- and nociceptive systems with a decrease in the influence of the latter. Before an attack, the level of brain activation increases, followed by a decrease during a painful attack. At the same time, the trigeminovascular system is activated on one side or the other, which determines the hemicranial nature of the pain. In the perivascular endings of the trigeminal nerve, when activated, vasoactive substances are released: substance P, calciotonin, causing a sharp dilation of blood vessels, impaired permeability of the vascular wall and initiating the process of neurogenic inflammation (release of nociceptive substances into the perivascular space from the vascular bed: prostaglandins, bradykinins, histamine, serotonin and etc.). The special role of serotonin in M. is known. Before an attack, platelet aggregation increases, serotonin is released from them, which leads to a narrowing of large arteries and veins and dilation of capillaries (the most important factor in the development of the 1st phase of an attack). Subsequently, due to the intensive release of serotonin by the kidneys, its content in the blood decreases, which, together with other factors, causes dilatation and atony of blood vessels. Pain in M, therefore, is a consequence of excitation of the afferent fibers of the trigeminal nerve, as a result of the release of a number of biologically active nociceptive substances involved in the formation of neurogenic inflammation. This process is cyclical, in its genesis the leading role belongs to cerebral mechanisms.

Migraine treatment

Significant advances achieved in the study of the pathophysiology of M serve as the basis for modern pharmacotherapy of migraine cephalgia. Treatment of M consists of arresting the attack and preventive treatment in the interictal period. A migraine attack significantly reduces the quality of life of patients and causes significant economic losses. The main requirements for modern means are efficiency, safety, and speed of action.

Stopping an attack

To relieve migraine attacks, 3 groups of drugs are used:

1st group. For mild and moderately intense attacks, paracetamol, acetylsalicylic acid (ASA) and its derivatives, as well as combination drugs: sedalgin, pentalgin, spasmoveralgin, etc. can be effective. The action of this group of drugs is aimed at reducing neurogenic inflammation, suppressing the synthesis of pain modulators (prostaglandins , kinins, etc.), activation of antinociceptive mechanisms of the brain stem. When using them, it is necessary to remember the contraindications to the prescription of ASA: the presence of diseases of the gastrointestinal tract, a tendency to bleeding, increased sensitivity to salicylates, allergies, as well as the possibility of developing abuse headaches with prolonged and uncontrolled use of these drugs.

2nd group. Dihydroergotamine preparations have a powerful vasoconstrictor effect, due to their influence on serotonin receptors localized in the vascular wall, they prevent neurogenic inflammation and thereby stop a migraine attack. Dihydroergotamine is a non-selective serotonin agonist and also has dopaminergic and adrenergic effects. In case of overdose or hypersensitivity to ergotamine drugs, chest pain, pain and paresthesia in the extremities, vomiting, diarrhea (phenomena of ergotism) are possible. Dihydroergotamine nasal spray has the least side effects. The advantage of this drug is its ease of use, speed of action and high efficiency (75% of attacks are stopped within 20 - 45 minutes).

3rd group. Selective serotonin agonists (zolmitriptan, sumatriptan). They have a selective effect on serotonin receptors of cerebral vessels, preventing the release of substance P from the endings of the trigeminal nerve and neurogenic inflammation.

Sumatriptan is used in tablet (100 mg tablets) and injection forms of 6 ml subcutaneously. The effect occurs within 20 - 30 minutes; the most severe attacks are stopped within a maximum of 1 hour.

Zolmitriptan belongs to the second generation of selective serotonin agonists. The drug, in addition to its peripheral effect, which consists in narrowing the vessels dilated during a migraine attack and blocking pain impulses at the level of trigeminal nerve afferents, also has a central effect. The latter is achieved by influencing the interneurons of the brain stem, due to the penetration of the drug through the blood-brain barrier. The advantages of zolmitriptan compared to other triptans are: 1) higher clinical efficacy when taken orally; 2) faster achievement of the therapeutic level of the drug in the blood plasma; 3) less vasoconstrictor effect on the coronary vessels. Zolmitriptan is used in 2.5 mg tablets.

Side effects of serotonin receptor agonists: a feeling of tingling, pressure, heaviness in different parts of the body, facial flushing, fatigue, drowsiness, weakness.

Drugs of groups 2 and 3 are currently the basic drugs used to relieve migraine attacks.

Preventive treatment during the interictal period

Preventive treatment in the interictal period is carried out for patients with a frequency of attacks 2 or more times per month. In this case, a course of treatment lasting 2-3 months is necessary. For patients suffering from infrequent migraine attacks, preventive therapy is not indicated. The main goal of preventive treatment is to reduce the frequency of attacks, reduce their intensity and generally improve the quality of life of patients. The task of curing M is incompetent due to the hereditary nature of the disease.

For preventive therapy, non-drug methods are used, as well as various pharmacological agents. Non-drug methods include a diet limiting foods containing tyramine; gymnastics with an emphasis on the cervical spine; massage of the collar area; water procedures; acupuncture; post-isometric relaxation; biofeedback.

Drug preventive treatment of M includes drugs of various pharmacological groups, which are individually selected for each patient, taking into account provoking factors, concomitant diseases, emotional and personal characteristics, as well as pathogenetic factors of M. The most widely used are b-blockers (propranolol, atenolol, etc.); calcium channel blockers (nimodipine, verapamil); antidepressants (amitriptyline, etc.); serotonin antagonists (methysergide, peritol). It is possible to use small (antiplatelet) doses of ASA (125 - 250 mg daily); in older patients, good results are achieved by prescribing nootropic drugs (pyritinol, etc.); in the presence of allergies, antihistamines are recommended. The presence of muscular-tonic or myofascial syndrome in the pericranial muscles and muscles of the upper shoulder girdle on the favorite side of pain necessitates the administration of muscle relaxants (tizanidine, tolperisone), since activation of the trigger can provoke a typical migraine attack.

The most effective prevention of migraine cephalalgia is a combination of non-drug and medicinal treatment methods. Effective and safe relief of migraine attacks in combination with preventive therapy in patients with frequent attacks can significantly improve the quality of life of patients suffering from this hereditary disease.

Vein A.M., Avrutsky M.Ya. Pain and pain relief. M. Medicine. 1997; 277 p.
Vein A.M., Kolosova O.A., Yakovlev N.A., Karimov T.K. Headache. M. 1994; 286 pp.
Vein A.M., Kolosova O.A., Yakovlev N.A., Slyusar T.A. Migraine. M. 1995; 180 pp.
Vein A.M., Voznesenskaya T.G., Danilov Al. B. Effect of aspirin on CNF in healthy subjects. Journal of neuropathology. and a psychiatrist. 1995; 4:45-6.
Osipova V.V. Treatment of migraine and cluster headache with sumatriptan. Journal of neuropathology. and a psychiatrist. 1996; 3:100-4.
Solovyova A.D., Filatova E.G., Vein A.M. Treatment of acute migraine attacks with digidergot - a nasal aerosol. Journal of Neurology. and a psychiatrist. 1999; 2:21-4.
Diener H.C., Ziegler A. Medikamentose Migraineiprophylaxe. Der Schmerz. 1989; 3:227-32.
Olesen J. Larsen B. Focal hyperemia followed by spreading oligemia and impaired activation of CBF in classic migraine. Ann. Neurol. 1991; 238:23-7.
Olesen J. Clinical and pathophysiological observations in migraine and tension-type headache explained by integration of vascular, supraspinal and myofascial inputs. Pain. 1991; 46:125-32.
Ziegler K.D. The Treatment of Migraine./Wolff""s Headache and other Headpain. New York, Oxford. 1987; .87-111.

Medicines Index

Serotonin receptor agonists -
Zolmitriptan: ZOMIG (Zeneca)
Sumatriptan: IMIGRAN (Glaxo Wellcome)

Non-steroidal anti-inflammatory drugs -
Ketoprofen: KETONAL (Lek)

Muscle relaxants -
Tolperisone: MYDOCALM (Gedeon Richter)

Nootropic drugs -
Pyritinol: ENCEPHABOL (Merck)

Combined nootropic drug -
INSTENON (Nycomed)