Migraine treatment

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Migraines

Migraine, migraine, or migraine  is a complex disorder that is the occurrence of repeated attacks of headache that usually affects one side of the head. What happens before the headache begins, but sometimes it may occur during or after the attack,In fact, migraines are divided into several types, and many of them share the same symptoms, which include: nausea , vomiting, dizziness, sensitivity to light or smells, And sometimes a feeling of numbness and difficulty speaking, and the most prominent of these types can be explained as follows: 

• Migraine with aura: , where the aura is a predictor that predicts the imminent occurrence of a migraine attack, and the symptoms of aura focus on visual disturbances. 

• Migraine without aura: This is the most common type of migraine. Symptoms of a migraine start without prior warning. 

• Other types: The other types of migraine have in common that they are related to a specific disease or cause, and as follows:

1. Chronic migraine: This is the frequency of migraine attacks for more than 15 days a month. 
2. Migraine during menstruation:, where the frequency of migraine attacks is linked to the date of the menstrual cycle .
3.  Hemiplegic migraine, which is temporarily associated with weakness on one side of the body. 
4. Abdominal migraine: This type of headache is more common in children under the age of fourteen, and is characterized by the association of migraine attacks with disturbances in the intestine and abdomen. 
5. Migraine with aura that affects the brain stem:  Although this type of migraine is rare, it affects the nerves and leads to severe symptoms, such as affecting the ability to speak.

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Although the exact underlying cause of migraine attacks is still unknown, many factors may trigger their occurrence, such as various environmental factors, physical factors, psychological and emotional disorders , hormonal changes , and some foods and medications, and it is believed that migraine is caused by the presence of activity. Abnormalities in the brain that affect the way nerves, blood vessels, and chemicals in the brain communicate. The genetic factor may play a role in increasing the person’s sensitivity to various stimuli, In general, migraines may seriously affect the lives of some individuals, preventing them from practicing their normal daily life and making them feel the urgent need to stay at home for several days, but fortunately there are many medicines and treatments available that alleviate the symptoms of a migraine attack. Migraines may get worse over time, but most people with migraines have fewer or no symptoms over several years. 

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Migraine treatment

In fact, there is no cure for migraine per se. Rather, the treatment aims to get rid of the symptoms of migraine attacks and reduce the chance of further attacks in the future, and the affected person may need to try several types of available treatments for this in order to be able to know the appropriate treatment for it, in general. The choice of the most appropriate treatment for migraines depends on the severity of the headache attacks, the extent of their frequency, the extent of their impact on the patient's ability to carry out his daily activities, the extent of their association with the occurrence of symptoms such as nausea and vomiting, and whether the patient suffers from other health problems, and in this context it should be clarified that these treatments Pharmacokinetics is divided into two main types, which can be explained as follows:

• Medicines that treat seizures: , represented by pain-relieving drugs that are taken during a migraine attack in order to relieve or stop symptoms, in addition to other drugs that relieve symptoms associated with the attack. 

• Preventive drugs: , which are taken regularly with the aim of relieving the severity of migraine attacks and reducing their frequency.

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Medicines for seizures

As mentioned earlier, the goal of using anti-seizure medications is to stop a migraine attack as soon as it starts. Therefore, the best time to take these medications is immediately after the symptoms of a migraine attack begin or when it feels close, and the following is an indication of the most important drug groups that are included in the list of painkillers, whether these drugs are prescribed or without a prescription.

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pain killers

Several over-the-counter pain relievers can be used to relieve symptoms of a migraine, such as paracetamol and some nonsteroidal anti-inflammatory drugs, such as ibuprofen and aspirin . These drugs are available in many pharmaceutical forms, including tablets dissolving in water, which have a faster effect because the body absorbs them faster compared to regular tablets, and suppositories that can be used if a migraine attack is accompanied by nausea and vomiting, and it should be noted the importance of adhering to the instructions attached to the medicine regarding Specifies the recommended dose and the period of use; Continuous use of these painkillers may worsen migraine symptoms and cause what is known as a headache resulting from overuse of drugs . In this case, a headache may occur when taking an overuse of analgesic in its usual dose or in an overdose, but fortunately it eases after stopping it.  As for the caveats of using painkillers available without a prescription, it is not recommended to take aspirin by Children under the age of 16 years unless consulting a doctor, and ibuprofen and aspirin are not recommended for people who suffer from stomach, kidney, or liver problems. 

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Sometimes the doctor may prescribe another type of analgesic known as opioid painkillers, such as codeine, which is characterized by its ability to prevent pain signals from forming in the brain and spinal cord,  Where the doctor resort to prescribing analgesics of this group in the event that the pain is more severe and the regular analgesics do not meet the purpose, but when using this type of analgesics for a long time, attention should be paid to the possibility of the development of what is known as Tolerance. That is, the body needs a higher dose than that it takes to obtain the same effect, or the patient may suffer from a condition called physical dependence , which is the body's accustomed to the drug as a result of using it for a long time, which causes side effects when discontinuing Take the medicine suddenly, and it is known as drug withdrawal symptoms, such as diarrhea, nausea, vomiting, muscle pain, and anxiety, and these medicines may also be addictive .

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Tryptans

The doctor may prescribe one of the drugs of the group of Triptans  in the event that analgesics, especially those available without a prescription, fail to relieve migraine pain, in addition to the ability of this group to relieve headache pain, it may contribute to relieving nausea, vomiting, and sensitivity towards Light and sound, triptans are available in many pharmaceutical forms. Such as oral tablets, nasal sprays, and injections, such as Sumatriptan and Naratriptan, and in fact the doctor depends on choosing among them the symptoms of headache and the duration of the headache attack, and it is necessary to point out that these drugs are not prescribed for people exposed At risk of stroke, hypertension, or diabetes, or heart disease, or hypercholesterolemia , or hemiplegic migraine , which is the occurrence of weakness in an entire part of the body, or a migraine accompanied by an aura in the brainstem which is They cause symptoms such as dizziness and problems with the ability to speak, and it is worth noting that triptans interact with some medications and cause serious problems, such as ergotamines, monoamine oxidase inhibitors, and selectiveotonin. reuptake inhibitors); Therefore, it is important to inform the doctor about the drugs used to avoid such problems. n fact, it is believed that the principle of action of triptans depends on reversing the changes that a migraine causes in the brain. For example, tryptans lead to constriction of the blood vessels in the brain that have widened due to a migraine. 

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Antiemetics

Anti-emetic drugs can be used in the treatment of migraine headaches accompanied by aura and associated with the emergence of symptoms of nausea and vomiting, but they may also be effective in treating migraine even if these symptoms do not appear, and usually the doctor prescribes these drugs together with Pain relievers or triptans; It has been found that antiemetics such as metoclopramide and domperidone contribute to the acceleration of bowel movement and thus speed up the absorption of pain relievers, and in this context it is indicated that metoclopramide is not recommended for children and adolescents due to its association with some effects. Side effects that may be dangerous. In addition, this group also includes Prochloroperazine. 

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Dihydroergotamine

Dihydroergotamine is used to treat migraine attacks that have already occurred but has no efficacy in preventing or even reducing their recurrence. Thus, taking dihydroergotamine even two hours after the start of the headache can be effective in Control them, and this drug is available in several pharmaceutical forms. Nasal spray, and intravenous injections that are advised to use in the event of suffering from chronic or difficult-to-treat migraine, and it should be noted that it should not be used by people who suffer from uncontrolled high blood pressure or heart disease , as well as for pregnant women because of what it may cause From birth defects of the fetus. 

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Combined drugs

Combination medicines contain more than one active medicinal substance in the same pill. The medicine may combine a pain reliever with an anti-nausea medicine or a triptan. In fact, some patients find that taking combined medicines is the most appropriate option for them, but combined medicines usually contain reduced concentrations of the medicines that make them. Therefore, it may not be sufficient to relieve the symptoms of migraine for some, and in this case it is recommended to take the medicines separately.Examples of combined medicines available in pharmacies are a medicine that contains paracetamol, aspirin and caffeine, which is safe, and can be bought without the need for a prescription And it is indicated here that caffeine may play a role in enhancing the body's absorption of painkillers, thus achieving better therapeutic results, but continuing to take this drug may be associated with the occurrence of headache after stopping it, and the reason for this is due to caffeine. 

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Preventive medications

One of the best ways to avoid migraine attacks is to avoid triggers. In the event of tension or eating a certain type of food or otherwise, and among other methods that are used as a preventive treatment: Medicines, and as we mentioned earlier, preventive medicines are used in the treatment of recurrent, chronic, or severe migraines that do not respond well to previous treatments ; Because it contributes to reducing the frequency, intensity, and duration of migraine attacks,  In fact, the doctor may prescribe any of the preventive drugs in the event of suffering from four migraine attacks in a month or more, and preventive medicines include the following drug groups:

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Medicines to lower blood pressure

The doctor may prescribe blood pressure lowering medication, specifically some of the beta blockers and calcium channel blockers. As a preventive treatment for migraine with aura, As for beta-blockers, one example is propranolol, which reduces the activity of brain cells that play a role in the occurrence of migraine, but it should be noted that it is not suitable for people who suffer from asthma  and chronic obstructive pulmonary disease ( Chronic obstructive pulmonary disease, diabetes, and some heart problems, as for calcium channel blockers, such as Flunarizine, they block calcium from entering brain cells, making them less responsive to a migraine attack, and they also block dopamine receptors  in the brain. 

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Tricyclic antidepressants

Tricyclic antidepressants are known to be used - especially in the past - in the treatment of depression , but the doctor may prescribe these drugs as a preventive treatment for migraines, especially in cases of migraines accompanied by sleep disorders, as it is believed that tricyclic antidepressants It prevents the re-absorption of serotonin  and norepinephrine , as it may block serotonin receptors. Among the drugs of this group is amitriptyline. The desired amount of amitriptyline may be felt after 6 weeks of daily adherence.

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Anticonvulsants

The doctor may prescribe anticonvulsants or antiepileptics  as a preventative treatment for migraine. Because it contributes to reducing the frequency of migraine attacks, examples of which are Valproate and Topiramate and with regard to the latter, it has been used very widely to treat migraines, and it is worth noting that topiramate may harm the fetus It is used by pregnant women, and it may reduce the effectiveness of hormonal contraception , and to solve this problem, the doctor may resort to replacing the contraceptive method with another that is not affected by topiramate. 

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Other treatments

Other preventive treatments that may be resorted to in the event of migraine include the following:

• Botulinum toxin A: or what is known as botoxIt is a drug derived from a toxin produced by a type of bacteria known as Clostridium botulinum (scientific name: Clostridium botulinum). Where it is used in low doses to treat many problems, including chronic migraine, which did not respond to at least three other preventive treatments, and usually the doctor injects botox in multiple sites around the head and neck, and its effect may last from 3-12 months, but the doctor can give injections Botox again after three months have passed, and in fact it has not yet been clear why botox injections are effective in treating migraines, but in general the principle of botox action is to weaken some muscles or paralyze them, or block the work of some nerves, and it is worth noting that Botox is not Suitable for pregnant or breastfeeding women, and among the most common side effects of these injections: pain, swelling, or bruising at the injection site.

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• Calcitonin gene-related peptide monoclonal antibodies; It is one of the preventive treatments that was developed to treat migraines, and the principle of its work depends on inhibiting the activity of the peptide associated with the calcitonin gene, either by binding to it or by its receptors, which inhibits the occurrence of a migraine attack, as this peptide plays a role in the occurrence of pain and the expansion of cerebral blood vessels, and the bodies are divided Counter to four types of vehicles; Three of them are designed to be injected under the skin once a month, and the fourth, known as Eptnizumab, is designed to be administered intravenously once every 3 months.

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Treatment for menstrual migraine

Migraines associated with menstruation usually begin two days before the menstrual period and last for three days after it. And because it is easy to predict its occurrence, it can be prevented by using hormonal and non-hormonal treatments .

• Non-hormonal treatment: The doctor may prescribe non-steroidal pain relievers and triptans to control migraine attacks associated with menstruation, and you can start taking them two days before or after your period begins and continue taking it until the last day of it.

• Hormonal treatments: where the doctor can prescribe combined contraceptives (containing the hormone estrogen and progesterone) or contraceptives that contain progesterone only, or that contain only estrogen, whether they are oral tablets, patches, injections, and other pharmaceutical forms, and it must be noted Noting that hormonal treatments are not suitable for women who suffer from migraine with aura; This is because it increases the risk of developing serious health complications.

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Treating migraine for pregnant women

The stage of pregnancy is very sensitive, and you need to be precise in choosing the best treatment without harming the fetus, and in fact, avoiding migraine triggers is the best option at this stage as well, and if drug treatment is necessary, the doctor may prescribe paracetamol at a reduced dose. It did not work, then the doctor may prescribe Sumatriptan or Ibuprofen, which the pregnant woman uses intermittently, and in this context it is indicated that the doctor takes into account the stage of pregnancy before choosing drug treatment. For example, take ibuprofen during the first and last trimesters of pregnancyIt is associated with some risks, and this is why the doctor may prescribe it conservatively and under certain conditions. As for preventive treatments during pregnancy, the doctor often does not prescribe them except in severe cases, and although migraines improve gradually during pregnancy, the symptoms soon return after childbirth, With regard to women who are planning to become pregnant and who suffer from migraines, they must consult a doctor and obtain sufficient information to ensure a safe pregnancy and a healthy birth.

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Tips for relieving migraine symptoms

The best thing to do when a migraine attack begins is to go to a quiet, dark room and try to relax or take a nap, especially if the attack is accompanied by an aura, and an ice cube wrapped in a cloth can be placed on the forehead or on the back of the neck to alleviate the symptoms of migraine. ,  On the other hand, knowing the triggers for migraines and avoiding them is an early preventive treatment that can be followed to prevent migraine attacks or limit their development as much as possible.  In addition, the following tips can be followed to relieve migraine symptoms: 

• Do relaxation exercises and yoga . 

• Organizing the time for waking up and sleeping, as well as the times for eating meals, and making sure to stick to them. 

• Drink enough fluids, especially water, to avoid dehydration. 

• Acquisition of a migraine journal, through which it is possible to identify the triggers of the headaches and to know which treatments are used are the most effective. 

• Getting regular exercise, such as aerobic exercise; Walking, swimming, and cycling because of their role in reducing stress and excess weight, and it should be noted the need to warm up before starting to exercise, as exercising may suddenly trigger a migraine attack.

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