Despite being the seventh leading cause of disability in humans, migraines receive very little attention as a major health problem, wrote Dr. Andrew Charles, a neurologist from California, for The New England Journal of Medicine. .
Migraines can occur in childhood, become more frequent in adolescence, and most often occur between the ages of 35 and 39.
Migraines are a disorder that affects the whole body, and recent research has shown that it is an "abnormal condition of the nervous system that involves several parts of the brain," says Dr. Charles from the University of California. Before it was possible to study brain function with MRI or PET scans, it was thought that migraines were caused by swollen, ruptured blood vessels in the skull, and that they usually affected one side of the head.
Common migraine symptoms are treated with vasoconstrictor drugs. However, they can only help some patients, and it is not safe for people with heart disease to use them.
In addition, traditional medicines can only help a small number of those who suffer from this phenomenon. These are drugs sold in pharmacies, such as "acetaminophen" or non-steroidal anti-inflammatory drugs such as "ibuprofen" and "naproxen", but also prescription triptans such as "imitrex", and opioids that are not properly prescribed , and ergot used as a nasal spray. They all have side effects.
Neurologists who specialize in the study and treatment of migraines now treat migraines as a brain disorder, with symptoms and signs that may appear a day or more after the headache begins and persist even if the pain goes away.
Based on the new understanding of the problem, more powerful and less harmful drugs are now available, although some have yet to be approved. In order to be as effective as possible, new therapies require patients to respond to the warning signs of migraine in the so-called prodromal phase - when symptoms such as yawning, irritation, fatigue, food cravings and sensitivity to light and sound appear a day or two before the headache.
"It's possible that many therapies are effective, including meditation and relaxation techniques, that don't help when the train leaves the station," says Dr. Charles. What can trigger migraines in people who are susceptible to them is avoiding meals, irregular caffeine intake, poor sleep and stress.
"Preventive therapy should be considered if migraines occur once a week or four or more days in a month," writes Dr. Charles.
Potential medications include blood pressure medications such as beta blockers; antiepileptics such as "topiramate" (topamax), and tricyclic antidepressants such as "imipramine" (tofranil). Also, botulinum toxin, or Botox, is approved in America for the treatment of migraines.
Now there are new drugs that act on the brain, which have very few side effects. These are devices that are held in the hand or worn as headbands, such as "single-pulse TMS" (used for transcranial magnetic stimulation) and "cefaly t-SNS" (for transcutaneous electrical nerve stimulation), which transmit magnetic or electricity to the nerves through the skull to the brain.
A new class of drugs that directly target peptides believed to trigger migraines will soon be approved in America. These are also monoclonal antibodies that are given by injection or intravenously, and the so-called CGRP drugs that are taken orally, Nedeljnik reports.
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