Today we will talk about Her Majesty Migraine - how to live in relative harmony with it, how to relieve the excruciating headaches caused by this disease, and how you can reduce the frequency of attacks.
Dmitry GoncharFebruary 22, 20215 min read 705
Hemicrania or migraine is primarily a hereditary neurological disease associated with pathologically high sensitivity of cerebral vessels. Unfavorable external and/or internal factors periodically cause dilation and inflammation of these vessels, which results in attacks of severe headaches and other “signature” symptoms of migraine – sound and photophobia, nausea, etc.
The term “migraine” itself comes from a New Latin word that passed into the French language - hemicrania, which means “half of the head.” The symptoms of migraine were described in ancient Greek medical works, and the ancient Greeks considered evil forces to be the culprits of the disease (and it was proposed to drive out the evil spirit from the head by drilling a hole in the skull, but these are details :)).
Migraine as such does not pose a threat to the health and life of the person suffering from it. During migraine, the blood vessels of the brain do not undergo any lasting changes - they dilate and become inflamed only during an attack, and then return to normal. By the way, people suffering from migraines, in most cases, are characterized by a clear mind, good memory, high cognitive abilities - all this persists for many years. True, painful migraine attacks nullify all these positive aspects.
Nomigren
A combined drug for relieving headache attacks of vascular origin, it helps people with migraine well. Nomigren is a relatively safe drug that contains propyphenazone, caffeine, ergotamine, meclosamine and kamilofin. "Nomigren" relieves headaches not only of a migraine nature - it is an antispasmodic and analgesic. When taking Nomigren for the first time, choose the minimum dosage, since the list of contraindications and side effects of the drug, despite its relative safety, is large.
Nomigren
Bosnalek, Bosnia and Herzegovina
acute attacks of migraine (including those accompanied by an aura);
migraine-like headaches of vascular origin. from 127
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What it is?
Migraine is a neurological disease, the most common and characteristic symptom of which is episodic or regular severe and painful attacks of headache in one (rarely in both) half of the head.
In this case, there are no serious head injuries, stroke, or brain tumors, and the intensity and pulsating nature of the pain is associated with vascular headache, and not with tension headache. Migraine headache is not associated with an increase or a sharp decrease in blood pressure, an attack of glaucoma, or an increase in intracranial pressure (ICP).
Migrepam
The main active ingredient of Migrepam is zolmitriptan. This anti-migraine drug targets exactly the cause of the headache, so it helps to cope with even long-term migraines and severe episodes of headaches. In addition to headaches, Migrepam also relieves symptoms such as fear of light and sensitivity to sounds, nausea and sweating. Improvement occurs approximately an hour after taking the tablet. But not everyone can use this drug due to side effects. Therefore, be sure to consult your doctor before purchasing Migrepam.
Migrepam
Migrepam® effectively relieves headaches and other symptoms of migraine (nausea, photophobia, phonophobia).
Equally effective against migraine with aura, without aura and migraine associated with menstruation. from 166
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Migraine and contraception
More than anything else, the procurator hated the smell of rose oil, and everything now foreshadowed a bad day, since this smell began to haunt the procurator since dawn... Yes, there is no doubt! It’s her, her again, the invincible, terrible disease of hemicrania, which makes half your head hurt. There is no remedy for it, there is no salvation. M. Bulagkov “The Master and Margarita”
Migraine is a painful headache that can be accompanied by nausea, aggravated by the slightest sound or light, and forces us to immediately go to bed in a dark room, close our eyes and hope that the attack will soon pass. Not every headache is a migraine. If, despite the pain, you can somehow move around and perform your usual duties, most likely the pain is not migraine in nature.
Rapid test for migraine
If you answer “Yes” to any question, you may be suffering from migraines.
- Are headaches accompanied by a feeling of nausea?
- Are headaches accompanied by increased sensitivity to light and noise?
- Do you experience headaches that interfere with your ability to work and perform daily activities for one or more days?
Why do gynecologists need this headache?
Despite the fact that “the head is a dark subject and cannot be examined,” gynecologists often have to delve into the details of patients’ headaches. How does it hurt, when does it hurt, is the pain related to the menstrual cycle. We always send the most “suspicious” patients for a consultation with neurologists to clarify the diagnosis.
The diagnosis is very important when it comes to using hormonal contraception. To ensure the safe use of hormonal contraceptives, WHO reviews the Medical Eligibility Criteria for Contraceptive Methods every 5 years1. This multi-page document makes it easy to select patients for whom the use of COCs is permitted without restrictions, and for whom there is a risk of complications.
Sumamigren
This drug contains the substance sumatriptan, which has serotin-generating and anti-migraine effects. The headache is relieved quickly because vasoconstriction occurs selectively. Sumatriptan is a truly effective substance that helps quickly get rid of a migraine attack. “Sumamigren” contains only 50 mg of sumatriptan, so during an intense migraine attack you can take two tablets at once. Moreover, the headache will go away in about 15-20 minutes. But Sumamigren has serious contraindications and side effects, so it must be prescribed by a doctor.
Sumamigren
Polfa, Poland
Relief of migraine attacks with or without aura.
from 206
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Amigrenin
The active ingredient of Amigrenin is also sumatriptan, but in a higher dosage than the previous medicine. Amigrenin quickly relieves migraine symptoms, not only headaches, but also other symptoms. Moreover, if you take a pill at the beginning of the aura, you can even avoid a headache. The drug contains a high dosage of sumatriptan - 100 mg - which is why Amigrenin has such a large list of contraindications.
Amigrenin
Veropharm / Lance-Farm, Russia
The active substance of the drug Amigrenin interacts with type I 5-hydroxytryptamine receptors located in the smooth muscles of the walls of blood vessels in the brain, selectively constricts blood vessels in the carotid artery system, and inhibits the activity of the trigeminal nerve.
All this helps reduce the severity of migraine pain. The clinical effect is observed after 30 minutes. from 187
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Monoclonal antibodies for the treatment of migraine
And what targets can we target with monoclonal antibodies in migraine?
For migraines, we can block a special protein called CGRP or its receptor.
What is CGRP?
The abbreviation stands for Calcitonin gene-related peptide. This is one of the pain mediators that is released in the trigeminal nerve system and is responsible for headaches during a migraine attack. We can say that CGRP controls the volume: the more it is released, the stronger and more excruciating the pain.
How are the trigeminal nerve and migraine related? Migraine is a change in vascular tone?
Just the blood vessels have little or nothing to do with migraine. The “vascular” theory of migraine was relevant in the middle of the last century. In the last 20-30 years, it has become clear that the cause of migraine is a disruption of the brain, or more precisely, its individual parts (trigeminal nerve system, hypothalamus, cerebral cortex). Scientists have discovered substances whose concentration increases during a migraine attack (CGRP, PACAP, VIP) and have come up with new revolutionary drugs.
How do these drugs work?
They block the pain pathway that involves the CGRP protein. There are two schemes: the drugs fremanezumab, galcanezumab, eptinezumab work in one. They block the protein itself. Erenumab works differently: it affects the receptor, a special area on the surface of the cell that is sensitive to this protein. But in general, the principle of operation of the drugs is common - to interrupt the “pathway of pain” with the participation of the CGRP protein. We can influence this pathway either by blocking the CGRP protein itself with fremanezumab, galcanezumab and eptinezumab, or by blocking the action of CGRP on its receptor (a special area on the cell surface) with Erenumab.
How are monoclonal antibodies administered for migraines?
By simple subcutaneous injection: (Ajovy, Irinex, Aimovig and Emgality) or intravenously (Vyepti).
What effect will I feel?
The main goal of this therapy is the prevention of migraine attacks. We cannot (no one in the world can) cure migraines completely, since it is an innate feature of your brain, but we can take control of it and make the attacks weaker and less frequent. Treatment that aims to reduce the frequency of attacks is called migraine preventative therapy.
Will my migraine go away completely?
This is possible with a probability of approximately 20%. This is the number of people who participated in the study whose migraine attacks completely ended by the end of the year of treatment. There was a 75% reduction in seizures in approximately 45% of study participants, and a 50% reduction in ⅔ of patients. These results are very good compared to previously available migraine treatments (antiepileptic drugs, beta blockers, candesartan, antidepressants and botulinum toxin).
How often should these medications be used?
The drugs are administered subcutaneously every month (Irineks, Ajovi/Ajovy, Emgality) or once every three months (Ajovi/Ajovy and Vyepti).
And will they need to be injected for the rest of their lives?
Of course not. The goal of migraine preventive therapy is to bring migraines under control and make them rare and responsive to painkillers. Typically, prophylaxis is prescribed for 6 or 12 months - this period is usually enough to “reboot” the brain, after which the attacks will become fewer or disappear altogether.
How do I know that I am one of the people who benefit from this treatment?
According to the recommendations of the European and American headache treatment associations, we can evaluate whether the treatment is working after 3 months (if the drug is administered once a month) or after 6 months (if the drug is administered once every three months).
What about the side effects? Surely something terrible?
Not at all. The most common side effects (about 20% of study participants experienced them) are reactions at the injection site (redness, pain, burning, swelling). It goes away quickly. Otherwise, the study showed no serious adverse events.
How long ago did they appear?
The first drugs (Aimovig and Ajovi) went on sale in the United States in 2018. Our University Headache Clinic has been conducting studies on all four drugs since 2021.
What medications do we have?
Two of the four drugs are registered in Russia - Irinex (in other countries it is called Aimovig) and Ajovi.
How do I get treatment with anti-CGRP or anti-CGRP receptor monoclonal antibodies?
You can purchase the drug at a pharmacy or at a specialized clinic (such as ours). The drug is recommended to be administered under medical supervision.
How much does this therapy cost?
The cost of treatment with the drug Irinex in our clinic is 17,000 rubles. The cost of treatment with the drug Adjovi is 20,000 rubles. Before administration, consultation with a doctor is necessary.
How much does treatment with Irinex cost?
The cost of an Irinex injection is 17,000 rubles + the cost of a doctor’s consultation.
Consultation is needed only before the first administration. During a course of treatment in the future, you only pay for the injection. How much does treatment with Ajovi cost?
The cost of Adjovi injection is 20,000 rubles + the cost of a doctor’s consultation.
Consultation is needed only before the first administration. During a course of treatment in the future, you only pay for the injection.
How to make an appointment and administer Irinex or Ajovi?
If you are not seen in our clinic, make an initial appointment with any specialist at a time convenient for you. If the doctor confirms the diagnosis and that these drugs are suitable for you, you can administer Irinex or Ajovi immediately.
If you are already being observed in our clinic with a diagnosis of migraine , make an appointment for a short follow-up appointment (30 minutes) with doctors Nina Vladimirovna Vashchenko or Daria Zakharovna Korobkova. When making an appointment, say that you are interested in an injection of Irinex or Ajovi. If your previous visit was no more than 2 months ago , you will only need to pay for the drug, without consultation.
Sumatriptan
This drug is one of the best in the fight against persistent migraine. The active ingredient of the drug is sumatriptan succinate. "Sumatriptan" selectively constricts blood vessels without affecting cerebral blood flow. The drug not only relieves headaches, but also helps relieve other symptoms of migraine: sensitivity to light and noise, nausea. The migraine subsides just 15 minutes after taking the pill. Sumatriptan is a drug with a stable effect, so migraine attacks do not return for a long time after taking it.
