In fact, the drug "treatment" of migraine comes down to stopping its attack, since the "disease" itself, being a constitutional anomaly in the nervous regulation of blood vessels, is not curable. Prevention of migraine is the use of drugs that prevent the development of migraine attacks.

Preventive treatment should not only reduce the frequency, intensity and duration of attacks and improve the quality of life, but also prevent the progression of migraine into its chronic form. In this article we will talk about the prevention of migraine with drugs.

For whom is drug prophylaxis indicated?

Prophylactic treatment of migraine is prescribed for patients suffering from frequent and severe attacks. As a rule, such a situation occurs if a person is subject to the frequent influence of migraine-provoking factors, some of which may be impossible to eliminate. Drug prevention is focused on preventing the development of a cascade of pathological reactions in intracranial blood vessels occurring during a migraine attack.

Do you need preventive therapy if:

The spectrum of drugs for migraine prophylaxis

Several groups of drugs are used, because universal remedy does not exist, and each patient requires an individual selection medicinal product, its dose, the duration of the prophylactic course.

• vasoactive drugs (blockers calcium channels, beta-blockers);
• serotonin antagonists (preparations containing ergot derivatives - vasobral, bellataminal, caffetamin, sandomigran);
• NSAIDs (non-steroidal anti-inflammatory drugs);
• antidepressants (amitriptyline, selective serotonin reuptake inhibitors);
• anticonvulsants (topiramate, gabapenten, carbamazepine, clonazepam, valproates).

In the absence of the desired therapeutic effect shows the use of a combination of drugs. A.V. Amelin and his co-authors recommended the following:

• antidepressants + vasoactive drugs;
• antidepressants + valproic acid preparations.

Adequate therapy for your condition can only be selected by a doctor!

Characteristics of individual drugs

Amitriptyline belongs to the group of antidepressants. For the prevention of migraine attacks, this drug allows you to use the central analgesic effect of amitriptyline (that is, anesthesia at the level of the receptor pain system of the brain) and the normalizing effect on the exchange of serotonin in the central nervous system. Perhaps, in some cases, there is an improvement due to the elimination of the patient's sluggish current depression with amitriptyline. This drug should not be taken by persons unable to give up alcohol - the effect can be fatal! Most patients report positive influence amitriptyline (in the sense of a significant reduction in migraine attacks), but also side effects he is not kept waiting.

Vasobral- the drug is very "friendly". Let's call it that because:

• an extremely rare occurrence in people taking this medicine of unpleasant side effects, which, moreover, were mild and eliminated on their own;
• The high compatibility of Vasobral with other drugs taken by the patient;
• And, most importantly, high preventive activity against migraine. Already a month after the start of taking Vasobral, the majority noted a positive trend. The treatment of young patients was especially effective (due to the shorter duration of the disease and the severity of attacks)
• Significantly improved general well-being, increased performance

Vasobral is a combination of ergot alkaloid and caffeine, necessary for better absorption of the former in the stomach, and also showing an independent effect.

The drug Vasobral is successfully used in the prevention of migraine (both alone and in combination), residual effects after a violation cerebral circulation; dizziness various types, tinnitus, hearing loss of ischemic origin; diabetic and hypertensive retinopathy; disorders of the peripheral arterial circulation (syndrome and Raynaud's disease). And such unwanted "companions" of our stress-prone life as irritability, memory impairment, decreased attention and mental activity Brain Vasobral is also able to warn! This pleasant effect allows even students to arrange a kind of “prophylactic course” with this drug before or during the session.

Many who take this medicine note the greater effectiveness of the Vasobral solution compared to the Vasobral tablet form.

Topiramate (aka Topamax) is an antiepileptic agent. What does it have to do with migraines?

The expediency of using anticonvulsants (antiepileptic drugs) in the prevention of migraine is considered in view of their ability to reduce the increased excitability of brain neurons. The action of the drug Topiramate is based on its effect on ion channels nerve cells and biochemical correction of neuronal excitability, as well as a direct effect on the pain receptor systems of the brain. Thanks to this, Topiramate (Topamax) eliminates the prerequisites for the development of an attack.

Topiramate (Topamax) is indicated for patients with frequent and severe migraine attacks resistant to other treatments, patients with chronic migraine, and chronic tension headache.

Currently, Topiramate and Topamax are the most promising prophylactic agents for migraine according to multicenter studies.

So don't let it scare you pharmacological group drug: if the doctor prescribes Topiramate (Topamax), then he considers it pathogenetically justified

Medication that "paralyzes" migraine

There is such "medical wisdom" that the difference between poison and healing remedy lies ... in the dose. Man endowed amazing ability use for the benefit of a completely, it would seem, not intended for this phenomenon. This human feature also manifested itself in relation to the deadly botulinum clostridium: its poison (toxin) is now known to many as botulinum toxin type A, or Botox for short.

In recent years, the possibility of using Botox preparations for the relief of various pain syndromes due to its very attractive features:

• security
• well tolerated by patients
• long period actions
• no side effects

It should be noted that the study of the analgesic effect of botulinum toxin type A was initiated by a surgeon who eliminated mimic wrinkles with its help. The grateful responses of the patients were not long in coming, but they mainly concerned ... the reduction of headaches.

How can Botox serve as a preventive treatment for migraine?

Botulinum toxin, relaxing muscle fibers after their long reduction, thereby reduces the release active substances that irritate muscle pain receptors. But, most importantly, Botox eliminates neurogenic inflammation, which plays its insidious role in the development of a migraine attack.

The procedure for Botox injections for the prevention of migraine involves the introduction of it at several points, which are determined by the doctor after collecting anamnesis and a thorough objective examination of the patient. The injection points are more often projected onto the glabella, temporal regions, rarely frontal and occipital lobes.

So, Botox can be a real salvation for people suffering from frequent, severe migraine attacks, sometimes putting them out of action for several days, for patients with chronic form migraine; the patient's awareness of control over this disease significantly improves the quality of his life and cannot but please the attending physician.

Migraine is the strongest headache which is very difficult to get rid of. This disease is hereditary, so it cannot be prevented. However, there are certain migraine prevention measures that can help the patient to normalize the condition and control attacks.

Migraine Prevention Starts Small

For occasional seizures migraine, the best thing to do is start regular preventive measures. The goals of migraine prevention and treatment are:

• prevention of painful attacks;
• reduction in the frequency of seizures;
• reduction of the strength of the headache during attacks.

So, let's start with simple preventive actions that are suitable for combating migraines:

1. Sleep compliance. You can not fall asleep under the TV, music, conversations, with the lights on.
2. Prevention of stress. You need to learn to control emotions, relax, do what you love.
3. Relaxing massages.
4. Prevention with drinks (coffee, herbal tea) if these drinks do not cause a backlash.
5. Proper nutrition. The diet should consist in the exclusion of foods that can cause migraines.

Products - provocateurs of migraine

• Alcohol. Drinks with an excess of caffeine, invigorating substances and alcohol can even cause healthy people headache.
• Chocolate. This product also has a stimulating effect on the nerves and can cause headache attacks.
• Smoked meats and canned food. They contain nitrites and nitrates, and other vasodilators.
• Flavorings and flavor enhancers. You need to buy food only after studying the composition on the label.
• some fruits. Headache attacks can cause bananas, raisins, avocados, citrus fruits, plums.

You should be careful about taking medications. Particular attention should be paid to the choice of drugs for migraine prevention in children. Many medicines that help adults are contraindicated in babies, and can increase the pain attack.

Another way to prevent migraine is to use healthy foods:

• Ginger. Its root not only has a beneficial effect on the blood and immunity, but can also relieve headaches.
• Red pepper. A little pepper can be added to dinner dishes, and at night it is recommended to put a little cream with pepper on the whiskey.
• Tea with mint and lavender baths with these herbs.

To help relieve pain can cold lotions on the temples and acupressure. Use all of these remedies and they will help you cope with painful and prolonged migraine attacks.

Many people are familiar with migraines. An excruciating headache makes you forget about household chores, work and plans for the weekend. Most often, only sleep with closed curtains helps. The patient is irritated by any sounds. But the bad thing is that the attack may not go away for several days. This is a big hindrance, because most of us need to go to work under almost any circumstances. This symptom is difficult to treat, so migraine prevention drugs are a good option for most people.

General characteristics of migraine

This is a neurological disease, which is characterized by the development of a strong, pressing headache. Not everyone has heard of migraine prevention drugs. Usually we start thinking about pills during an attack. But with a migraine, this number will not work. Often patients complain that during an attack the stomach does not take any food or pills. Attempting to take the drug causes vomiting. It remains to use only drugs for intramuscular or intravenous injections.

Disappointing forecast

Unfortunately, there is no cure for migraines. This complex disease, which may be caused by whole complex reasons, including psychological and physiological. Therefore, migraine prevention is very important. Preparations for this can be selected by a neurologist or therapist.

If we cannot cure the disease, then we need to prevent attacks, or at least make them less pronounced. To do this, you need to find out the causes of migraine and identify irritating factors. It has not yet been possible to determine the exact causes, but it is known that the disease develops against the background of constant stress, an unbalanced diet, bad habits and hormonal changes. The mechanism of the development of the disease is associated with vasodilation. Preparations for the prevention of migraine today are sold in pharmacies in large quantities, but before using them, you should definitely consult a doctor.

Smart Prevention

You can say as much as you want that you don't have enough time. But migraine attacks, especially if they are frequent, steal a lot more resources and strength from you. Smart Prevention Provides long-term remission and excludes the development of long-term pathology. Timely preventive measures will help cure the first symptoms. It must be well understood that migraine prevention medications will not work unless they are supplemented with vitamins, topical medications, and folk remedies from a headache.

Nutrition

We are what we eat. This well-known saying becomes even more relevant if we are talking about migraines. Seizures provoke certain nutritional supplements that are included in the menu. These are not empty words, but a proven fact. That is, you can choose drugs for the prevention of migraine attacks as much as you like, but if you eat a lot of fatty and sweet, they will be ineffective.

Therefore, we begin prevention by excluding fatty foods and a large number of sweets. Biscuits and a couple of caramels with tea are allowed, but cream cakes are best left only for the most solemn days. A large number of spices can also provoke seizures. Headaches can be caused by chocolate and smoked meats, alcohol and caffeine.

your behavior

Also very important point. As you know, migraine is a neurological disease. That is, stress and anxiety, serious loads- all this affects the frequency of seizures. This pattern is confirmed by the reviews of doctors. Migraine prophylaxis drugs have an auxiliary effect. Human behavior plays a huge role in prevention.

The patient must know what causes his seizures, and be careful. This may be a reaction to weather changes, stress or phobias. After conflict situation Sometimes no drugs help. That is it neurological problem and the first thing you need to do is calm down.

The basis of prevention is the correct daily routine. You need to work productively, but in moderation. Be sure to take breaks, switch to other things on weekends and take vacations. Sleep less than 6 hours will negate all prevention. But it is also not recommended to sleep for a long time, because it provokes headaches.

Experts recommend that you plan your day off and work as much as possible. You need to get up and go to bed at the same time. Excellent tool is an cold and hot shower, strong and very morning exercises. Need to drink more pure water so that the vessels are constantly filled with liquid.

If a person feels that the symptoms are approaching, then preventive measures no longer help. Aura symptoms, fear of lights and sounds, smells, and nausea are common. Reviews of drugs for the prevention of migraine confirm that at this moment it is too late to take something. You need to take a horizontal position and put on your forehead cold compress. The best way out is to switch off from problems and eliminate annoying factors. Sometimes neurologists suggest taking an antidepressant.

Medicines for the prevention of migraine

The list should be in every home where there is a person who suffers from this disease. Please note: when the head already hurts, it is too late to drink them. And be sure to pay attention to the psycho-emotional state. Frequent exposure to stress not only provokes a headache, other organs also suffer.

If a person suffers diabetes This can also cause headaches. Therefore, you need to monitor the level of sugar. Overstrain mental and physical becomes the cause more often than others. In this case, resort to sedatives.

Let's take a look at the names of migraine prevention medications that can help prevent a serious attack:

• "Ibuprofen". This is one of the universal painkillers and anti-inflammatory drugs. After about 10 minutes, the medicine blocks the hormones that bring pain.
• "Aspirin". It is used for migraines with aura. It is combined with antiemetic drugs. After about 4 hours, the pain completely disappears.
• "Paracetamol". Its effectiveness cannot be called high, but in some cases it can help.

In fact, it is quite difficult to find drugs for the prevention of migraine. The names and reviews of prescribed medicines indicate that most of them can help directly to stop or relieve an attack. Moreover, the sooner you felt his approach and took the pills, the sooner you will feel relief. If attacks are often disturbing, you should consult a doctor who will prescribe more serious and effective medications:

• Beta blockers. They are prescribed courses for the purpose of prevention. But the mechanism of action is still not clear, so it is difficult to say whether the drug really has a significant effect on the body. This medicines such as Atenolol, Metoprolol, Nadolol and others.
• Serotonin antagonists. They provoke the release of serotonin and can theoretically be used as a prophylaxis.
• Triptans. Responsible for preventing pain. That is, drugs of this group are taken at the moment when they feel the first symptoms: nausea, aura. These are Zomig, Imigran, Sumatrix. Reviews of doctors recommend these drugs as the most effective, they are not addictive and can be used for a long time.

• Hormonal drugs. Used when seizures are associated with menstrual cycle.
• Combined analgesics-antispasmodics. Combined drugs are used to treat and prevent seizures, as they act immediately on a number of symptoms. The base is paracetamol.
• Antidepressants. According to doctors, they are effective for the treatment and prevention of chronic migraine. Independent uncontrolled use is highly undesirable, as it leads to mental disorders. Often prescribed drugs such as "Amitriptyline", "Venlafaxine". Of course, antidepressants have a number of side effects, but in some cases they help to return to normal life.

Preventive treatment with folk remedies

This method requires more time than using tablets. But otherwise, this is a gentle way to relieve a migraine attack:

• Infusion of clover. It is effective for any headache. To prepare the infusion, you need to pour 1 tablespoon of inflorescences with a glass of boiling water. Take 1/3 cup after meals.
• Oregano brewed in a similar way relieves an already developing attack.
• Strong sweet tea is great for coping with seizures and boosting immunity.
• Menthol ointment. When applied to the temples, it increases blood circulation and relieves pain.
• Baths with sea ​​salt. Just 15-20 minutes - and you can relax.
• Massage. Effective for early headaches.

Instead of a conclusion

We reviewed the main drugs for the prevention of migraine. The list of titles can be saved so that it is at hand at the right moment. If pain attacks occur more than twice a week, then you need to see a doctor and undergo an examination. Preventive treatment sometimes requires the appointment of quite serious vascular preparations. If you regularly take such a course, you can avoid severe attacks. Of course, we must not forget about proper nutrition and daily routine.

A. V. Amelin, St. Petersburg State Medical University. acad. I.P. Pavlova

IN last years there is a growing interest in the problem of preventive (interictal) treatment of migraine. This is due to an increase in the number of patients suffering from frequent and severe attacks of headaches and in need of prophylactic treatment for migraine. The main goal of preventive treatment is to reduce the frequency and severity of migraine attacks. Effective interictal treatment reduces the amount of analgesics consumed, prevents the development drug addiction And dosage form headache, improves the quality of life of patients.

The basis for the appointment of preventive treatment are the following: testimony:

• two migraine attacks or more per month over the past 6 months, with a significant limitation of the patient's capacity;
• low efficiency drugs used to treat an attack and / or the presence of contraindications to their use;
• the use of drugs used to stop a migraine attack more than 2 times a week;
• special circumstances: hemiplegic migraine or migraine with infrequent attacks, but with persistent focal neurological symptoms and high risk of stroke.

Goals of preventive treatment should primarily be achieved through lifestyle modifications (Table 1) and only if necessary, the addition of medicines. If lifestyle changes have not led to a decrease in the frequency and intensity of migraine attacks, then drug treatment. Despite a significant arsenal of drugs used for the prophylactic treatment of migraine, highly effective prevention of its attacks is currently very difficult. This is due to insufficient knowledge of the pathogenesis of migraine, the specific mechanisms of action of drugs, as well as the individual sensitivity of the patient to drugs.

Medical prevention of migraine attacks It can be carried out episodically or constantly, over a long period of time. An example of episodic preventive treatment is when the migraine trigger is well known to the patient ( exercise stress, certain foods, etc.), but does not occur regularly. In such cases, to prevent a headache attack, the drug is taken immediately before the action of the provoking factor. Another example of periodic prophylaxis of a migraine attack is the use of non-steroidal anti-inflammatory drugs (NSAIDs) 3-4 days before the upcoming menstruation for menstrual migraine. In the presence of a large number of provoking factors, frequent occurrence migraine attacks, the inability to foresee their occurrence preventive treatment carried out regularly, for several months and even years.

If according to the algorithm (see picture) decided to start preventive drug therapy, the primary choice of drug is based on comorbidity, compatibility with drugs used to relieve an attack, as well as available data on its clinical efficacy and spectrum of side effects.

In most cases, the first drug used for prophylactic treatment should be prescribed at a minimum dose, and then slowly increase it, “titrating” the dosage until a positive therapeutic result is obtained or side effects occur. The dose of the first drug is increased if the desired reduction in the frequency and intensity of headache cannot be achieved within 1 month. Usually in patients with migraine, to obtain a therapeutic effect, lower doses of the drug are required, compared with the doses required for the treatment of other diseases. For example, the tricyclic antidepressant amitriptyline for depression is usually used at a dose of 100 to 200 mg/day, while for migraine it is effective at a dose of 10-20 mg/day. In addition, in patients with migraine, side effects often appear when prescribing even relatively small doses of drugs. Thus, the dose of amitriptyline 25-50 mg is the starting dose for the treatment of depression, but can cause serious side effects in a patient with migraine. Valproic acid preparations are usually effective in migraine at a dose of 500-750 mg / day, while for the treatment of epilepsy and mania, they are used at much higher doses. The anticonvulsant topiramate is effective for migraine at a dose of 50-100 mg/day, and for epilepsy at a dose of 200 mg/day and above.

To obtain the maximum effect from prophylactic treatment, patients should not abuse the intake of analgesics or ergot alkaloids in large doses. In addition, oral hormonal contraceptives, hormonal replacement therapy, vasodilators (nifedipine, nitrates) may interfere with the action of prophylactically prescribed drugs. Women receiving preventive treatment for migraine should use reliable non-hormonal contraception and should be warned of the possibility if pregnancy occurs. negative impact drugs for the fetus.

The result of prophylactic treatment is considered to be positive in case of a decrease in the frequency of migraine attacks or the number of headache days by 50% or more compared to the initial period. It may take several months to achieve a positive result without the development of side effects. The final conclusion about the effectiveness of the first chosen drug and the need to replace it or combine it with another drug can be made in the absence of a therapeutic effect within 3 months of treatment. You should not refuse the chosen drug if its dose has not been increased to the individually maximum and well tolerated. With absence positive reaction for treatment or the appearance of side effects, it is recommended to replace the selected drug with a drug of another class. In case of insufficient effectiveness, but good tolerability of the primary selected drug, a second drug from another class can be added to it. Combinations of two drugs from different classes, but at low doses, can give a more pronounced therapeutic effect with less likelihood of side effects.

The decision to increase or decrease the dose of the drug should be made on the basis of a critical assessment of the relationship between the effectiveness of the treatment and the degree of risk of side effects. An attempt to reduce the dose and/or amount of drugs used is justified only after a positive therapeutic result is maintained at the desired level for 1 year. Sudden interruption of treatment can lead to a relapse of migraine, the development of a withdrawal syndrome (b-blockers, clonidine, antidepressants).

Principles of drug selection for interictal treatment

Virtually all drugs used today for interictal treatment of migraine were discovered by chance, as a result of their clinical application rather than created specifically for this indication. For preventive therapy of migraine, b-blockers, calcium channel blockers, topiramate, valproic acid, antidepressants, antiserotonin drugs, clonidine, NSAIDs, and female sex hormone preparations are used.

As noted, when choosing a drug, one should take into account the effectiveness of the drug, concomitant pathology, range side effects drug, previous drug experience (Table 2).

In some cases, patients with difficult-to-treat headache may be recommended combinations of several drugs. (Table 3). Some of them are highly effective and safe (for example, b-blockers and cinnarizine, b-blockers and antidepressants). At the same time, the combined use of b-blockers with verapamil and diltiazem should be treated with caution, since the combination with verapamil increases the risk of developing bradycardia and intracardiac blockade. Because of high risk the development of dangerous side effects, the combination of MAO inhibitors with serotonin reuptake inhibitors is contraindicated.

Clinical experience shows that most Russian doctors use calcium antagonists, b-blockers, topiramate or a combination of b-blockers with antidepressants or calcium antagonists (cinnarizine) with anticonvulsants to prevent migraine attacks. The combination of valproic acid with antidepressants is logical in patients with comorbid depression or mania. The combination of methysergide and some calcium channel blockers (flunarizine, cinnarizine) may reduce the vasoconstrictor side effects of the former.

Preventive treatment may have a significant influence on the choice of drugs used during an attack. Some combinations are mutually beneficial, and some combinations are invalid. For example, ergot alkaloids and 5HT1B/1D receptor agonists can enhance the vasospastic properties of methysergide and β-blockers, but at the same time there are clinical evidence that the effectiveness of ergot alkaloids during an attack is significantly increased against the background of the preliminary use of methysergide. In this regard, on the one hand, the combination of these drugs is possible and even effective, and on the other hand, it will require close monitoring of the course of treatment from the doctor.

Eliminate or significantly limit the consumption of foods containing tyramine (cheese, chocolate, cocoa, coffee, tea, marinades, citrus fruits, nuts, eggs, tomatoes).

Maintain an adequate diet (exclude diets, a long break in eating).

Limit alcohol consumption, especially red wine.

Stop or significantly reduce smoking.

Avoid physical overwork, sudden lifestyle changes. Increase aerobic physical activity(walking 30-45 minutes at least 4 days a week).

Normalize sleep patterns (both insufficient and excessive sleep are harmful).

Avoid situations that lead to excessive emotional stress.

Maintain magnesium intake at the level necessary for your health (food, preparations containing magnesium).

Women should not use hormonal contraceptives.

Treatment of concomitant arterial hypertension.

Limit contact time with bright light sources ( sunlight, computer monitor, TV), pungent odor(paints, perfumes), intense noise.

Table 2. The choice of drug for interictal (prophylactic) treatment of migraine

A drug	Clinical Efficiency *	Side effects*	Concomitant disease
			not recommended	recommended
b-Blockers**
propranolol Atenolol	++++	++	Asthma, depression, heart failure, diabetes, Raynaud's disease	Hypertonic disease, ischemic disease hearts
Antiserotonin
methysergide Pizotifen Cyproheptadine	++++	++++	Coronary artery disease, hypertonic disease, peripheral vascular disease	hypotension
Calcium channel blockers
Verapamil Flunarizine Cinnarizine	+++	+	Hypotension, bradycardia, constipation (for verapamil) Sedation, parkinsonism (for cinnarizine)	Migraine with aura, hypertension, asthma, coronary heart disease
Antidepressants
Tricyclic antidepressants	+++	++	Urinary retention, manic syndrome, heart block	Chronic pain, depression, anxiety, sleep disturbances
Serotonin reuptake inhibitors
	++	+	manic syndrome	Depression, obsessive compulsive disorder
MAO inhibitors
	++++	++++	Patients who violate the medication regimen	Refractory depression
Anticonvulsants
Valproic acid	+++	+++	Liver disease, Hemorrhages	Manic syndrome, epilepsy, anxiety
Topiramate	++++	++	Weight loss Nephrolithiasis
NSAIDs
Naproxen diclofenac Indomethacin	++	++	peptic ulcer, gastritis	Arthritis, other pain syndromes

Note: * - symptom severity from + (minimum) to ++++ (maximum);
** - for migraine, b-blockers are effective without internal sympathomimetic activity.

Table 3 Combination drugs for interictal treatment of migraine

Rational combinations
Antidepressants	b-blockers
	Ca-channel blockers
	Valproic acid
	Topiramate
methysergide	Ca-channel blockers
Serotonin reuptake inhibitors (fluoxetine)	Tricyclic antidepressants (amitriptyline)
Topiramate	Ca-channel blockers
Valid Combinations
b-blockers	Ca-channel blockers (cinnarizine)
	methysergide
MAO inhibitors	Amitriptyline, nortriptyline
Invalid combinations
MAO inhibitors	Serotonin reuptake inhibitors (fluoxetine)
	Most tricyclic antidepressants (except amitriptyline, nortriptyline)
	Carbamazepine
NSAIDs	Lithium

MAO inhibitors increase the half-life and distribution in the tissues of sumatriptan, taken orally, which increases the risk of cumulation of the drug and the development of side effects when it is repeated. Meperidine and sympathomimetics, which are part of the series combined drugs used to relieve an attack, potentiate the action of MAO inhibitors and increase the risk of developing serotonin syndrome or a hypertensive crisis.

The simultaneous use of NSAIDs, including aspirin, for the prevention and relief of an attack significantly increases the risk of side effects from gastrointestinal tract. Joint application preparations of valproic acid and barbiturates potentiates their suppressive effect on the central nervous system.

There are a significant number of foreign and domestic studies indicating the effectiveness calcium antagonists in the prophylactic treatment of migraine. 45 controlled clinical trials calcium antagonists in migraine. The results of double-blind, placebo-controlled studies showed that the appointment of flunarizine at a dose of 10 mg per day was effective in 46-48% of patients. However, a comparison of flunarizine with propranolol and metoprolol did not reveal any advantage of the calcium antagonist over β-blockers. It should be noted that the main side effect of flunarizine is the development of Parkinson's syndrome, muscle weakness and depression. In a double-blind multicenter study (Nimodipine European Study Group), it was shown that the effectiveness of nimodipine (120 mg / day) in the treatment of migraine with and without aura did not differ from the effectiveness of placebo. The results of three placebo-controlled studies indicate that verapamil at a dose of 320 mg / day was significantly more effective than placebo in the treatment of migraine, and no significant differences were obtained at a dose of 240 mg / day.

Foreign publications on the treatment of migraine with calcium antagonists are mainly devoted to flunarizine, which is not widely used in the domestic medical practice, while most domestic research is devoted to cinnarizine. Accumulating clinical data show the efficacy of this calcium antagonist in approximately 48% of patients, which is consistent with the results of treatment with drugs such as β-blockers and antidepressants. However, the use of cinnarizine for the prevention of migraine is limited by its sedative effect, which often develops with prolonged use of the drug.

An attempt to level the sedative effect of cinnarizine was implemented in the drug "Fezam". The drug is a successful combination of pharmacodynamic effects of two known drugs- cinnarizine and piracetam - in therapeutic doses of 25 and 400 mg, respectively. Phezam has antihypoxic, metabolic and vasodilating effects. The activating effect of piracetam reduces the sedative effect of cinnarizine and allows phezam to have a normothymic effect, ensuring good tolerability of the drug during its long-term use. Mutual potentiation of the pharmacodynamic properties of the two drugs provides a pronounced antihypoxic effect of Phezam.

Effective action the drug is due to the metabolic and vascular effects of piracetam and cinnarizine. The dilatation of cerebral vessels caused by cinnarizine does not lead to a decrease blood pressure, and piracetam, which is part of fezam, increases intracellular metabolism, optimizes intracellular glucose consumption and energy metabolism, inhibits platelet aggregation, stimulates cholinergic neurons, and improves interhemispheric transmission. It is not known which of the listed mechanisms of action ensures the effectiveness of the drug in migraine.

We conducted a comparative study of the effectiveness of phezam (1 capsule 3 times a day) and cinnarizine (75 mg/day) in the prophylactic treatment of migraine for 3 months. The results showed good efficiency fezam and confirmed the effectiveness of cinnarizine in the treatment of frequent migraine attacks. After 3 months of treatment, the number of patients with positive results treatment (reducing the frequency of attacks by 50% or more) was 49% and 47%, respectively, which is comparable to the effectiveness of b-blockers and antidepressants in the treatment of migraine. Note the good tolerance long-term use fezam and significantly fewer complaints of drowsiness and muscle weakness in the group of patients receiving this drug compared with the group receiving cinnarizine. In the same group of patients, a significant improvement in attention and memory, increased tolerance to stress was revealed. Thus, the combination of cinnarizine and piracetam (phezam) has confirmed its efficacy and safety in the treatment of patients with migraine.

It is well known about the relationship of female sex hormones (estrogen, progesterone) and migraine. In the prepubertal period, migraine occurs with the same frequency in both boys and girls, but after the age of 15, it significantly predominates in women. The first migraine attacks appear with the first menarche in 33% of women. In the future, migraine attacks can appear a few days before menstruation, during it, and less often during ovulation. Migraine that occurs only during menstruation is often combined with dysmenorrhea and is called menstrual.

Migraine that appears a few days before menstruation is considered as one of the symptoms premenstrual syndrome. This period is also characterized by dysphoria (mood changes, depression, anxiety, tension, bouts of tearfulness); feeling tired or exhausted; drowsiness; lower back pain; edematous syndrome; nausea; bulimia; excessive consumption of salt, sugar. The appearance of premenstrual syndrome and menstrual migraine is associated with a lack of progesterone at the end of the luteal phase of the menstrual cycle, as well as an increase in the level of prostaglandins and a violation of the production of endorphins. Therefore, the basis for the prevention of premenstrual and menstrual migraine is the principle of replacing estrogens and progesterone before menstruation and suppressing the synthesis of prostaglandins. NSAIDs inhibit the synthesis of prostaglandins and are effective means of preventive therapy for menstrual migraine. hormone therapy migraine is carried out in the absence therapeutic effect from the use of NSAIDs or to enhance their action, but only after consultation with a gynecologist.

Thus, today for the preventive treatment of migraine, a wide range of drugs with varying degrees efficacy and tolerability. Therefore, the choice of one or another means should be based on the results of evidence. clinical research And personal experience doctor and patient.

Literature

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(hemicrania) - chronic illness which doctors have been trying to understand for decades. Experts have long been inclined to believe that severe headache, nausea, sensitivity to sound, light have no clear cause. Today everything is different. It turned out that migraine attacks are most often caused by stress, caffeine, and even a lack of vitamins in the diet. Does this mean that migraine prevention is possible? Yes, it is possible to prevent an attack, both with the help of medications and through lifestyle changes.

Migraines can be avoided

Migraines cannot be cured, but they can be prevented. Preventive therapy reduces the frequency of attacks, reduces the intensity of pain. Preventive treatment is intended for patients who have 3 or more attacks per month, suffering from pain lasting for several days. When prescribing therapy, it is necessary to take into account the side effects of drugs. Rarely this method is recommended for women during pregnancy using hormonal contraception.

Indications for prescribing preventive treatment:

• high frequency of migraine attacks - more than 3 per month;
• Seizures are prolonged or unresponsive to acute treatment;
• contraindications or deficiency acute therapy, for example, in patients with difficult to control arterial hypertension, after a heart attack;
• significant side effects of acute treatment;
• prevention of rare types of migraine, such as hemiplegic or basilar, a disease with a prolonged aura, where there is an increased risk of irreversible neurological deficit.

The main goals of preventive treatment:

• reduction in the frequency, severity, duration of migraine attacks;
• improving response to acute treatment, reducing the dose of drugs used;
• improving the quality of life of patients with migraine.

When initiating prophylactic therapy, it is important to strictly adhere to individual approach taking into account the wishes of the patient. Many people are so satisfied with the use of triptans during an attack that they prefer only acute treatment.

Triptans are drugs used to relieve acute migraine attacks. Available in the form of tablets, injections, nasal sprays.

Medical preventive therapy

Drug prevention of migraine (drugs) uses the following therapeutic groups of drugs: β-blockers, calcium channel blockers, antidepressants - TCAs and SSRIs, serotonin antagonists, antiepileptics, NSAIDs.

β-blockers

Propranolol, a non-selective β-blocker with a half-life of 4-6 hours, is the 1st choice in this group worldwide. Its efficacy compared to placebo has been demonstrated in several studies. Initial dose - 20 mg 2 times a day, may increase depending on tolerance and efficacy up to 240 mg / day.

In our country, Metoprolol is mainly used in a therapeutic dose of 100-200 mg / day. It starts with a low dose (2x50 mg), slowly increases depending on tolerance.

Calcium channel blockers (CCBs)

CCBs are drugs for the prevention and treatment of migraine that have the ability to block the release of serotonin, influence the mechanism of sterile neurovascular inflammation, and prevent the formation and spread of cortical depression. Flunarizine shows the greatest efficiency in this group. The drug is taken at a dose of 5-10 mg daily (1 mg 5 times a day). The increase to the full therapeutic dose is carried out gradually due to the risk of fatigue.

Sedation is the most common side effect of the drug. Often there is an increase in appetite and, as a result, weight gain.

Other drugs in this group include Verapamil. Starting at 2x40mg per day, the dosage is increased depending on the effect and tolerance. Maximum daily intake equal to 240 mg. Side effects include hypotension, constipation, fluid retention in the body (edema). Verapamil is contraindicated in a number of diseases:

• serious violations of alveolar transmission;
• sinus node weakness syndrome (sick sinus syndrom);
• sinus bradycardia;
• heart failure;
• hypotension;
• aortic stenosis.

A good effect in the prevention of migraine shows the use of Cinnarizine (75 mg / day). Reception begins with a fairly low dose of 2-3x25 mg / day.

The effect of Nimodipine and Nifedipine in the prevention of migraine has not been reliably studied.

Antiepileptic drugs

Antiepileptic (another name - anticonvulsant) drugs play an indispensable role in the prevention of migraine attacks. These are the first choice drugs for migraine accompanied by epilepsy, bipolar disorder, anxiety, Raynaud's disease, diabetes.

Gabapentin in controlled studies demonstrated high efficiency. The recommended dosage is 600-1800 mg/day, with a higher dose (2400 mg/day) the prophylactic efficacy is significantly increased. High doses are also used for drug-resistant migraine and daily headache. The undeniable advantage of Gabapentin - low frequency side effects. However, it should be started at a low dose and gradually increased according to tolerance and efficacy.

Topiramate demonstrated nice results in 2 placebo-controlled studies. The recommended daily dose is 100 mg. Side effects of the drug include paresthesia, taste disturbance, loss of appetite followed by weight loss, memory impairment.

Topiramate and Gabapentin are the drugs most commonly used to prevent migraines and to suppress signs of illness in a child.

Antidepressants

Drug prevention of migraine from all groups of antidepressants includes only tricyclic antidepressants. The mechanism of action of these drugs is the inhibition of 5-HT2 receptors. The most commonly used medicine is Amitriptyline in the recommended daily dose 25-100 mg. Reception begins with 25 mg, the dosage is gradually increased.

Nortriptyline has less sedative effects, taken at 10-150 mg / day.

Both drugs also inhibit the uptake of norepinephrine and serotonin. Therapy and prevention of seizures with these drugs is recommended, in particular, in patients with comorbid depression, anxiety, sleep disorders, or other disease syndromes. The most common side effects include fatigue, drowsiness (should start at a low dose), dry mouth, increased appetite, weight gain.

Serotonin antagonists (5-HT2 receptor antagonists)

This is a group of previously popular prophylactic agents that modern medicine rarely used. 5-HT2 receptor antagonists have anticholinergic and antiradikinin effects in addition to their direct effects on serotonin receptors and antihistamine properties. Some drugs also affect dopamine receptors. The best-known substance in this group is Pizotifen. This is a means for the prevention of migraine, the peak of which falls on the 60-70s of the XX century.

Pizotifen reduces platelet aggregation, inhibits the permeabilizing effect of serotonin, has an antihistamine, anticholinergic effect. The full therapeutic dose is 1500 mg / day (in 3 daily doses of 500 mg). The most common side effects are: drowsiness, decreased attention, a significant increase in appetite, and therefore an increase in body weight.

Cyproheptadine, due to its good tolerability, is used mainly in children. It is a sedative H1 antihistamine, an anticholinergic drug. In adults, it is used, in particular, for hormonal migraine in the daily prophylactic dose 4-8 mg.

Non-pharmacological preventive methods

In addition to medical approaches, migraine can be treated and prevented through lifestyle changes, physical therapy. The doctor, together with the patient, tries to identify provocative factors that can cause an attack - this helps to some extent provide for the onset of pain.

The most common factors are:

• lack or excess of sleep;
• hypoglycemia;
• excessive alcohol consumption;
• fatigue;
• stress;
• exhaustion;
• dehydration, etc.

These triggers can be influenced by a person. But there are incentives that cannot be eliminated. These include hormonal changes(appearance of attacks during menstruation), weather effects (especially rapid changes atmospheric pressure). If the patient knows his triggers, he can try to avoid them by reducing the frequency of migraine attacks.

Non-pharmacological methods of prevention include:

• acupuncture;
• relaxation;
• autogenic training;
• light exercise;
• yoga
• meditation;
• walk outdoors.

Homeopathy and folk methods

Folk remedies for prevention are, first of all, herbs that play an indispensable role in the fight against many ailments. Mint, chamomile, ginger, Baikal skullcap are recommended for migraine.

• Mint. To prevent and relieve headaches, mint can be used as a raw material for tea or essential oil(aromatherapy).
• Chamomile. In the absence of an allergy to chamomile, the plant is used in the form of a tea or bath.
• Ginger. The root is used as a tea.
• Baikal skullcap. This herb is not recommended for children under 6 years old, it has a mild analgesic effect, so it is suitable for less severe attacks.

Homeopathy suggests the following substances for migraine prevention:

• Bryonia;
• Gelsemium sempervirens;
• Nux vomica;
• Staphysagria;
• Kalium phosphoricum.

Application homeopathic remedies should be carried out under the supervision of a specialist. The drug is taken in a dilution of 15 CH.

Migraines are caused by stress, poor nutrition, heredity; the disease is often associated with the menstrual cycle, the use oral contraceptives. Frequent use painkillers reduces their effectiveness, can contribute to chronic headache, so it is important to prevent the development of this condition.

Avoid stress

Frequent migraine attacks indicate unsatisfactory mental health person. For effective prevention important to avoid stressful situations. If you cannot eliminate the factors that cause stress, you should change your attitude towards them so that certain situations affect your mental state as little as possible.

Lead a healthy lifestyle

An important role in the prevention of migraine is played by lifestyle changes, sufficient hydration of the body, and relaxation. If there are precursors to migraine (for example, impaired visual perception), you can try to prevent the further development of an attack by using a large number fluids and adequate rest. Set aside work, close your eyes, relax. You need complete peace of mind, including turning off the TV, computer.

Eat Right

The conclusions of the last scientific research show that migraine is closely associated with vitamin deficiency, namely vitamins D, B6, B12. Therefore, it is important to pay attention to foods rich in them.

Vitamin D

In addition to getting rid of the suffering caused by severe headaches, vitamin D is important for the formation and strength of bone tissue, work thyroid gland, nervous system; it has a positive effect on blood clotting. The main source of vitamin D is Sun rays. After 10 minutes in the sun, the body will begin to produce it on its own. Vitamin D is also found in fish oil, milk, eggs, butter, avocado.