People who suffer from migraine (read more about migraine in our article "") suffer regular bouts of unilateral throbbing moderate or severe headache, accompanied by nausea or photophobia, or sound phobia, or all of these together. These attacks usually begin after age 40, but can occur in childhood and adolescence. The frequency of seizures varies significantly in different patients. Chronic migraine is diagnosed when attacks occur more than 15 days per month.
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International criteria for migraine without aura
At least five seizures qualifying for items A-C
A. Headache attack lasts from 7 to 72 hours (without or with treatment),
b. Headache has at least two of the following characteristics:
- located on one side of the head
- has a pulsating character
- has medium or high intensity,
- exacerbated by normal physical activity
C. With pain, at least one of the following occurs:
- nausea or vomiting
- photophobia or sound sensitivity
D. No association with other diseases
In population studies, the prevalence of migraine is estimated at 10%. The disease affects women more often than men. The important role of heredity in the development of migraine is clearly traced.
The World Health Organization ranks migraine 19th among the diseases leading to disability.
Recently, methods of treatment and prevention of migraine have been developing rapidly, but the coverage of patients with adequate treatment remains insufficient.
When should migraine prophylaxis be carried out?
There is no single approach to the problem of migraine prevention. Most experts consider prescribing drug prophylaxis if the following criteria are met:
- the quality of life, the ability to perform official duties or attend classes are significantly reduced,
- two or more migraine attacks per month
- migraine attacks are poorly stopped by the treatment prescribed to stop them,
- there is a frequent, prolonged aura that causes discomfort
The appointment of prophylactic treatment requires the patient to understand that its effectiveness can be reduced if drugs are used improperly in stopping seizures. So analgesics should not be used more than 15 days a month, and their combinations with other drugs for stopping seizures - 10 days a month.
What are the goals of preventive treatment for migraine?
The main goal is to reduce the frequency and severity of seizures. It is important to understand that migraine is currently incurable and it is important to reduce the adverse effect it has on a patient's life.
An important goal of preventive treatment is to reduce the risks associated with active treatment of migraine attacks (side effects of the drugs used in this case) and the frequency of seeking medical help.
What medications are used to prevent migraines?
Beta-blockers (beta-blockers)
The efficacy of propranolol and metoprolol in migraine prevention has been studied in large studies. Propranolol has been found to be effective for short-term use, but there are no data on long-term use. The use of long-acting drugs creates convenience in the form of a single dose during the day. It is preferable to use beta-blockers in patients with high blood pressure. Use in patients with asthma is contraindicated. Use in depression should be done with caution.
Calcium channel blockers
Some patients may benefit from common drugs in this group such as amlodipine and verapamil. Caution should be exercised in patients receiving drugs for the treatment of hypertension, due to the likelihood of an excessive decrease in blood pressure.
Other drugs for hypertension
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have been studied as potential agents for the prevention of migraine attacks, although due to the lack of specific data, these drugs are regarded as second- or third-line agents in the treatment of migraine.
Studies have found that lisinopril reduces both the number of migraine days. So is its intensity.
Both of these drug classes can be alternatives to beta-blockers and calcium antagonists.
Antidepressants
The tricyclic antidepressant amitriptyline has been shown to be beneficial in several randomized trials and is regarded as a first-line drug.
The dose of amitriptyline for the prevention of migraine is lower than the dose recommended for the treatment of depression and the benefit in migraine is independent of that in depression. Other tricyclic antidepressants, such as protriptyline and nortriptyline, have also been shown to be beneficial, although data are not yet available for inclusion in clinical guidelines.
When taking antidepressants, constipation and dry mouth may occur.
Effective in preventing migraine attacks and selective serotonin reuptake inhibitors (Venlafaxine). These drugs may be the means of choice in patients suffering from fibromyalgia as well.
Antiepileptic drugs
Valproate and Topiramate are considered as first-line drugs in the prevention of migraine according to the data of the conducted studies. There is reason to believe that the entire class of antiepileptic drugs is well tolerated by patients with migraine and can reduce the duration, frequency and intensity of attacks. The use of Valproate should be evaluated with caution in women of childbearing age due to possible effects on the development of the fetal nervous system. When using the drug, weight gain, hair loss, trembling can be observed. In turn, taking Topiramate leads to weight loss. Relative contraindications to its use are kidney stones. Topiramate is regarded as the drug of choice in patients. Taking excessive amounts of drugs to relieve migraine attacks. Lamotrigine may be helpful in preventing migraine with aura.
Nutritional supplements and herbs
Some vitamins, minerals, and herbal remedies may be used in patients who refuse to take regular medications. Butterbur hybrid reduces the frequency of migraine attacks (according to some reports, by almost 50%). However, those who decide on herbal medicine should remember. That the leaves of this plant are carcinogenic and can only be used for treatment when processed. Coenzyme Q10 reduces the frequency of attacks, but it does not affect the severity of attacks and thus does not reduce the amount of medication taken during an attack. Data on the effectiveness of tansy maiden has not been confirmed.
Botulinum toxin A
In recent years, the use of Botulinum toxin A has attracted the attention of doctors. There are no exact data on effectiveness yet, but empirical use is allowed in many countries. The drug is administered every three months in the form of injections into 31 points. Among them are the forehead, temporal muscles, suboccipital region, cervical and trapezius muscles.
Human monoclonal antibodies
It is possible that the problem of drug prevention of migraine can be completely solved by using drugs from the class of monoclonal antibodies. One such drug, erenumab (Aimovig co-developed by Amgen and Novartis), is already under consideration by the US Food and Drug Administration (FDA). Reliable data have been obtained that Aimovig significantly reduces the frequency and severity of migraine attacks by inhibiting the activity of a neuropeptide (hormone of the nervous system) encoded by the calcitonin gene.
Other drugs of this class are also on the way: eptinezumab, galcanezumab, and fremanezumab.
When should prophylactic migraine treatment be stopped?
Prophylactic treatment is discontinued in patients whose migraine attacks continue to have the same frequency, duration, and intensity. That is, preventive treatment of migraine is ineffective.
In cases of effective therapy, the decision to terminate it is made individually.
In about 70% of cases, competent migraine prevention avoids the development of a hereditary disease and even cures the first signs. This is not only about taking medications and constant monitoring by a neurologist, but also about some additional measures that are simply necessary to follow. Sometimes drugs do not work if they are not combined with vitamins, ointments and other auxiliary folk remedies for headaches.
Causes of migraine
Migraine is a disease that has a local character and develops over the years. The causes of the headache in this case are difficult to establish: it can be hereditary vascular weakness, problems with pressure, or the so-called. seasonal migraines that arise from changes in the weather, during the menstrual phases.
They say that it is not difficult to distinguish a migraine from a headache: whoever suffered from the first one at least once will definitely not confuse it with an ordinary stress one. The sensations are 5-6 times stronger, they are not relieved by conventional drugs, and if timely treatment is not carried out, the attacks increase and eventually reach several days. However, our goal is not to intimidate, but to prove the benefits of prevention, because it is more effective at the stage of youth.
Whereas the treatment itself at a later age may not bear fruit.
The word "migraine" comes from the Greek "hemicrania", literally "half of the head". Usually the nature of the headache is half-hearted, but it can also be concentrated in the back of the head, and in the top of the head, and even in the neck.
Even in ancient times, when the prevention of diseases like migraine was carried out by folk remedies, its symptoms could be recognized instantly:
- The headache is throbbing and cutting.
- Signs may be exacerbated by irritants such as drugs, food, smells, bright lights, and loud noises.
- Sometimes migraines get worse with treatment.
- Prevention of migraine should be of a regular nature, since headache attacks can occur at intervals of 2-4 times a month, or even every day.
The mechanism of action of the disease is explained by the expansion of cerebral vessels. Neither tumors, nor infections, nor concussions can be cured by folk remedies alone or by taking the same drugs as for migraine. This disease is often transmitted through the female line, and to activate it, it is enough to change the biochemical composition of the blood, hormones or stress.
How to Avoid Migraines
First of all, the disease is provoked by food and aromatic additives included in our diet. It has been proven by doctors who carry out treatment that competent prevention of migraine should exclude fatty and sweet foods, as well as spices from the diet: cardamom, nutmeg, cinnamon, red pepper, all these are provocateurs. Also, headaches are caused by chocolate and some, especially smoked cheeses. From drinks - alcohol, of course, as well as caffeinated drinks like coffee or green tea.
The behavioral factor is also important in prevention planning. Try to remember what situations provoked the condition: phobias or stress, changes in the weather, or getting out of bed late. It also happens that no drugs will save a person from a migraine after communicating with an unpleasant person. In any case, prevention should be based on a competent daily routine. You need to work in moderation, taking breaks and always reserving the right to days off, vacation, leisure.
If you sleep less than 6 hours a day, this can negate the treatment. But a long sleep - more than 9-10 hours also causes headache attacks.
Doctors advise: equalize your daily routine on workdays and weekends as much as possible. You need to get up at the same time as you go to bed, take your medications on schedule, drink the same amount of coffee or tea, and eat equally light meals. If there is time for treatment with folk remedies - a mask, preparation and use of herbal tea, or gymnastics, do not miss the opportunity. The main thing is to drink as much clean water as possible - the norm for an adult is 30 ml per 1 kg of body weight. After all, our vessels, like blood, are made up of fluid, and it needs to be replenished constantly.
If the patient feels that the usual drugs no longer save, and the so-called aura arises - fear of light, dizziness, nausea and other symptoms of an approaching headache, lie down to rest with a cool compress in a dark room and try to relax. It is necessary to completely turn off the brain from work, remove sound stimuli and pungent odors. Ideally, the best treatment is sleep, you can take sleeping pills and sleep.
Prevention with pills
It is advisable to remove migraine attacks with potent drugs. But with frequent recurrence of headaches, they should not be abused. For example, Ergotamine can even lead to necrosis of brain tissue if used frequently. But in the treatment of folk remedies, for example, belladonna and the addition of sedatives, it is suitable for getting rid of migraine pains and dystonia. The dose is not more than 0.3 mg.
Also, from the folk first-aid kit, such a remedy as ergot migrated to medicine. Treatment based on its alkaloids in the form of a 0.2% solution can be done regularly, at 15-20k. Inside on an empty stomach. In the absence of it, it is replaced by Redergin or Gidergin 1.5 mg 2-3 times a day. In order for the treatment to have an effect, the drugs must be taken as a prophylaxis for at least six months. First, start taking small doses.
By the way, recently scientists in the West discovered that the hormone of happiness - serotonin can be stimulated and used to treat migraine. Drugs such as Deseryl and Sandomigran act as catalysts. Effectively cope with the disease and beta-blockers, for example, the new drug Atenolol 50-100 mg.
As for antidepressants, you need to be careful with them - drugs like Melipramin or Azafen are addictive. Doctors also note the effectiveness that treatment with Sumotripan brings, but its administration is categorically contraindicated for those who have heart defects and ischemic vascular diseases.
Migraine prevention is just as important as the treatment itself. If the patient wants to forget once and for all about excruciating headache attacks, he should carefully follow the recommendations for the prevention of the disease. Otherwise, frequent seizures can significantly reduce the quality of his life.
Migraine is an unpleasant phenomenon that creates serious discomfort for its owner. The pain can be so severe that the patient cannot lead his usual lifestyle: work, study, attend events. For this reason, migraine is necessarily subject to treatment, and in some cases, prevention.
First of all, preventive measures are necessary for people who have ever experienced a migraine attack. In this case, the doctor gives recommendations that can reduce the likelihood of a recurrence of the disease. Such prevention is called secondary.
The primary type is aimed at preventing the onset of migraine in individuals who have never experienced attacks, but have an increased risk of them. This group may include:
- Children who have a hereditary predisposition. For example, if both parents periodically suffer from migraines, then their child is more likely to face a similar problem;
- Children with a number of neurological disorders, for example, who suffered from hypoxia during fetal development;
- Persons with a disturbed hormonal background;
- Persons who are often under stress. Most often this is due to a large amount of work and high responsibility;
- Persons who frequently interact with bright light sources, flashes, monitor screens. It may also be related to the nature of the work;
- Adolescents during puberty;
- Persons with a disturbed daily routine and suffering from chronic lack of sleep;
- Persons who do not tolerate the process of acclimatization.
In addition, it is worth remembering that the likelihood of a migraine increases with prolonged inflammatory processes, allergic reactions, and nervous exhaustion.
The main goal of prevention
Prevention of migraine attacks should be selected as carefully as the treatment itself. First of all, preventive actions should be aimed at finding out the factors that provoke the disease. Only by identifying them and excluding them from the patient's life can he hope for a good result of the measures taken.
So, for example, if the headache provoker is the intake of foods with a high content of tyramine, then until the patient reduces their consumption, the treatment will not have the desired effect.
To prevent migraine, the doctor should develop such a complex of drugs or procedures that can provide:
- Reducing the frequency of seizures and their duration;
- Relief of the nature of seizures;
- Improving the effectiveness of the treatment;
- Minimizing the risk of severe consequences and disability;
- Improvement in the general condition of the patient.
Thus, prevention should be carried out not unilaterally, preventing attacks, but comprehensively, providing a general improvement of the body.
The most effective drugs
Medicines for the prevention of migraine quickly and effectively cope with their function. As a rule, their action is aimed not only at pain relief, but also at actions such as vasodilation, stimulation of blood circulation, normalization of sleep and psycho-emotional state. All medicines should be taken only with the prescription of the attending physician.
This drug is a combination of components such as dihydroergocryptine and caffeine. They provide an analgesic effect due to the desensitization of the central receptors of the nervous system. In addition, the product, produced in the form of tablets and drops, stimulates blood circulation in the brain area.
While taking the medicine, the patient experiences:
- Expansion of capable vessels;
- Elimination of signs of hypoxia and asthenia;
- Increased performance, both physical and mental;
- Stimulation of the respiratory center.
The drug is usually given to patients who experience migraine attacks at least twice a month. The duration of one course of treatment is 3-4 months, during which the patient takes the drug 2 times a day with meals.
Proroxan is an effective remedy for migraine prevention One of the ways to prevent migraine medication is to take Proroxan tablets. The components of the drug are able to block some types of brain receptors, which allows you to get rid of the feeling of pain. In addition, the drug performs the following functions:
- Expands blood vessels and eliminates their spasm;
- Stimulates blood flow and blood supply;
- Suppresses the excitability of some brain structures.
The standard treatment regimen involves taking up to 30 mg of the drug 2-3 times a day. But the exact dosage, as well as the duration of the course, can only be prescribed by the attending physician. Otherwise, the drug can provoke the occurrence of side effects such as impaired stool, hypotension, arrhythmia, bradycardia.
Botox is a well-known botulinum toxin drug widely used in the field of cosmetology. It is based on a natural protein that can affect muscles and nerve endings. Not everyone knows, but Botox is also an excellent tool for the prevention of migraine attacks.
During the procedure, the patient is injected with a substance in the areas of the head in which pain is localized. It can be the forehead, temples, neck, neck and even nose. Once in the body, Botox blocks the nerve endings, and, on the contrary, relaxes the muscles. All this allows you to stop pain syndromes for an average of 3-5 months.
Since botulinum toxin is a natural substance, over time it is independently excreted from the body. If the effect of the drug has ended, and the headaches begin to reappear, you can repeat the procedure. It is important that the procedure is carried out by a qualified specialist, since the wrong dosage can cause discomfort in the injection area.
This drug is also included in the list of medicines for the prevention of migraine. It belongs to the group of homeopathic medicines and is a sublingual lozenge. Depending on the degree of exacerbation of symptoms, resorption of up to 4 tablets is allowed with an interval of 15 minutes.
Taking Spigelon provides:
- analgesic effect;
- Elimination of spasms;
- Normalization of sleep;
- Calming action;
- Elimination of attacks of dizziness.
It is also capable of acting as an antidepressant. The drug has a good analgesic effect, but is prohibited from taking:
- Children under 3 years old;
- Persons suffering from lactose intolerance;
- Persons with individual intolerance to the components of the drug.
Non-pharmacological means of prevention
The peculiarity of non-drug prophylaxis is the minimum number of side effects. But do not neglect the advice of a doctor and carry out these procedures on your own, since in most cases they require professional training and knowledge.
Massage
One of the most effective methods to prevent the occurrence of migraine is massage. It is usually carried out not only on the head area, but also on the cervical-collar zone. With the right technique, you can expect results such as:
- Pressure stabilization;
- Normalization of metabolic processes;
- Stimulation of blood circulation and, accordingly, nutrition of blood vessels and brain tissues;
- Activation of the regeneration of damaged cells and nerve endings;
- Elimination of pain.
And, of course, massage promotes relaxation, and this is not an unimportant factor for people suffering from frequent migraine attacks. In most cases, after a course of massage, patients note an improvement in their psycho-emotional state and normalization of sleep.
In this case, it is not necessary to resort to the help of professional specialists; it is quite possible to master the massage technique on your own. All movements are carried out smoothly and without much effort. Areas massaged with fingertips:
- Between the eyebrows and above them;
- Near the outer corners of the eyes;
- Viskov;
- Nape.
Reflexology
Reflexology is also known as acupuncture. It can even be used to prevent migraine with aura. Unlike massage, reflexology cannot be carried out independently. The procedure is carried out by a qualified specialist, since improper stimulation of the points may not only not have a positive result, but, on the contrary, worsen the general condition of the patient.
Prevention of migraine with the help of reflexology is carried out if:
- Attacks occur at least 2 times a month;
- Medicines do not have the desired effect or the patient has contraindications to them;
- There are complications associated with the disease.
One course of acupuncture can include up to 12 sessions. At the same time, to achieve a really good effect, as a rule, it is necessary to conduct at least 2-3 courses.
Manual therapy
Manual therapy, like acupuncture, should only be performed by a qualified professional. Its essence lies in carrying out certain techniques, which, unlike classical massage, can affect not only the muscles, but also the joints and even blood vessels.
This method is most preferable if headaches are caused by problems in the structure of the cervical spine, for example, osteochondrosis. Such therapy allows you to relieve tension from the muscles, restore the correct structure of the vertebrae, stimulate joint mobility, and eliminate pain.
Psychotherapy
If the cause of frequent migraine attacks is not a physical pathology, but a psychological one, then a visit to a psychotherapist can become a method for solving the problem. The patient will be offered various types of therapy, such as auto-training. It consists in working out one's own consciousness and self-hypnosis. The result of such actions can be a complete disposal of hemicrania and an improvement in the general condition of the body.
This method is usually suitable for people living in metropolitan areas or associated with nervous work.
Blackcurrant juice - a folk remedy for the prevention of migraine attacks Folk recipes for migraine prevention
Despite the fact that the effectiveness of drugs in the prevention of migraine has been scientifically proven, many patients prefer not to immediately seek their help, but to solve the problem in a more gentle way. For this, various methods of alternative medicine are used, which in some cases can indeed have a good result.
Migraine prophylaxis with folk remedies can also be carried out as an addition to the main drug therapy. These methods come down to use:
- Strong tea or coffee. Everyone knows that these two drinks can relieve headaches by increasing blood pressure and tonic effect;
- Valerian. Its crushed root is brewed with boiling water, after which it is taken 1 tablespoon every day;
- Melissa. The herb is brewed in boiling water and taken daily in 3 tablespoons;
- Blackcurrant. A quarter cup of the juice of this berry is taken 3 times a day to prevent headaches.
In fact, the list of folk methods for migraine prevention is quite extensive, but it should be understood that the effect of them is not guaranteed, and if attacks occur more often and there is a risk of complications, then it is imperative to connect drugs.
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 to 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:
- Sleep compliance. You can not fall asleep under the TV, music, conversations, with the lights on.
- Prevention of stress. You need to learn to control emotions, relax, do what you love.
- Relaxing massages.
- Prophylaxis with drinks (coffee, herbal tea) if these drinks do not cause a reaction.
- 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 cause headaches even in healthy people.
- 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.
Cold lotions on the temples and acupressure can help relieve pain. Use all of these remedies and they will help you cope with painful and prolonged migraine attacks.
Since migraine attacks can provoke various factors, it is necessary to determine them for each patient and decide how best to eliminate or weaken them. It is important to rationally organize the regime of work and rest, including sufficient, but not excessive sleep.
Since stressful and conflict situations affect the development of migraine attacks, despite the fact that many patients do not attach significant importance to them, it is important to discuss this aspect with them. If negative circumstances cannot be eliminated, it is advisable to consult a psychologist, who may prescribe psychological methods of treatment (autogenic training, biofeedback treatment, etc.). The latter are especially indicated for increased anxiety and mood deterioration.
In some women, taking oral contraceptives causes the first migraine attack in their life or increases the frequency of previous ones. In these cases, another type of contraception should be recommended. Sometimes, on the contrary, the use of oral contraceptives reduces the frequency and intensity of seizures.
Many patients report that certain foods and drinks provoke migraine attacks in them and therefore exclude or limit their use. These foods include cocoa, chocolate, cheese, milk, nuts, eggs, tomatoes, celery, citrus fruits, fatty foods, alcohol, especially red wine and beer. It is advisable for some patients to wear light-protective glasses, especially in the summer, since bright light can provoke seizures.
Prevention of migraine with drugs
The use of drugs to prevent migraine attacks is indicated only for frequent (two or more per month) and severe attacks and, therefore, it is necessary only for a small (no more than 10%) part of patients. In most cases, the duration of treatment is several months.
Groups of pharmacological drugs used to prevent migraine:
- beta-blockers;
- tricyclic and tetracyclic antidepressants;
- calcium channel blockers;
- anticonvulsants;
- non-steroidal anti-inflammatory drugs;
- antagonists of serotonin.
Beta-blockers are first-order drugs for the prevention of migraine, The mechanism of their action is not completely clear. The effectiveness of beta-blockers in the prevention of migraine attacks is associated with inhibition of the dilatation of cranial arteries and arterioles, which occurs due to a decrease in the concentration of serotonin. They have a hypotensive effect and therefore are especially effective for the prevention of migraine occurring against the background of arterial hypertension. Due to their anxiolytic action, beta-blockers are also effective for migraine against the background of severe anxiety, it is necessary to warn patients about the main side effects of beta-blockers (fatigue, drowsiness and depression) in order to recognize them as early as possible. |
Migrainemigraine attackMigraine treatmentMigraine PreventionAlternative treatment of migraineAyurveda for migraine treatment |
Those who have physical activity should be warned about a possible decrease in heart rate so that they do not dose the load depending on its indicators. Drugs in this group contribute to hypoglycemia, which leads to increased appetite and weight gain. This causes additional concern for women who are overweight. The main contraindications for the use of beta-blockers: bronchial asthma, heart failure, atrioventricular conduction disturbances, arterial hypotension. Beta-blockers should not be abruptly discontinued in patients with coronary heart disease, as this may exacerbate ischemia and cause arrhythmia.
If one beta-blocker is ineffective, another should be tried, it may be more effective. In other words, a lack of response to one beta-blocker does not preclude the use of another.
Beta-blocker drug for migraine prevention: Propranolol
The action of Propranolol is due to the effect on the vessels of the pia mater, which has beta-adrenergic receptors. It penetrates well through the blood-brain barrier, has antiserotonergic activity, affects platelet aggregation. For the prevention of migraine, the drug is taken at an initial dose of 40 mg 2-3 times a day; if necessary, the dose is gradually increased to 160 mg per day. Side effects: slow heart rate, arterial hypotension, heart failure, dry mouth, nausea, sleep disturbance, depression, impaired visual acuity, skin rash. Contraindications: atrioventricular blockade, slowing of the heart rate less than 55 beats per minute, arterial hypotension, acute and chronic heart failure, Raynaud's disease and other obliterating vascular diseases. Release form: 40 mg tablets, 30 pcs in a pack.
Similar drugs are produced under the names:
Anaprilin (ICN Leksredstva, Russia); Inderal (ICN Galenika, Yugoslavia); Inderal (Astra Zeneca, UK); Obzidan (AWD, Germany); Obzidan (Schwarz Pharma, Germany); Propra (Ludwig Merckle, Austria); Propranolol (Weimer Pharma, Germany); Propranur (Henning Berlin, Germany); Propranolol (Sicomed, Romania).
Beta-blocker drug for migraine prevention: Atenolol
It is a selective beta-blocker. When used in medium therapeutic doses, it has a less pronounced effect on smooth muscle elements of peripheral arteries than non-selective beta-blockers. It is used in the initial dose of 50 mg 1 time per day. With insufficient severity of the effect, the dose is increased to 100-150 mg per day. The drug is recommended to be taken before meals, without chewing, drinking water. Side effects: at the beginning of therapy, fatigue, dizziness, depression, sleep disturbance, nausea, pruritus are possible; in some cases, there may be a slowdown in the heart rate, hypotension, impaired conduction of the heart. Contraindications: violation of atrioventricular conduction of 2-3 degrees, slowing of the heart rate below 55 beats per minute, acute and chronic heart failure, bronchial asthma. Release form: tablets of 50 mg and 100 mg.
Similar preparations are produced under the names Apo-Atenol (Apotex, Canada); Atenolol (Lupin, India); Atenobene (Ludwig Merckle, Austria); Atkardil (Sun Pharmaceutical, India); Betacard (Torrent, India); Dignobeta (Luitpold Pharma, Germany); Catenol (Cadila, India); Prinorm (ICN Galenika, Yugoslavia); Tepolol (Irsa, India); Tenormin (Astra Zenes, UK): Falitonsin (Salutas Fahlberg-List, Germany); Atenolol (IC En Marbiopharm, Russia).
Beta-blocker for migraine prevention: Korgard (Bristol-Myers Squibb, USA)
Contains active ingredient - nadolal- non-selective beta-blocker of prolonged action. It is used in the initial dose of 40 mg, if necessary, the dose of the drug can be increased to 160 mg. Side effects: slow heart rate, atrioventricular block, bronchospasm, heart failure, dizziness, nausea, skin allergic reactions. Contraindications: atrioventricular blockade of 2-3 degrees, heart rate slowing below 55 beats per minute, acute and chronic heart failure, Raynaud's disease, severe liver and kidney dysfunction, diabetes mellitus, pregnancy. Release form: tablets of 40 and 80 mg.
Antidepressants for migraine prevention
Antidepressant drug for migraine prevention: Amitriptyline (Polfa, Poland)
An effective drug for the prevention of chronic headaches, especially mixed forms, such as a combination of migraine and tension headache. The drug blocks the reuptake of serotonin from the central synapse and has a central analgesic effect, as it reduces the frequency of discharges in the spinal nucleus of the trigeminal nerve - the main zone of craniofacial pain sensitivity in the central nervous system. The analgesic effect of tricyclic antidepressants does not depend on their antidepressant effect, although the latter is undoubtedly important for patients with migraine in combination with depression and sleep disorders. In addition, Amitriptyline has a sedative effect, which is important in comorbid anxiety disorders. For the prevention of migraine, as a rule, small doses of the drug are required. Amitriptyline is prescribed initially at a dose of 12.5-25 mg / day at night, gradually increasing it by 12.5-25 mg every 3-6 days to 75-100 mg / day. The therapeutic effect begins from the 2-3rd week, which should be warned patients. It should be remembered about the side effects associated with the anticholinergic effect of the drug: dry mouth, constipation, accommodation disorders, Contraindications for the use of Amitriptyline: recent myocardial infarction, MAO inhibitors and a period within two weeks after their withdrawal, glaucoma, prostatic hypertrophy, chronic heart failure, accompanied by tachycardia. Release form: dragee 25 m.Similar drugs are produced under the names Amitriptyline (Slovakofarma, Slovakia); Amitriptyline (Weimer Pharma, Germany); Amitriptyline Lechiva (Lechiva, Czech Republic); Amitriptyline Nycomed (Nycomed, Norway); Amitriptyline (ICN Polfa Rzeszow, Poland).
Antidepressant drug for migraine prevention: Lerivon (Organon, Netherlands)
Active substance - mianserin. Blocks 5HT2 and alpha2-adrenergic receptors. Enhances adrenergic transmission in the brain, stimulating the release of the neurotransmitter into the synaptic cleft. Unlike most tricyclic antidepressants, it does not show anticholinergic activity. Rapidly absorbed from the gastrointestinal tract. The maximum concentration of the drug in the blood after taking 15 mg is reached after 2-4 hours. Lerivon is recommended to be prescribed at night, starting with a dose of 15 mg, followed by an increase in 3-5 days to 30 mg. The maximum daily dose is 120 mg. The main side effects of the drug are drowsiness, arterial hypotension, impaired liver function, and edema. Contraindications: manic syndrome, liver dysfunction, acute period of infarction, age up to 18 years. Release form: tablets of 10, 20, 30 and 60 mg.
Similar drugs are produced under the names Miansan (Zorka-Pharma, Yugoslavia); Seridak (Cadila, India).
Antidepressants, as well as beta-blockers, are effective for migraine (or tension headache) accompanied by psychogenic autonomic crises (panic attacks). When prescribing antidepressants, as well as other psychotropic drugs, it is necessary to systematically monitor the patient's condition.
Calcium channel blockers for migraine prevention
This group of drugs has firmly established itself as a means of preventing migraine, despite the fact that their therapeutic efficacy is not as pronounced as compared to beta-blockers and antidepressants. It is advisable to use them in migraine accompanied by neurological manifestations, for example, in basilar or hemiplegic migraine, migraine with ophthalmic, ophthalmoplegic or prolonged aura. Calcium channel blockers also inhibit the release of serotonin, alter slow potential shifts, and prevent pervasive depression, which is considered one of the mechanisms of migraine attack.
Calcium channel blocker drug for migraine prevention: Verapamil
Calcium antagonist, blocks both activated and "closed" (prevents their activation) calcium channels. Ultimately, tissue perfusion increases, arterial extensibility increases, and the disproportion between the need and supply of oxygen to the tissue decreases. Verapamil is usually used at a dose of 40-120 mg per day. Side effects: dyspeptic disorders, bradycardia, hypotension, heart failure, allergic reactions. Contraindicated in hypersensitivity, severe bradycardia, heart failure, acute myocardial infarction, impaired cardiac conduction. Release form: dragee 40 and 80 mg.Similar drugs are produced under the names: Verapamil (Hemopharm, Yugoslavia); Verapamil (Weimer, Germany); Verapamil hydrochloride (ICN October, Russia); Verapamil hydrochloride (Akrikhin, Russia); Isoptin (Knoll, Germany); Isoptin (German Remedies, India); Kalan (Vitas Corporation, USA); Falicard (Solutas Fahlberg-List, Germany); Finoptin (Orion Corporation, Finland).
Calcium channel blockers for migraine prevention: Nemotan
The active substance of the drug is nimodipine- a selective 2nd generation calcium antagonist from the group of dihydropyridines, which has a selective effect on the smooth muscles of the cerebral arteries. Eliminates spasm of blood vessels, improves blood supply to the brain, has a systemic antihypertensive effect. When using the drug, the "steal syndrome" does not develop. Nemotan is successfully used for the prevention and treatment of ischemic cerebrovascular accidents, treatment of cerebrovascular accidents in elderly patients (memory loss, concentration of attention, emotional lability), as well as the treatment of residual effects of cerebrovascular accidents and the condition after surgery for subarachnoid hemorrhage. Prevents the development of strokes. Effective in chronic cerebrovascular insufficiency and migraine, cerebrovascular disorders. Well tolerated by patients. Of the side effects, arterial hypotension, hyperemia of the skin, headache, and heart rhythm disturbances can sometimes develop. In some cases, sleep disorders, increased psychomotor activity, aggressiveness, and depression are possible. During periods of pregnancy and lactation, Nemotan is used only for health reasons. Use the drug with caution in patients with impaired renal function. Available in the form of tablets containing 30 mg of the active substance.
Calcium channel blocker drug for migraine prevention: Nimotop
Active substance - nimodipine. Calcium antagonist, has a vasodilating effect mainly in relation to cerebral vessels. Relieves and prevents spasm of the arteries of the brain, causes their expansion and improvement of the blood supply to the brain, has a neuroprotective effect. It is used orally at 60 mg 4 times a day. Side effects: a feeling of heat, tachycardia, hypotension, dizziness, sleep disturbance, hyperkinesis, impaired renal function, peripheral edema. Contraindications: severe liver dysfunction, marked increase in intracranial pressure, pregnancy. Release form: tablets of 30 mg.
Calcium channel blocker drug for migraine prevention: Nimotop S
It blocks calcium channels, has a selective vasodilating effect on the brain, normalizes its blood supply, and improves ischemia tolerance. It is used intravenously at the beginning of treatment, 2 mg (10 ml of solution) for 2 hours, then 2 mg per hour, daily dose - 10 mg. Side effects: hyperemia, tachycardia, hypotension, dizziness, hyperkinesis, impaired renal function, peripheral edema. Contraindications: severe liver dysfunction and pregnancy. Release form: solution for infusions of 10 mg in 50 ml in a 50 ml vial.Calcium channel blocker drug for migraine prevention: Octidipine
A drug nitrendipine. By enhancing coronary blood flow, the drug improves blood supply to ischemic areas of the myocardium without the development of the "steal" phenomenon, activates the functioning of collaterals. Does not inhibit myocardial conduction, enhances renal blood flow. Octidipine is available in the form of 20 mg tablets.
Flunarizine (10 mg/day) and nimodipine (60-120 mg/day) are also effective. Possible side effects: dizziness, fatigue, nervousness. Contraindications to the use of this group of drugs: bradycardia, atrioventricular blockade, Wolff-Parkinson-White syndrome, chronic heart failure. Calcium channel blockers can be combined with tricyclic antidepressants.
Anticonvulsants for migraine prevention
The use of anticonvulsants in migraine is based on the fact that they reduce the pain sensitivity of vascular wall receptors, the conduction of pain impulses and enhance the effect of antinociceptive systems, especially in associated forms of migraine.
Anticonvulsant drug for migraine prevention: Antelepsin
Contains 1 mg per tablet clonazepam. It has anticonvulsant, central muscle relaxant, sedative effect. Reduces the excitability of the subcortical areas of the brain (thalamus, hypothalamus, limbic system) and inhibits the interaction between these structures and the cortex. It is used as an additional remedy in the treatment of migraine and other pain syndromes. Daily dose for adults - 3-6 mg; for infants - 0.551 mg, from 1 year to 7 years - 1 mg. The daily dose should be distributed evenly over 3-4 doses. Contraindicated in myasthenia gravis, acute poisoning with psychotic drugs, alcoholism. Side effects may include lethargy, confusion, with prolonged use - impaired speech, dizziness, nystagmus, muscle weakness. Release form: 1 mg tablets.
Anticonvulsant drug for migraine prevention: Carbamazepine-Akri
The most commonly used anticonvulsant drug, which has an analgesic effect in neurogenic pain. The mechanism of action involves gamma-aminobutyric acid receptors, which can be associated with calcium channels, and the effect of carbamazepine on neurotransmission modulator systems is also important. The initial dose is 100-200 mg 1-2 times a day. If necessary, the dose can be increased, but not more than 200 mg per day. After reaching the maximum therapeutic effect, the dose of the drug is gradually reduced to a maintenance dose, which is taken for a long time. Contraindications: atrioventricular blockade, concomitant use of MAO inhibitors, hypersensitivity. Side effects of the drug are manifested in the form of dizziness, drowsiness, headache, unsteadiness, dry mouth, nausea, vomiting, hematopoietic dysfunction, myocardial conduction disorders. Release form: tablets of 0.2 g.
Anticonvulsant drug for migraine prevention: Finlepsin
It is used to relieve neurogenic pain in various conditions by increasing the excitability threshold of nerve cells. The initial dose is 100-200 mg 1-2 times a day. Then the dose is slowly increased until the maximum therapeutic effect is achieved; it is usually achieved at a dose of 400 mg per day in 2-3 doses. Contraindicated in violations of bone marrow hematopoiesis, simultaneous administration of MAO, lithium preparations, hypersensitivity. Side effects: drowsiness, headaches, dizziness, unsteady gait, visual disturbances, atrioventricular blockades, less often - speech impairment, muscle weakness, hallucinations, aggressive behavior, pruritus, rash. Release form: tablets of 200 mg.
Valproate preparations for the prevention of migraine
More recently, valproates (Depakine, Konvuleks, etc.) have been used in the prevention of migraine. Their effectiveness is due to the ability to increase the concentration of gamma-aminobutyric acid in the central nervous system with a subsequent effect on the state of calcium and sodium membrane channels. In addition, they mediate their anti-migraine effect through their influence on serotonergic neurotransmission in the brainstem raphe nuclei, as well as through opposition to glutamate-activating amino acids. The initial dose is 20-30 mg / kg of body weight, increasing it every 3-4 days, but not higher than 50 mg / kg. Common side effects: asthenia, tremor, weight gain, in some cases - baldness. Despite the absence of a clear hepatotoxic effect in adults, valproate is not recommended for use in concomitant active hepatic pathology. When treating with valproate, it is not recommended to prescribe drugs containing barbiturates. Recent studies have shown that valproate competes in efficacy with beta-blockers in the prevention of migraine and chronic daily headache.
Depakine for migraine prevention
The active ingredient is sodium salt of valproic acid. Valproic acid increases the content of gamma-aminobutyric acid in the central nervous system, which causes an increase in the excitability threshold of brain neurons, affecting the state of calcium and sodium membrane channels. It easily passes histohematic barriers, including the blood-brain barrier. The drug is rapidly absorbed when taken orally, reaching peak blood concentrations in adults after 2-4 hours. It is prescribed in the initial dose of 200-300 mg 2 times a day. The dose is gradually increased by 200 mg per day until a clinical effect is achieved. Contraindications: violations of the liver and pancreas, hemorrhagic diathesis, drug intolerance. Side effects include nausea, vomiting, loose stools, stomach pain, drowsiness, staggering when walking, tremors, and long-term use - hair loss. If necessary, use with caution during pregnancy and lactation (although it is better not to use). Release form: tablets of 300 mg.
Convulex for migraine prevention
Sodium salt of valproic acid. The mechanism of action is associated with an increase in the level of GABA in the brain, which leads to an increase in the excitability threshold of nerve cells, a decrease in pain sensitivity of vascular wall receptors, and an increase in the action of antinociceptive systems, especially in associated forms of migraine. The drug is rapidly absorbed, easily passes the blood-brain barrier. The average daily dose of Convulex in adults is 8-12 mg per kg of body weight, the time to achieve equilibrium with stabilization of the concentration of sodium valproate in the blood is 2-4 days. The exit to the average therapeutic dose should be carried out gradually. Side effects of the drug are dyspeptic disorders, drowsiness, apathy, tremor, nystagmus, impaired coordination of movements. Contraindications: violations of the liver and pancreas, hemorrhagic diathesis, drug intolerance. Release form: capsules of 150, 300 and 500 mg in a package of 100 pcs.; drops for oral administration (300 mg / ml) in a 100 ml vial; syrup for children (50 mg / ml) in a 100 ml bottle.
Serotonin antagonists for migraine prevention
The drugs of this group, apparently, act as partial agonists-antagonists of serotonin, potentiate the action of biogenic serotonin and cause narrowing of the arteries of the external carotid artery during their paroxysmal expansion. At the same time, these substances, as false mediators, probably occupy serotonin receptors and provide functional protection of blood vessels in case of an excess of serotonin in the blood and tissues.
Serotonin antagonist drug for migraine prevention: Divascan
Active substance - iprazochrome- has an antagonistic effect on serotonin-induced reactions, reduces vascular permeability increased by this amine, affects the phase of local metabolic disorders in the preterminal cerebral circulation, prevents or weakens the effect of various vascular and platelet damaging factors. Effective for the prevention of many forms of migraine. The average dose is 1-2-3 tablets 3 times a day. Of the side effects, allergic reactions are possible. Release form: tablets of 0.25 mg.
Serotonin antagonist drug for migraine prevention: Dizeril
Contains active substance methysergide. It has been proven to be highly effective in migraine in the interictal period. It is also important to note that by influencing serotonergic transmission in the central nervous system, Dizeril normalizes the conduction and perception of pain, and also has a sedative, calming and antidepressant effect. Dizeril inhibits platelet aggregation, the enhancement of which seems to play a role in the pathogenesis of migraine. When administered orally, the drug is almost completely absorbed from the digestive tract. One of the products of its transformation is methylergonavine, which has a vasoconstrictive effect. When using the drug, dyspeptic symptoms, insomnia, euphoria and other side effects are possible. Sometimes, especially with prolonged use, there is an proliferation of fibrous connective tissue of the peritoneum, pleura. Therefore, the drug is prescribed not for too long courses with interruptions of 3-4 weeks.
Serotonin antagonist drug for migraine prevention: Sandomigran
Active substance - pizotifen- shows antagonism in relation to biogenic amines and, first of all, to serotonin. The drug eliminates serotonin-induced vasoconstriction, vasoconstriction, and in large doses enhances the effect of the amine on the vessels of the external carotid artery. It also has antihistamine activity and eliminates the vasodilating effect of histamine, and also has an atropine-like effect. The chemical structure of pizotifen is close to tricyclic antidepressants. The initial dose is 1 tablet per day, then gradually increase the dose to 3 tablets per day. With persistent migraines, the dose can be increased to 6-9 tablets per day. Side effects: drowsiness, nausea, fatigue, increased appetite with weight gain. The drug should not be prescribed to drivers of transport and other persons whose work requires a quick mental and physical reaction. Release form: dragee 0.5 mg.
