According to the WHO , World Health Organization, migraine is the most common disorder in the world and one of the most disabling.
From the Greek hemikranìa (pain on one side of the head), migraine is an episodic headache with generally unilateral and throbbing pain. It can last from 4 to 72 hours and can be accompanied by symptoms such as nausea, hypersensitivity to light, sounds or smells. Although it can be a telltale for something wrong, such as when we sleep little or have a fever, headache is most often a primary headache , without demonstrable cause, a kind of pain free .
More frequent in the female sex , it is probably connected to the presence of a hereditary factor and its pathogenesis is not yet fully understood. Migraines commonly occur during puberty or young adulthood , varying in frequency and intensity over the following years and decreasing after 50 years. Migraines exist with or without aura, about 25% of cases, and can be preceded by aura . The aura consists of temporary and reversible abnormalities of vision, sensitivity, balance, muscle coordination or speech. It can be for few minutes to an hour. Therefore, in these cases you may see flickering, twinkling or flashing lights or a dark spot with undefined edges .
Migraine treatment is predominantly pharmacological. In fact, there are preventive drug treatments to be used when attacks of headaches are particularly frequent and / or lasting (to reduce the frequency, intensity and duration of headaches).
Migraine: what it is
Migraine is a type of headache (primary headache) which is characterized by a unilateral pain or bilateral , which may last from 4 to 72 hours and may be associated with signs and autonomic symptoms such as:
- He retched
- photophobia and phonophobia (annoyance to light and noise).
In addition, the pain is throbbing , of medium strong intensity and disabling The seizures can last even a few days, significantly affecting the quality of life .
Thus, the term ” headache” a localized pain in the head . It is a very frequent symptom, with a high incidence in the population and, in most cases, it is harmless. It may be secondary to an underlying pathology, but generally presents itself as an occasional symptom or, if the episodes are repeated over time, as a clinical correlate of a primary cephalalgic syndrome. Therefore, it is essential to recognize the alarm bells and, if a secondary nature is suspected, carry out thorough diagnostic investigations.
In Italy, migraine affects about 50% of the population its impact, therefore, is significant and not only on the individual, but on the whole society in terms of direct and indirect costs (lost working days and medical expenses).
The stages of migraine
Can Migraine Be Cured? No, but you can check it out. In fact, the migraine attack is generally preceded by headaches or the manifestation of an aura.
In fact, it is characterized in 4 phases , not always present in all subjects, in which the first, the ” prodrome ” phase , takes on a certain importance, since knowing how to recognize it can help prevent the subsequent phases. So, this phase is characterized by a particular symptomatology such as:
- feeling hungry (craving for certain foods in particular)
- widespread tired feeling
- drop in mood
It can occur between 2 and 48 hours before the aura and / or before the onset of a headache attack.
If in the Assyrian-Babylonian civilization “demons of the head” were cursed, the Egyptians used exorcisms and magic formulas and, in the most serious cases, the trepanation of the skull to make evil spirits escape .
In addition, the medical papyrus of Ebers (ca. 1550 BC) advised to cook the head of a catfish fish in oil and to spread the ointment thus obtained on the head for a few days. But it was Hippocrates , in ancient Greece, who first described the visual disturbances that sometimes precede a migraine attack. As a remedy he recommended the use of a powder extracted from the willow bark , and in this he was truly forward-looking as the salicitates are anti-inflammatory substances.
But, in the following centuries, the most followed theory was the “humoral” one , according to which every alteration of health depended on the imbalance of the brain, blood, spleen and liver.
In fact, migraine was believed to be caused by the excess bile that accumulated in the liver, blood and stomach. So, the cure then consisted of taking laxatives to rid the body of excess bile.
In the seventeenth century the English anatomist Thomas Willis sensed that the headache arose from a “traffic jam” of the cerebral blood vessels caused by various causes (such as cold, too much sun, binges) and that it was associated with symptoms such as:
- increased hunger
- He retched
- polyuria (abundant urine).
So, for this reason, patients were forbidden to consume wine, spiced meats, take baths and have sex. The “violent disturbances of the mind and body” were also prohibited, instead recommending “enemas, bloodletting, decoctions” and even a juice of centipede and well mixed moth.
Numerous epidemiological studies show that migraine affects about 15-18% of women and 6% of men throughout life, with a peak of prevalence between 25 and 55 years .
A study published in the Journal of 2017 Neurological Science , conducted by researchers at Stanford University School of Medicine in Palo Alto, United States, reports the following results:
- overall prevalence of migraine is 11.6%
- prevalence by continent is 10.4% in Africa , 10.1% in Asia , 11.4% in Europe , 9.7% in North America , 16.4% in Central and South America
- at the demographic level, the prevalence is 13.8% among women , 6.9% among men , 11.2% among urban residents , 8.4% among rural residents , 12.4% among students
- historical data shows the tendency to increase prevalence globally.
In summary, therefore the study indicates that:
about one in ten people suffer from migraines, with significant fluctuations especially in the American continent.
In addition, the disorder mainly affects women, students and residents in urban areas, for reasons allegedly related to biological factors and lifestyles.
Migraine without aura
It is a very common form that affects about 12% of the general population and is three times more frequent in the female sex. This prevalence gradually increases from 12 to 40 years, an age beyond which there is a progressive decrease. Therefore, it is a pathology of young age that in the majority of cases occurs within 30 years.
It is characterized by a symptomatic triad , with pain, neurovegetative symptoms and hypersensitivity to sensory stimuli. It generally presents with recurrent and disabling attacks of throbbing pain, of intensity and duration varying from 4 to 72 hours if left untreated. But, it can also be accompanied by symptoms such as photophobia, phonophobia, nausea and vomiting. In about half of the cases, the localization of pain is bilateral or variable, just as the pain may not be pulsating .
Migraine with aura
Migraine attacks with aura, in about 20% of cases, are preceded by transient neurological symptoms (migraine aura).
The frequency of attacks is more irregular than aura without migraine, with even very long periods of remission; generally the two forms can coexist.
But, there are then particular types of aura, such as the trunk-encephalic and hemiplegic one. In the first case, the symptoms can be :
- hearing loss
- reduced level of consciousness.
Instead, hemiplegic migraine is also characterized by a fully reversible motor deficit over 72 hours.
Other forms of migraine
It is a form of migraine characterized by at least 15 headache days per month (of which at least 8 migraine days) for at least 3 consecutive months.
It is characterized by one-sided pain attacks , high intensity in the orbital, supra-orbital and / or temporal area (the area of the skull between the eye and ear) which can last from 2 to 30 minutes. Hence, the frequency of attacks is usually above five per day.
It is a rare syndrome characterized by attacks of unilateral, orbital, supra-orbital or temporal pain, of the transfectional type, and can last from 5 seconds to 10 minutes. The frequency of attacks is generally high and the therapy is only preventive, since the attacks are too short in duration to be treated with drugs.
It is a unilateral persistent headache , with moderately intense daily and continuous pain for at least 3 months. In addition, it can be accompanied by symptoms such as:
- nasal congestion, and / or miosis (pupil narrowing).
Complete remission is achieved only with adequate doses of indomethacin.
Other primary headaches
These are clinically heterogeneous headaches, which develop for reasons that are still not well known.
They mainly include: cough headache, physical activity, associated with sexual activity , cold stimulus and external pressure. In some forms the pain can be especially acute .
Migraine: causes and risk factors
Migraine is a clinically heterogeneous pathology in which a genetic and therefore hereditary component can interact with triggering environmental factors.
- changes in sleep-wake rhythm
- psychological stress alterations
- environmental factors (climatic variations, altitude, exposure to intense light, etc.)
- taking medications (oral contraceptives, antihypertensives, etc.)
- psychophysical stress
- hormonal fluctuations
- irregularities in meals
- intake of particular foods or alcoholic beverages.
Given the prevalence of migraine in women, hormonal factors often play a decisive role. In fact, generally, migraine crises coincide with the ovulation phase or with the menstrual cycle. During puberty (when estrogen levels rise) migraines become much more frequent among girls than boys, while they become less intense in the last trimester of pregnancy , when estrogen levels are relatively stable.
Furthermore, oral contraceptives seem to worsen the course of the pathology and increase the risk of stroke in women who suffer from migraine with aura. Generally menopause involves an improvement in the frequency and intensity of seizures.
In migraines, throbbing or throbbing pain is usually felt on one side of the head but can also occur on both sides. And it can be moderate but also serious and disabling. In addition, physical activity, intense light, loud noises and some smells can aggravate pain. In fact, the increased sensitivity forces many people to stay in the dark , to lie down and if possible to sleep. Migraines typically pass during sleep.
Symptoms in migraine without aura
The symptoms that accompany the migraine crisis, particularly related to hypersensitivity to environmental stimuli, are very frequent (in more than 80% of cases) and represent a disorder as unbearable as pain. Those affected, tend to remain still, relaxed and in the dark, avoiding any environmental , auditory, visual or olfactory stimulus .
At the end of the migraine attack, feelings of exhaustion, irritability, difficulty concentrating or, on the contrary, euphoria and hyperactivity, may occur.
Migraine should be considered a chronic pathology , although with episodic manifestations, which presents comorbidity with other neurological diseases such as cerebrovascular , psychiatric, autoimmune disorders, other algic syndromes and epilepsy.
Symptoms in migraine with aura
Symptoms develop gradually over 5-20 minutes up to a maximum of 60 minutes and are completely reversible .
The typical aura is made up, in the majority of cases, of visual symptoms such as an initial sparkling scotoma , that is, a small bright monochromatic or multicolored dot that expands like wildfire, sometimes involving a large part of the visual field. In other cases the visual perception can be distorted , for example mosaic or as if it were filtered by a frosted glass.
All visual disturbances can be followed by sensory symptoms such as paresthesias (altered sensitivity of the limbs or other parts of the body), such as tingling or pinpricks. Instead, sometimes, a speech disorder can also arise . Symptoms such as blurred vision, loss of visual field and hypoaesthesia (partial or total decrease in tactile, thermal or pain sensitivity) are generally rarer.
The progression of symptoms is called “migraine march”.
Migraine complications are quite rare and consist mainly of:
a completely disabling state that lasts for more than 72 hours
migraine infarction (when an ischemic stroke occurs with the typical characteristics of the attack of migraine with aura in an individual who is affected)
The diagnosis of migraine is essentially clinical. Diagnostic tests such as Computed Tomography (CT) or Magnetic Resonance Imaging are not necessary, but in the presence of atypical symptoms and if the results of the physical examination (which includes a neurological examination) are altered become necessary.
- Changes in sensitivity or vision, sudden loss of strength, loss of coordination, convulsions, difficulty in speech, excessive sleepiness, confusional state or altered state of consciousness
- fever and cervical stiffness, which makes it painful or sometimes impossible to flex the chin towards the chest
- sudden and intense headache (thunderclap headache)
- pain in the temples or pain in the jaws when chewing
- presence of a neoplasm or immune system disorder
- use of immunosuppressant drugs
- weight loss
- eye redness and vision of halos around the lights.
Diagnostic criteria in migraine without aura
A. AT LEAST 5 ATTACKS THAT MEET B-D CRITERIA
B. HEADACHE LASTS 4-72 HOURS (UNTREATED OR UNSuccessfully TREATED)
C. HEADACHE PRESENTS AT LEAST TWO OF THE FOLLOWING CHARACTERISTICS:
1. UNILATERAL LOCALIZATION
2. PUSH BUTTON TYPE
3. PAIN WITH MEDIUM INTENSITY 0 STRONG
4. AGGRAVATED BY 0 THAT LIMITS THE PHYSICAL ACTIVITIES OF —- ROUTINE (eg WALKING, CLIMBING THE STAIRS)
D. AT LEAST ONE OF THE FOLLOWING CONDITIONS IS ASSOCIATED WITH THE HEADACHE: 1. PRESENCE OF NAUSEA AND / OR VOMITING ‘0 \ 2. PRESENCE OF PHOTOPHOBIA AND PHONOPHOBIA
E. NOT OTHERWISE SPECIFIED BY ANOTHER DIAGNOSIS
If the crisis is not treated, the intensity of the pain is often so strong that it does not allow you to carry out normal daily activities , also due to the increase in pain during physical activity or movement in general.
Also, warning symptoms such as mood swings or behavioral changes (irritability, euphoria, depression, hyperactivity, apathy) or other symptoms such as:
- difficulty concentrating
- olfactory sensitivity
- loss of appetite.
Diagnostic criteria in migraine with aura
A. AT LEAST 2 ATTACKS III GIVES THE B-D CRITERIA
B. AURA CHARACTERIZED BY AT LEAST ONE OF THE FOLLOWING SYMPTOMS, IN THE ABSENCE OF MOTOR DEFICIT:
1. VISUAL SYMPTOMS COMPLETELY REVERSIBLE, POSITIVE (SUCH AS FLASHING LIGHTS, STAINS, LINES) AND / 0 NEGATIVE (FOR EXAMPLE LOSS OF THE VISUS)
2. SENSITIVE SYMPTOMS COMPLETELY REVERSIBLE, POSITIVE (FOR EX. “PIN STINGS”) AND / 0 NEGATIVE (FOR EXAMPLE HYPESTHESIA)
3. DISORDERS OF PARMA AND / 0 OF THE LANGUAGE
4. MOTOR DISORDERS
5. DISORDERS OF THE BRAIN TRUNK
6. RETINICAL DISORDERS
C. AT LEAST TWO OF THE FOLLOWING 4 CHARACTERISTICS:
1. AT LEAST ONE SYMPTOM OF LAURA GRADUALLY DEVELOPES IN 5 MINUTES AND / 0 2 0 PIO SYMPTOMS MANIFEST IN SUCCESSIONS
2. EVERY INDIVIDUAL SYMPTOM OF AURA LASTS 5-60 MINUTES
3. AT LEAST 1 SYMPTOM OF LAURA AND UNILATERAL
4. LAURA IS ACCOMPANIED, 0 FOLLOWED WITHIN (60 MINUTES, BY THE CURLER
D. NOT OTHERWISE SPECIFIED BY ALMA DIAGNOSIS ICHD-3 AND A TIA WAS EXCLUDED
Migraine: cures and therapy
Migraine therapy involves the use of defined symptomatic drugs , to be taken during the actual migraine attack, in order to decrease or eliminate the symptoms, and a prophylactic therapy that the patient takes daily , for a variable time, but not less than 3 months. So the goal is:
- decrease the frequency of attacks, their intensity, duration and impact on quality of life
- improve the effectiveness of symptomatic therapy by acting synergistically.
Symptomatic therapy involves taking analgesics , nonsteroidal anti-inflammatory drugs (NSAIDs) and specific therapies for migraine, such as triptans; finally adjuvant therapies such as those for gastrointestinal disorders.
Medicines and side effects
The drugs most used for the pharmacological treatment of acute migraine attack.
Simple analgesics and NSAIDs
They work by inhibiting the synthesis of prostaglandins and reducing pain and inflammation in all processes with tissue damage. Hence, they are nonspecific drugs for migraine, but if used correctly they can be a valid resource for mild attacks , in very young patients or in case of intolerance or ineffectiveness of triptans. The most used are:
Side effects . The most common are epigastric pain and diarrhea. The NSAIDs are contraindicated in those who suffer from gastritis or peptic ulcer disease and those who take anticoagulants.
They are specific drugs for migraine and act both at the level of the central and peripheral nervous system. Particularly suitable drugs for migraine attacks and multiple attacks , even in the long term, are to be considered. These drugs, due to their peculiar mechanism of action, act not only on pain, but also on associated symptoms (photo-phonophobia, nausea and vomiting) and on functional disability in general. The most used drugs are:
- zolmitriptan nasal spray
Side effects . They are contraindicated in people at risk of cardio or cerebrovascular disease and in hypertensive subjects. In addition, they can cause:
- sense of mild and transient thoracic constriction.
They can be used effectively to reduce neurovegetative symptoms (tachycardia, tremor, sweating, etc.), sometimes disabling, associated with a migraine attack. The most used are:
Side effects . The main side effect is sedation and the appearance of effects on the extrapyramidal system (alteration of posture, balance, muscle tone, etc.), for this reason they must be used with caution.
Migraine: diet and nutrition
The migraine / nutrition association does not have certain scientific evidence, however resorting to proper nutrition to prevent and alleviate the symptoms of migraines is an ancient practice. In fact, Hippocrates already knew the relationship between the use of certain substances and the onset of migraine. So some foods, due to the presence of certain nutrients, can cause migraines.
It is ascertained that in the migraine attack there are two phases , one of intracranial vasoconstriction and one of extracranial vasodilation, with the release of some substances such as serotonin, histamine, various prostaglandins and neuropeptides. So, for this reason, predisposed people should avoid foods that contain these substances or that induce their release into the blood.
Migraine: foods to avoid
• COFFEE: THE DAILY CONSUMPTION OF TOO MANY CAfft, FOR EXAMPLE, IS NOT INDICATED, BECAUSE THE CAFFEINE CONTAINED NOT ONLY IN THE COFFEE, BUT ALSO IN SOME DRINKS 0 IN THE CHOCOLATE, IT TENDS TO STIMULATE THE NERVOUS SYSTEM AND, THEREFORE, THEREFORE INSURANCE OF MIGRAINE.
• COLD DRINKS, ICE CREAM, GRANITE, FCC .: COLD, STIMULATING THE NERVOUS TERMINATIONS OF THE PALATE, CAN PROMOTE THE APPEARANCE OF A MIGRANIC ATTACK.
• ALCOHOLIC BEVERAGES: INDEPENDENTLY OF THEIR GRADATION, THEY MUST BE CONSUMED WITH MODERATION, BECAUSE THEY CAUSE VASODILATION. THEN THEY CONTAIN FERMENTATION PRODUCTS, SUCH AS HISTAMINE,
• FOODS FROM COMPLEX DIGESTION: CITRUS FRUITS, ONIONS, , OLIVES IN BRINE, DRIED FRUIT IN THE SHELL, HOT BREAD AND PIZZA (JUST FILLED), MATURE BANANAS, FRIED, FISH, DRIED SALT. ANGIE MILK, YOGURT AND Sour cream SHOULD BE CONSUMED WITH CARE.
Furthermore, it is good to pay attention also to some substances contained in food: in particular to nitrates used to store salami and sausages, to the tyramine present in aged cheeses, to sodium glutamate used in broth nuts and in ready-made soups or in Chinese cuisine , to the tannins of red wine.
Since food sensitivity is subjective, migraine or headache sufferers should pay attention to the possible correlations between the onset of symptoms and the previous meal , to identify exactly the foods that cause or aggravate the attacks.
The general indications are however those of a balanced diet avoiding too much salt and periodically associating vitamins and minerals with the diet.
Natural cures and migraines
To soothe migraine attacks, there are a number of natural remedies or cures that can ease pain and relieve related symptoms. However, there is no scientific evidence in this regard. Here are some in summary:
There are soothing plants suitable especially for stress migraines .
These include the feverfew , whose flower resembles that of chamomile, which has an anti-inflammatory effect and relieves symptoms such as nausea and sensitivity to light. Even the ginger root is known to relieve pain.
According to some studies, ginger would be able to block prostaglandins , the molecules that trigger inflammation and which are, in part, responsible for headaches. In addition, Bach flowers are also very useful to choose based on the type of migraine and the symptoms.
Aromatherapy and essential oils
To relieve migraine, the following essential oils are particularly suitable:
- orange oils
A good way to relieve headaches is to massage with lavender essential oil and mint oil . In fact, lavender has sedative and relaxing properties while mint has a natural analgesic effect, also useful for dissolving muscle contractures.
To balance the nervous system, supplements that contain magnesium and vitamin B6 are useful . Studies have shown that a coenzyme Q10 supplementation can help fight migraine and related symptoms like nausea naturally .
Other treatments to treat migraine
According to US researchers at Duke University, the ‘ Acupuncture seems to be very effective in the treatment of migraines, especially those due to muscle tension. Even official medicine is acknowledging that this technique is even more effective than pain relievers taken to calm chronic and acute pain . In addition, it does not have the side effects that the drugs have and its effects are long lasting.
According to some research, the feather pillow is the least suitable for fighting migraines. The best seems to be a pillow containing buckwheat chaff instead .
In fact, in Japan it has been used for centuries to relieve pain and they are very common. This pillow, covered with cotton, is a valid remedy to relieve muscle tension and to allow relaxation . It does not heat up in contact with the body and does not absorb moisture as most used cushions do. In addition, buckwheat chaff is a durable material that does not deteriorate .
An effective method of treating headaches is an abhyanga massage (hot massage) with a particular oil based on sesame oil and medicinal plant extracts. This type of massage is indicated to rebalance the doshas , principles responsible for all the processes of birth, growth, decay and death.
For Ayurveda, there are three forces that determine a person’s psycho-physical balance:
To relieve pain, Vata oil is indicated which helps stimulate circulation , relax the nervous system, calm headaches.
Sports and physical activity
Physical activity if done regularly can definitely be a good antidote to migraine . In fact, the increased supply of oxygen, the reduction of the dilation of the cerebral blood vessels and the increase of muscle elasticity in the neck and shoulder area are a cure-all for those suffering from migraines . However, prolonged physical exertion should be avoided because they can be counterproductive.
Among the activities recommended by the experts there are pilates , yoga and Qi gong because they help to desensitize pain in the central nervous system. Even the running or cycling can help , because it relieves stress and muscle tension contributing to the release of endorphins which are natural painkillers. Same thing goes for swimming, especially to strengthen the back and neck muscles.
But, yoga , in particular, can reduce the intensity and frequency of migraines as it combines physical positions that strengthen and stretch the muscles with deep breathing, meditation and relaxation.
In case of high frequency and intensity of monthly migraine attacks (at least 3 crises that cause disabilities lasting 3 or more days), or when the response to symptomatic therapy is no longer effective, it is important to support a preventive drug therapy to be taken daily for at least 3 months. It is considered effective when it manages to reduce the number of monthly crises by at least 50% , although any improvement in symptoms in terms of intensity and duration of crises is still positive.
So first-line drugs for preventive therapy are:
- beta blockers
- calcium channel blockers
- tricyclic antidepressants.
Their effectiveness has been widely demonstrated in numerous studies, and is probably related to the stabilization of cortical excitability. However, these drugs can have several side effects such as:
- weight gain or loss
- gait disturbances
- skin rashes
- hematological disorders.
Therefore, continuous medical monitoring is essential .
Beta blockers also represent first choice drugs in the prevention of migraine since they are able to cross the blood brain barrier and develop the anti-migraine effect at the level of the central nervous system. But, among the possible side effects are:
- mood depression.
In addition, they are contraindicated in patients with asthma, diabetes mellitus, marked bradycardia.
Calcium channel blockers
These drugs have an anticonvulsant, modulatory effect on vascular tone and have an inhibitory effect on dopaminergic and serotonergic tone. They are generally well tolerated , but can cause:
- weight gain
- gastrointestinal complaints
- extrapyramidal effects (particularly in elderly subjects).
Therefore, calcium channel blockers should be used under close clinical supervision and for short periods.
Amitriptyline is the first choice antidepressant in the prevention of migraine . It is a substance used in the therapy of different types of chronic pain. Its efficacy on migraine does not appear to be linked to the antidepressant effect of the drug itself, given that the dose used for the prevention of migraine attacks is much lower than that with antidepressant activity. But, among the possible side effects are:
- orthostatic hypotension
- weight gain
- urinary retention
- mental confusion
- cardiovascular disorders.
Recent studies have shown a positive effect of botulinum toxin administration in the cranial muscles of chronic migraine patients.
Recently, anti-CGRP monoclonal antibodies , administered intravenously once a month, have proven extremely effective in reducing the number of migraine episodes in patients with high frequency migraine.
In addition to traditional drugs, the efficacy of alternative therapies such as the administration of magnesium, riboflavin, coenzyme Q10 , has been demonstrated , less effective but with irrelevant side effects.
Other forms of prevention
Knowing how to recognize symptoms allows you to act quickly.
Very useful in this sense is the “headache diary” , in which to record all the symptoms that precede the arrival of the migraine, the triggering factors, the time of day in which the migraine attack appears and all useful information.
With this information, where possible, the triggering factors can be identified and eliminated by helping the doctor to plan and better regulate the therapy.
Finally, it is also advisable to adopt behavioral interventions such as relaxation, biofeedback and stress management to control migraine attacks, especially when stress is a trigger or when too many drugs are taken to control migraines.