Many female friends are very prone to headaches, especially "migraine", it is like a "nightmare", although whether it is a man, a woman, or a child, may suffer from "migraine", but "migraine" patients are mainly female friends, the World Health Organization statistics, there are about 1.3 billion migraine patients in the world, of which the number of female patients is three times that of men.
Typical presentation of migraine
Unilateral, throbbing moderate and severe headache, accompanied by nausea, vomiting, fear of light, fear of noise, dare not move, lasting 4~72 hours.
The onset of migraine often has more than one trigger for the individual patient, and the mainstream theory is that the occurrence of migraine is caused by dysfunction (genetic) of the trigeminal neurovascular system and the endogenous pain regulation system of the central nervous system, plus excessive internal and external stimuli.
Causes women to be more susceptible to "migraines".
Physiological factors
Sex hormone levels in women vary depending on the menstrual cycle, making some women prone to migraines around the time of menstruation. In addition, migraines may also occur during pregnancy and menopause due to changes in sex hormone levels.
Mental factors
Stress, lack or oversleep, anxiety, depression, crying and other stressors.
Dietary factors
Drinking alcohol, eating chocolate, and foods with pungent tastes or odors, including pickles, pickled foods, smoked products, etc., which are high in nitrates.
environmental factors
Such as weather changes, bright light irritation, noise and strong smells, etc.
Migraine harm
Affects sleep quality
Persistent migraine often causes difficulty falling asleep, waking up easily after sleep or waking up early, making the daytime lack of energy, fatigue, lack of concentration, and memory loss.
Affect life and work
In addition to pain and discomfort, patients often need to rest and avoid stimulation, which affects daily life, study and work, resulting in reduced work efficiency, reduced academic performance, and reduced social activities.
Affects physical health
Migraine is different from other types of headaches, the frequency of occurrence is higher, during the attack, the patient will feel the temples, back occipital and other parts of the severe pain, the pain will affect the cardiovascular and cerebrovascular system, and may even induce hypertension, cerebral thrombosis, cerebral hemorrhage and other complications.
Affects normal psychology
Due to long-term suffering from migraines, patients are prone to negative changes in their personality, causing anxiety, depression, depression or emotional instability.
How is migraine treated?
It is divided into medicine taken during headache attacks and medicine taken to prevent headaches.
Therapeutic drugs
The most commonly used non-specific treatment drugs for migraine are non-steroidal anti-inflammatory drugs, which are mainly used for mild to moderate migraine, including acetaminophen, ibuprofen, diclofenac sodium, celecoxib, etc., and non-steroidal anti-inflammatory drugs should be avoided for long periods of time or in excessive doses, as they may cause liver damage or gastrointestinal reactions.
If nonspecific therapy is ineffective, consider using a specific therapy.
Specific therapeutic drugs are mainly triptans, including rizatriptan, sumatrippla, and zolmitriptan, which can exert analgesic effects by constricting cerebral blood vessels and inhibiting nerve pain transmission. It is effective at any time during the headache phase, the first application is effective, the reuse is still effective after recurrence, and if the first application is not effective, a different triptan or a change in dose may be effective. Triptans are contraindicated for ischemic heart disease, ischemic cerebrovascular disease, ischemic peripheral vascular disease, uncontrolled hypertension, and those under 18 years of age and over 65 years of age because they can cause vasospasm and increased blood pressure.
Another specific therapeutic drug is mainly ergot, such as ergotamine and dihydroergotamine, although the efficacy is not as good as triptans, but it has the advantages of long half-life and low headache recurrence rate, especially for patients with a long duration of attacks, but it should be noted that it may lead to drug overuse headache and other adverse reactions. Caffeine ergotamine, which can be used for certain mild to moderate migraines, has been classified as a Class II psychotropic drug because the combination of caffeine increases the risk of dependence and addiction.
Prokinetic drugs such as metoclopramide and domperidone are mainly used to treat headache accompanying symptoms, such as nausea and vomiting, and can also promote the absorption of drugs to exert a rapid analgesic effect.
Betahistine can be used to treat migraine with vertigo.
Alprazolam has anxiolytic and sedative effects and is used in the treatment of insomnia caused by migraines.
Prophylactic medications
For patients with migraine who have frequent attacks, have a long duration of attacks, or seriously affect their life and work, preventive treatment can be considered, which can reduce the frequency, duration, and degree of migraine attacks to a certain extent. These prophylactic drugs are briefly described as follows:
Non-selective calcium channel antagonists, with sufficient evidence for prophylactic treatment of migraine.
For example, topiramate and sodium valproate have been supported by multiple studies to support the effectiveness of these two drugs in preventing migraines.
For example, venlafaxine and amitriptyline can be used to treat migraine prophylactically, especially in patients with tension-type headache or depressive states.
Patients with migraine may be treated with lifestyle interventions in addition to medication
1. Use more magnesium-rich foods, such as walnuts, peanuts, green leafy vegetables, etc., which have certain benefits for relieving migraine symptoms.
2. Ensuring reasonable sleep time and regular exercise is conducive to reducing headache attacks.
3. Avoid irregular diet, or eat cheese, chocolate, smoked fish, wine and other foods that are easy to induce headaches, and avoid taking certain drugs, such as caffeine.
4. Avoid sound and light stimulation.
5. Pay attention to keep warm and avoid direct cold wind.
6. Acupuncture therapy, relaxation therapy, biofeedback therapy, electromyography and cognitive behavioral therapy.
There is currently no effective cure for migraine, but the frequency and severity of the disease can be reduced by lifestyle modifications, preventive strategies, and the correct use of therapeutic drugs.
Reviewer: Lai Yongji, Deputy Chief Pharmacist, Wuhan Central Hospital
Author: Li Lu, Wuhan Central Hospital