The prestigious Dr. Heras Perez, specialist in Neurology, explains the treatment for migraines.
What are migraines and what types are there?
Migraine or migraine headache is one of the most frequent headaches (headaches) in the population and undoubtedly the one with the greatest repercussions, both for the patient who suffers from it and for his or her social and work environment.
It affects approximately 12% of the population, with a preference for the female sex and generally of working age, which has a great economic and quality of life repercussion.
The most frequent types of migraine are: migraine without aura, with aura or migraine with and without aura, a mixture of the two.
What are the symptoms and why do they sometimes cause loss of vision or dizziness?
Migraine usually produces intense pain on one side of the head (although not always) with “hammering or pounding” characteristics. It is accompanied by nausea, vomiting, special sensitivity to light and noises, which forces the patient to lie down in a dark and silent room, interfering with his/her activities. Sometimes the pain is preceded or accompanied by visual disturbances (lights, flashes, spots, decrease in visual acuity, etc.), sensations of “corking” or loss of strength in the face or extremities, dizziness and even language disturbances, which are known as migraine aura. They are generally transitory, disappearing in less than 60 minutes and are due to electrical and circulatory alterations that affect certain areas of the brain, due to the migraine.
What are the causes?
The origin of migraine is in the nervous system, due to an abnormal response, genetically determined, of certain nuclei of the brain to various stimuli. These can be internal, such as hormonal changes, or environmental, thus initiating a cascade of events that lead to changes in chemicals called “neurotransmitters”, which will eventually induce alterations in the blood vessels with dilation and inflammation of the vessel wall, thus generating pain and associated symptoms.
When we suffer them, how should we act to soften or stop them momentarily?
At the beginning of the pain, alcohol, stress and physical or intellectual efforts should be avoided. It is advisable to relax in a quiet, dark place, take an anti-inflammatory or triptan early (if possible within the first hour of onset) and try to sleep. Sleep has a beneficial effect on migraine.
Is there a solution and what are the treatments?
We cannot act on the genetic predisposition of the person who suffers from migraine, but in any case it is possible to prevent and treat the pain, if it appears, thus managing to control it adequately.
There are preventive treatments that try to reduce the frequency and intensity of the attacks, when they are frequent or very severe and prolonged. The most commonly used drugs are beta-blockers (propranolol, nadolol), calcium antagonists (flunarizine), neuromodulators (topiramate, sodium valproate) and some antidepressants (amitriptyline).
Special mention should be made of the so-called chronic migraine, in which pain occurs at least 15 days a month for more than 3 months. Many patients suffer from it on a daily basis and it represents a serious problem for the sufferer, both in terms of pain and loss of working hours or quality of life and leisure. In these cases, pericranial and cervical infiltration of botulinum toxin A (Botox) is indicated.
In crises, drugs are used to alleviate or eliminate pain when it begins. It is important to use the appropriate drug according to the intensity of the pain, to take it early and at effective doses. The most commonly used drugs for moderate pain are non-steroidal anti-inflammatory drugs (NSAIDs), the most useful being ibuprofen, naproxen, dexketoprofen or diclofenac, among others. In case of severe pain, the recommended drugs are the so-called triptans, which are more selective and effective than the previous ones. When pain is accompanied by vomiting, it is advisable to administer the drugs through inhalers or injectables to ensure their absorption.
The importance of limiting the use of analgesics, anti-inflammatory drugs and triptans should be emphasized to avoid the so-called analgesic abuse headache, since excessive consumption leads to a chronification of pain and worse response to preventive treatment. In general, analgesics, anti-inflammatory drugs and triptans should not be used for more than 8-10 days per month.