Migraine Treatment: A List Of Migraine And Headache Medications

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Migraine treatment: a list of migraine and headache medications

Migraine is a hereditary disease in which the vessels of the brain are hypersensitive and inflamed under the influence of unfavorable external and / or internal factors. Migraine attacks are accompanied by severe pain, photophobia, and nausea. There are no permanent degenerative changes in the brain, vasodilation and inflammation occurs only during an attack, and then stops.

Migraine does not pose a health hazard; moreover, people suffering from it retain clarity of mind and good memory longer. But during painful attacks, I don't want to think about the positive aspects of the disease. How do you know if you really have a migraine, or headaches are of a different nature?

Here's what you need to know about migraines:

• Attacks usually have four stages: prodrome, aura, pain itself and post-normal period;
• Prodrome is anxiety and a premonition of an attack, aura is visual, tactile, olfactory and speech disturbances before an attack, migraine pain is always very strong, pulsating and localized in a certain part of the head, and the post-normal period is a feeling of weakness after an attack;
• Sometimes there is a migraine without an aura, but its absence does not remove the diagnosis;

• Severe migraine attacks can be accompanied by vomiting, dizziness, double vision and darkening of the eyes, and even paralysis of the limbs. Recurrent abdominal pain and vomiting of unknown etiology in children can also be a manifestation of migraine.

In girls, migraine first manifests itself at the age of 13-23 years, often its arrival is associated with the first birth. Young men suffer from this disease much less often, but they begin to suffer earlier - from 8-10 years old, and it is difficult to predict when the attacks will end. Migraine is diagnosed in only 6% of the entire male population. Among women, one in five suffers, but almost all migraines recede after menopause.

It is impossible to completely cure migraine, as well as explain its causes or prevent the development. But the disease can and should be taken under control. Ideally, you shouldn't have more than two attacks a month, and they shouldn't last more than two hours. For those who are used to writhing in pain and running to the toilet for two or three days, such words seem like an unattainable dream. But don't be in a hurry to despair. We will try to teach you to live in such a way that it is not the migraine that controls you, but you.

To get your migraine under control, you need to:

• Calculate provoking factors and carefully avoid them;
• Understand the variety of pain medications, choose the right medication and take it correctly to quickly relieve pain;
• Do your best to reduce the frequency of attacks.

We will now analyze each of these three points in detail.

Content:

• Migraine triggers: face the enemy
• How to get rid of a headache?
• Simple pain relievers
• Special anti-migraine analgesics
• How to deal with nausea during a migraine attack?
• How to choose the right drug for migraine?
• How to take pain relievers for migraines correctly?
• Pain medications: help or harm?
• How to reduce the frequency of migraine attacks?
• The attack begins: what to do?
• When to call an ambulance

Migraine triggers: face the enemy

Migraine is not a headache per se, but only an increased sensitivity of the brain. For the pain to begin, provoking factors are needed, which are called migraine triggers. A person may have one or more of these triggers, and sometimes seizures only come from a combination of them.

What does this mean: if there is no reason, then there will be no seizures? Quite right, but it is difficult to completely isolate yourself from triggers - they are literally everywhere. Someone was more fortunate - their migraine overcomes only against a background of stress, while someone suffers from any drop in atmospheric pressure.

Do not rush to draw conclusions, try keeping a "migraine diary" for one month. Draw a spreadsheet, mark the dates at the top, and write down all possible triggers on the side. If you have a seizure, put down the pluses in the column opposite the provoking factors that occurred on that particular day. For example: drank - plus, didn't get enough sleep - plus, it rained - plus, quarreled with someone - plus, and so on. This mini-study will make it clear which triggers (or combinations of triggers) trigger migraine attacks in you.

And to help you spot your enemies, here's a list of all the possible internal and external triggers of migraine:

• Alcohol. First of all, you should beware of red wine and champagne. Any alcohol dilates blood vessels and provokes migraines, but red wine also contains flavonoids, and champagne contains bubbles of carbon dioxide, so that the vasodilating effect of these strong drinks is most pronounced;
• Food. Here, in the first place are products containing tyramine - smoked meats, blue cheese, beer. Less commonly, citrus fruits, bananas and chocolate are triggers. Recently, there has been evidence that migraine attacks can be provoked by the ubiquitous monosodium glutamate, a food additive that enhances the taste of most ready-made foods. As for caffeine, its role in triggering the migraine mechanism is controversial. On the one hand, coffee and strong tea constrict blood vessels, and on the other, regular consumption of caffeine is addictive. And a sharp refusal from it entails undesirable changes in vascular tone and, as a result, a migraine attack;
• Diet. In fact, it is not so much what you eat that matters as how regularly you do it. A long break between meals provokes a critical drop in blood glucose levels. And who is the most voracious in our body? Of course, the brain. And if he is prone to migraines, he will not fail to take revenge on you for the hunger strike with an attack of excruciating pain. Just remember to have a snack every 3-4 hours;
• Allergy. Individual intolerance to food, drugs or external factors (dust, pollen) is directly related to the frequency of migraine attacks. This fact was confirmed by a medical study, during which a group of patients was isolated from all allergens they had for three months. In absolutely all subjects, the frequency of attacks decreased, and the pain became less intense and prolonged;
• Liquid. Anyone, especially a migraine sufferer, needs to drink 1.5 liters of clean water a day. This will allow biochemical reactions in the body to proceed correctly, and the waste of these reactions will not accumulate in tissues and blood vessels. If you are involved in sports or strenuous physical work, consider the increasing need of your body for clean water. Not in tea, coffee or juice, but in plain water;
• Medicines. Drugs with a vasodilating effect (for example, Nitroglycerin, Curantil, etc.) will almost certainly trigger the migraine mechanism and cause an attack, so carefully read the annotations to all drugs before taking them;
• Sleep. An adult needs to sleep 6 to 8 hours a day, no less. Suppose you have changed your place of work, and instead of the usual 8 hours now sleep only 5. Adaptation to such a schedule will certainly be accompanied by migraine attacks. The same can happen to a person who has gone on vacation and decided to sleep until noon - it is very likely that your sybarism will result in a terrible headache;
• Emotional stress. It is difficult to imagine everyday life without stress, but you can learn how to properly relax and restore mental balance. This is especially important for people with migraines. During the stress itself, when the body is focused, there will be no attack - it will overtake you a few hours later, or the next day. Therefore, after a nervous shock or conflict, make every effort to drive away the negativity and release from tension;
• Sports and outdoor activities. A whole day in the garden, the first fitness workout, long shopping - and now you have already collapsed with a migraine attack. A familiar picture, isn't it? If you move little in life, do not rush to burden yourself, but if, on the contrary, regularly go in for sports, continue in the same spirit and never sharply reduce the pace;
• Weather. Air pressure drops are not the most popular triggers for migraines - these factors only affect people with unstable blood pressure. However, one does not interfere with the other, and it is likely that you are hypertensive suffering from migraines;
• Environment. An attack can also be triggered by other external factors: a long loud sound (construction site, production workshop, rock concert, football match), strong smell (perfume, paint, varnish, solvent), dirty air (smoky or dusty room);
• Hormones. Here is the answer to the question why migraine so "loves" the fair sex. During life, in the body of every woman under the influence of sex hormones, serious changes occur: a girl matures, menstruates, becomes pregnant, gives birth, feeds, and loses fertility. And hormones work at every stage. It is no wonder that almost all women with migraines experience severe attacks on the eve of their period, in the postpartum period and during menopause.

How to get rid of a headache?

Well, finally we got to the most important thing, you say and list in your mind all the questions that brought you to this page:

• Do I need to take pain relievers to treat migraines?
• How often can you do this?
• And how to get rid of nausea?
• Are headache pills harmful?
• How do they differ from each other, except for the price?
• When to take the medicine: during the aura, after the onset of pain, or when it is no longer possible to tolerate?
• Or maybe take a pill just in case, at the first premonition of an attack?

Let's deal with everything in order. Let's start with a complete list of all migraine and headache medications, with an indication of their true composition. Perhaps it will be a big surprise for you that for the same substance, the pharmacy may charge you an amount that differs by 10 or more times. It is equally important to learn to distinguish between pills that are suitable for treating migraines and those that are completely inappropriate, and also to assess the severity of possible side effects.

Simple pain relievers

Official medicine calls such drugs by the short abbreviation NSAIDs - non-steroidal anti-inflammatory drugs, that is, relieving inflammation without the help of hormones. Below we give a detailed list of these drugs, and even if you do not find the name of your tablets in it, read their composition - for sure, there are completely familiar terms.

Absolutely all NSAIDs relieve headaches by relieving inflammation in the vascular walls. In other words, these drugs eliminate the very cause of the pain, which is very good. However, some tablets contain additional components that have a sedative or antispasmodic effect. We will discuss in detail how relevant this is in the treatment of migraines.

And first, let's divide all drugs for headache into two large groups:

• One-component;
• Multicomponent.

One-component analgesics

Simple one-way analgesics include acetylsalicylic acid, ibuprofen, acetaminophen, naproxen, ketorolac, xefocam, lornoxicam, and diclofenac.

To date, the following drugs are registered in Russia:

• Acetylsalicylic acid (Aspirin, Upsarin). For the treatment of migraines, a dosage of 500 mg or more is relevant, the best option is to drink two 500 mg tablets at once. Effervescent tablets are much better because they are absorbed faster, which is very important in a nausea setting. In pharmacies, you can find the so-called cardiac aspirin (Thrombo ACC, Aspirin cardio), which is prescribed for prophylactic purposes in patients with the threat of stroke and heart attack, because acetylsalicylic acid reduces blood clotting. Be careful: such aspirin is absolutely not suitable for the treatment of migraines, it has too little dosage;
• Acetaminophen (Paracetamol). We used to think of paracetamol as a cure for fever in children. By itself, it is safe, but not very effective, so multicomponent analgesics with the addition of paracetamol are more suitable for the treatment of migraines. Pure acetaminophen is also sold under the names Panadol, Tylenol, Efferalgan;
• Ibuprofen (Nurofen 200 mg; Nurofen forte 400 mg; Mig 200; Mig 400; Brufen; Advil). It has analgesic, antipyretic and anti-inflammatory effects. Well tolerated by patients, quickly relieves headaches. With migraine, it is prescribed in a dosage of 500 mg;
• Metamizole sodium (Analgin 500 mg; Baralgin 500 mg). We did not start the list with this top-rated analgesic because it has been so badly discredited over the past few decades. Regular intake of metamizole sodium negatively affects blood composition, liver and kidney function. In the entire civilized world, a pure substance in a dosage of 500 mg has not been produced for a long time, but only 100-250 mg is added to the composition of multicomponent anesthetic drugs. In Russia, a penny Analgin with a horse dose of metamizole is still produced, which relieves migraine headaches well, but causes irreparable harm to health with regular use;
• Naproxen (Naproxen 250 mg, Nalgezin 275 mg, Nalgezin forte 550 mg). For the treatment of migraine, it is used both independently in a dosage of 500-750 mg, and as part of combined drugs for headache. It is also often used to combat recurrent pain in women;
• Diclofenac (Voltaren) is an anti-inflammatory agent that has been successfully used for back and joint pain. There are many trade names for diclofenac, and Voltaren is perhaps the most famous of them. For the relief of acute headaches and the treatment of migraines, use diclofenac tablets or Voltaren powder;
• Ketorolac (Ketanov, 10 mg);
• Lornoxicam (Ksefokam, Ksefokam rapid). Ketanov and Ksefokam - the most powerful analgesics, with which you can eliminate even pulsating toothache or cramps from hepatic colic. Both drugs are actively used in the treatment of migraines, and not only in tablets, but also in injections.

Multicomponent analgesics

Such pain relievers may contain one or more main active ingredients (for example, metamizole sodium and paracetamol), as well as one or two additional substances (for example, codeine, caffeine or phenobarbital).

Caffeine is known to have a vasoconstrictor effect, which is very important for migraines. Codeine and phenobarbital calm the nervous system and reduce the excitability of the cerebral cortex. In the past, phenobarbital has been used in high doses to treat epilepsy, and this practice has allowed the exposure of its serious side effects and the registration of an addictive effect. Keep in mind that codeine and phenobarbital are addictive, which means that pills with such supplements are not suitable for the regular treatment of migraines.

Let's list the most popular combined headache drugs:

• Citramon (paracetamol 180 mg + caffeine 30 mg + acetylsalicylic acid 240 mg). Askofen has the same composition. These drugs are suitable for the treatment of migraine in patients who do not have problems with high blood pressure and vascular spasms. To stop an attack, you need to drink at least 2 tablets at once;
• Migrenol, Panadol extra (paracetamol 500 mg + caffeine 65 mg). Here is a vivid example of pulling money from ignorant people suffering from wild headaches. They come to the pharmacy, where they are helpfully offered a special medicine for migraine, which is called Migrenol, and, of course, costs several hundred. In fact, both Migrenol and Panadol extra are a ten-ruble paper blister of Paracetamol and a cup of coffee. And for migraines, these drugs help worse than Citramon (also, by the way, ten rubles);

• Pentalgin. 4 drugs are sold under this trademark, slightly differing in composition and purpose. The first three are suitable for relieving pain during rare (no more than 2 times a month) migraine attacks, and the fourth has an antispasmodic effect and is designed to eliminate colic, cuts, dental, muscle, joint and menstrual pains:

  1. Pentalgin N (metamizole sodium 300 mg + naproxen 100 mg + caffeine 50 mg + codeine 8 mg + phenobarbital 10 mg);
  2. Pentalgin ICN (metamizole sodium 300 mg + paracetamol 300 mg + caffeine 50 mg + codeine 8 mg + phenobarbital 10 mg). The drugs Sedal M and Sedalgin neo have the same composition;
  3. Pentalgin plus (propiphenazone + paracetamol + caffeine + codeine + phenobarbital);
  4. Pentalgin (paracetamol 300 mg + naproxen 100 mg + caffeine 50 mg + drotaverine 40 mg + pheniramine maleate 10 mg).
• Caffetin (propiphenazone 210 mg + paracetamol 250 mg + caffeine 50 mg + codeine 10 mg) is good because it does not contain analgin, but it is not suitable for permanent treatment of migraine because of codeine;
• Tempalgin (metamizole sodium 500 mg + triacetonamine 4 toluenesulfonate 20 mg). These are the familiar "green pills from the head". Indeed, they relieve pain well, thanks to a large dose of analgin and a non-narcotic sedative supplement;
• Spazmalgon (Spazgan, Bral, metamizole sodium 500 mg + pitofenone 2 mg + fenpiverinium bromide 20 mg). It is a big mistake to use this drug for the treatment of migraines on an ongoing basis. It has a completely different purpose. Of course, 500 mg of analgin will dull any pain, but we have already talked about its harm. And the rest of the components of Spazmalgon have an antispasmodic effect, which is not relevant for migraines, since the vessels in the brain are dilated and inflamed, and not compressed. Let's dispel the myth to the end: Drotaverin (No-shpa) is also useless for migraines. It has an exclusively antispasmodic and not anti-inflammatory effect, and there are no spasms during a migraine attack;
• Andipal (metamizole sodium 250 mg + dibazole 20 mg + papaverine 20 mg + phenobarbital 20 mg). A very effective drug for relieving headaches in people suffering from migraines against the background of hypertension and increased nervous excitability. However, due to the fact that one tablet of Andipal contains only half a tablet of analgin, for the treatment of migraine, you have to drink two tablets at once, and this is 40 mg of phenobarbital. As a result, addiction is inevitable.

Let us now discuss "firefighters", injection methods for relieving a terrible headache during a migraine attack. They have to be resorted to when a person took absolutely inappropriate pills that did not help him and lost precious time, or when he courageously endured pain until he began to climb the wall. Of course, this cannot be done, but if the situation nevertheless arose, will have to inject.

The following analgesics are most commonly used for intramuscular injections at home:

• Baralgin - 2500 mg of analgin in 1 ampoule. The equivalent of five analgin tablets immediately enters the bloodstream. At the stage when the headache is unbearable and accompanied by nausea, this is the best way out;
• Ketorol - 30 mg of ketorolac in 1 ampoule. It helps Baralgin faster and better, does less harm to health, but it costs much more and is never at the disposal of emergency doctors. If you have a severe migraine, it is better to buy Ketorol from the pharmacy yourself, along with suitable syringes, and keep it close at hand.

An effective and painless alternative to injections is rectal suppositories. Since large vessels pass in the rectum, from there the anesthetic substances quickly enter the bloodstream, bypassing the digestive tract, seized by nausea.

The following suppositories are used to treat migraines:

• Voltaren 50 and 100 mg (diclofenac);
• Cefekon D (paracetamol);
• Indomethacin 50 and 100 mg.

If the nausea is not very strong and is not accompanied by vomiting, it makes sense to take diclofenac powder - Voltaren Rapid sachet. It is absorbed very quickly in the stomach and does not irritate the mucous membrane, so it does not aggravate nausea.

At the end of the conversation about combined painkillers for the treatment of migraines, I would like to dwell in more detail on prescription drugs. You cannot buy such pills in a pharmacy just like that, because they contain unsafe substances that are addictive. For example, Zaldiar (tramadol 37.5 mg + paracetamol 325 mg). We mentioned paracetamol above, and tramadol is a semi-narcotic substance that activates endorphin receptors. In other words, after taking tramadol, a person feels as if there is a lot of the hormone of joy in his blood - endorphin. The cause of the pain is not eliminated, but the anti-pain mechanisms in the brain are triggered. Zaldiar is only used to treat severe, uncontrolled migraines, and only as directed by a physician.

Special anti-migraine analgesics

As long as there are migraines, scientists continue to try to find a special medicine to treat this mysterious disease. A significant percentage of patients generally cannot find a pain reliever among the available and popular analgesics - no pills simply help them. This is why the scientific breakthrough in migraine treatment was only a matter of time, and recently took place.

In 1989, the German pharmaceutical company GlaxoSmithKline developed the first specific anti-migraine drug, sumatriptan. It constricts the dilated vessels, blocks the release of calcitoning-binding peptide and substance P from the endings of the trigeminal nerve, thereby completely arresting the migraine attack. To this day, sumatriptan is considered the "gold standard" in the treatment of migraine - this drug radically improves the quality of life of more than 70% of patients who have tried it on themselves.

Triptans

Sumatriptan became the first member of the family of anti-migraine drugs. Over the past 30 years, this family has expanded with several more effective tools. It is important to understand that triptans do not relieve any headache other than those caused by migraines. At the same time, no other type of drug is as effective in treating migraines as triptans.

The following triptans are sold in Russian pharmacies:

• Sumatriptan and its generics (drugs with the same active ingredient):

  1. Imigran in tablets of 50 and 100 mg and in the form of a spray 20 mg (one dose);
  2. Amigrenin 50 and 100 mg (Russia);
  3. Sumamigren 50 and 100 mg (Poland);
  4. Rapimed 50 and 100 mg (Iceland);
• Zolmitriptan (Zomig 2.5 mg);
• Eletriptan (Relpax 40 mg);
• Naratriptan (Naramig 2.5 mg).

Compared to the original drugs, generics are up to four times cheaper and have the same high efficiency. In our country, Amigrenin (generic Sumatriptan) is well-deserved love among migraine patients, which can be purchased for an average of 150-200 rubles.

The advent of triptans on the pharmaceutical market has been a salvation for millions of people suffering from excruciating migraine attacks with nausea and vomiting. But, as is often the case in life, any good thing has its drawbacks. Triptans are no exception. Since they greatly constrict the inflamed blood vessels, some people simply cannot take such drugs.

Important: Triptans are strictly contraindicated in patients with chronically high or poorly controlled blood pressure, ischemic heart disease, as well as those with myocardial infarction or stroke.

Although triptans have a point, selective effect on the cerebral vessels, their effect on the cardiac and peripheral vessels cannot be completely discounted. Therefore, doctors do not prescribe triptan treatment for migraines in relatively healthy and young patients who experience stabbing pain in the heart during intense physical exertion, or a feeling of lead heaviness in the legs. A history of varicose veins and thrombophlebitis are also factors not in favor of triptans.

If you have a migraine with an aura, it is very important to choose the right time to take the triptan. During the aura, the vessels of the brain are constricted, and the onset of pain signals their expansion and inflammation. This is why you should never take a pill during the aura stage to get ahead of the pain. So you will not get ahead of her, but only prolong the aura and intensify your torment during the attack.

It is better to start treating migraines with Sumatriptan or Zomig after consulting a doctor and a basic examination, including an electrocardiogram blood test. Of course, the pharmacy will sell you these drugs without a prescription, but do not rush to go there without visiting a doctor. The very fact that triptans are sold in 2 or 3 tablets in one package suggests that their overdose or improper use is fraught with serious negative consequences.

Important: Triptans cannot treat rare severe forms of migraine with aura - hemiplegic and basilar migraines. In addition, these drugs are contraindicated in children under 18 years of age, pregnant and lactating women.

Usually triptans are well tolerated, only sometimes patients notice a feeling of creeping on the skin, heaviness in the chest and impaired concentration. Thirty years of experience in treating migraine with triptans allows us to speak with confidence about their safety and high efficiency. Therefore, if you have no contraindications, there is nothing to fear - you can safely start treatment.

Read more: Triptans are an effective remedy for migraines

Ergotamine derivatives

There is another, older class of special anti-migraine analgesics - ergotamine derivatives. They, unlike triptans, only constrict blood vessels, and, moreover, very strongly and quickly, therefore, they can be dangerous, especially in large doses. In most foreign countries, these drugs are not prescribed for the treatment of migraines on an ongoing basis. Ergotamine derivatives are considered only as reserve substances for the relief of severe attacks, when no other means works.

For example, the drug Dihydroergotamine in ampoules is present in the arsenal of Western doctors in case of emergency care for a patient with a migraine status (that is, suffering from a headache for several days in the absence of the effect of conventional analgesics). You cannot buy Dihydroergotamine over the counter without a prescription, but you can buy combination pain relievers with a low ergotamine content.

Three such analgesics are registered in Russia:

• Nomigren (ergotamine tartrate 0.75 mg + caffeine 80 mg + propiphenazone 200 mg + camilofin chloride 25 mg + mecloxamine citrate 20 mg). Ergotamine constricts blood vessels, caffeine tones up their walls and accelerates the absorption of tablets, propiphenazone has an analgesic effect, and mecloxamine neutralizes nausea;
• Sinapton (ergotamine tartrate 1 mg + caffeine 100 mg + dimension hydrinate 25 mg);
• Cofetamine (ergotamine tartrate 1 mg + caffeine 100 mg).

But according to patients, two Nomigren tablets can stop a migraine attack with about the same speed and effectiveness as one Zomiga tablet. However, when comparing these drugs in terms of safety, triptan is preferred. And you also need to take into account that the joint intake of ergotamine derivatives and triptans is categorically contraindicated, since it leads to a critical narrowing of the cerebral vessels!

Important: If you have taken Nomigren or any other combined analgesic with the addition of ergotamine, you can use triptans no earlier than 24 hours later!

Ergotamine derivatives have a fairly wide range of contraindications:

• Diseases of peripheral blood vessels;
• Arterial hypertension;
• Angina pectoris;
• Ischemia;
• Myocardial infarction;
• Stroke;
• Glaucoma;
• Pregnancy and lactation.

How to deal with nausea during a migraine attack?

A migraine attack is almost always accompanied by nausea and sometimes repeated vomiting. Not only is it very unpleasant, it also interferes with the timely assimilation of the anesthetic drugs taken. If you took a pill and then vomited, you can assume that you did not take the medicine at all. Therefore, as soon as you feel nausea approaching, immediately take an antiemetic agent (Cerucal, Raglan), you can directly together with an analgesic.

However, even at the very beginning of a migraine attack, when it is too early to talk about nausea and throbbing pain, the stomach is already functioning incorrectly, not in full force, and the food eaten the day before is retained in it. The pain reliever you take is likely to suffer the same fate. It will lie there and eat away at the mucous membrane, further provoking nausea. To avoid this, take Motilium, an overeating medicine that contains a complex of gastric enzymes that speed up the digestion process.

How to choose the right drug for migraine?

From the variety of pain medications presented above, it is not surprising to get confused: which pills to choose, and where to start treatment for migraines? The most correct approach would be a consistent approach - start, so to speak, with the least evil, gradually moving towards the greatest, and only if simple analgesics do not help. It is important to choose an adequate dosage, otherwise you will drink 2 more tablets in an hour, two more in a few hours, in the end they will not work that way, because the moment is missed, and you will undeservedly write the drug into "ineffective migraine remedies."

Of all the simple NSAIDs, aspirin is the best treatment for migraine headaches. Timely taken 1000 mg of aspirin is comparable in effectiveness to triptans, but much more affordable. However, do not forget about the corrosive effect that acetylsalicylic acid has on the stomach. Because of this disadvantage, treatment of migraine with aspirin is contraindicated in patients with gastritis and peptic ulcer disease.

As we mentioned above, in Europe, a real persecution has been declared on combined analgesics due to harmful addictive additives (codeine, phenobarbital). Therefore, there, if you have a severe headache, you have to be content with ordinary aspirin.

Enterprising people have come up with a special "anti-migraine cocktail" consisting of simple and affordable ingredients:

• A glass of water with 1000 mg of effervescent aspirin dissolved;
• A cup of freshly brewed sweet black coffee or a can of cola;
• Motilium tablet.

How it works? First, you are taking a large dose of fast-absorbing aspirin. Second, you provide the body with fluid and glucose, which fills the stomach and calms the brain. Thirdly, you get a portion of gastric enzymes that will help to digest the contents of the stomach as quickly as possible and move it into the intestines, where aspirin will be absorbed. This cocktail really works! Try, and if you have an ulcer or gastritis, substitute nalgesin or naproxen for aspirin at a dosage of 500-750 mg.

Triptans are your first-line drugs in the presence of a stomach or duodenal ulcer, as well as an exacerbation of gastritis, or if the effect of Aspirin does not occur 45 minutes after taking. In this case, start taking triptans immediately, at the very beginning of the next attacks. We remind you once again: to treat migraines with triptans, you need to get permission from your doctor!

One-component analgesics (ibuprofen, analgin, paracetamol, diclofenac) should not be used in pure form, especially analgin. Try to test for yourself the effect of ibuprofen (600-800 mg) or ketorolac (20 mg), perhaps this will be enough to quickly and completely get rid of the headache during an attack. But paracetamol and diclofenac are unlikely to be as effective as aspirin in treating migraines. Although, as you know, each person is individual.

Combined analgesics (Citramon, Pentalgin) are much more often used to relieve migraine attacks, and they work better, but do not forget what we said about harmful additives and addiction. Drugs containing codeine and phenobarbital can only be used to treat mild migraines with 2-3 attacks per month.

The selected migraine drug can be considered effective if:

• It completely relieves headache no later than 4 hours after administration;
• During the first 2 hours, nausea and photophobia pass, and the pain goes from pulsating to dull and gradually subsides;
• It helps you to stop the attack always or almost always;
• The headache does not recur the next day;
• You do not have to repeat this drug or add another during an attack.

How to take pain relievers for migraines correctly?

No, it's not about strictly following the instructions, not chewing pills that are not intended for this and drinking them with a sufficient amount of water. It goes without saying. When treating migraine, the timing of the medication is perhaps the most important, not its composition. Any analgesic, simple or combined, ordinary or special, is able to stop a severe headache, whatever the cause. However, with a migraine, you have a few minutes to give him this opportunity.

The expansion and inflammation of the cerebral vessels is the only cause of headache only during the first 40-120 minutes from the onset of the attack (depending on how fast the pain increases). Thus, if you managed to take pain relievers within the first two hours, you have a chance to stop the attack. Otherwise, the chance is missed.

When nausea, fear of bright light and intolerance to loud sounds join the throbbing headache, this indicates that pain impulses have already passed through the fibers of the trigeminal nerve and have reached the cerebral cortex. Pain mechanisms were activated, which are very difficult to stop for analgesics, especially given the senselessness of oral administration.

Important: Painkillers taken too late, regardless of their type and composition, will not help you get rid of migraine headaches, but you will get all the negative consequences and side effects. Do not overdose or repeat the dose every hour, hoping for relief. If a migraine attack is accompanied by repeated vomiting, there is no point in taking pills at all - only injections.

Combination analgesics are more likely to help you when the optimal time is missed, but this is only because the anti-anxiety supplements they contain dull the sensitivity of the cerebral cortex and no longer fight the cause, but the effect. Since the concentration of codeine and phenobarbital in such drugs is scanty, success is not guaranteed. But uncontrolled treatment of migraine with combined analgesics will definitely lead to the emergence of dependence on them. It is recommended to take medications with the addition of phenobarbital or codeine no more than twice a month.

An untimely taken pain reliever usually becomes the reason that a person suffers from a terrible headache all day, and, in the end, calls an ambulance. Doctors inject him intramuscularly Baralgin, Diphenhydramine, sometimes even Relanium, as a result of which the exhausted patient quickly falls asleep. Try to never bring yourself to such a state: firstly, it is dangerous to health, and secondly, it leads to an increase in migraine attacks in the future.

Important: You can not stoically endure a terrible headache and refuse to take painkillers, citing their harm. The longer and more painful the attacks are, the more often they will be repeated.

Of course, you can do nothing at all and just endure: the brain has protective anti-pain mechanisms that turn off pain when it ceases to be an alarm for you, as the owner of the body, and becomes a threat to the body itself. After a maximum of 72 hours, a huge concentration of the hormone serotonin will accumulate in the blood, and the pain syndrome will be relieved.

However, the reserves of the brain are not endless - it cannot produce serotonin constantly in wild quantities, and the rise will inevitably be followed by a decline. And a low level of this hormone in the blood makes a person experience severe pain for any, even the most insignificant reason. In other words, the pain threshold decreases, and in conditions of migraine it is a disaster.

Pain medications: help or harm?

Absolutely all analgesics for relieving pain and inflammation disrupt the synthesis of the enzyme cyclooxygenase. But this enzyme is not only involved in the development of inflammation, but is also present in the mucous membrane of a healthy stomach. Cyclooxygenase deficiency leads to thinning and ulceration of the mucous membrane, so the abuse of NSAIDs is fraught with the development of gastritis and ulcers. These drugs also have a bad effect on the functioning of the liver and kidneys, since they are excreted from the body through one of these organs, or even through both.

The second negative point is physiological addiction. The body gets used to the fact that as soon as something got sick, a "good pill" appears out of nowhere and eliminates inflammation. He wants to do less and less himself, and more and more to receive such pills. As a result, if earlier you could get rid of migraines with 500 mg of aspirin, now only 1500 mg helps. The number of medications increases, therefore, side effects increase. This creates a vicious circle, and getting out of it is sometimes as difficult as giving up drugs.

In medicine, there is a special term for a drug-induced headache - abusal (from the English "abuse" - abuse). As soon as a person with such a problem has a decrease in the concentration of analgesics in the blood, pain occurs, simply as a reaction to the fact that he did not take the pill on time. He goes on about his addiction and continues to increase the intake of painkillers until it comes to hospitalization with a diagnosis of acute drug poisoning.

Important: According to the WHO, 1 in 50 inhabitants of the planet suffers from an abuse headache, and women become victims of drug addiction five times more often than men.

Almost all people who have long and regularly resort to treatment of migraine with analgesics also develop persistent psychological dependence on pills. They are afraid of a seizure all the time, carry a heap of boxes and blisters with them, spend a significant part of their income on medicines, take pills just like that, "to forestall pain." Did you recognize yourself in this description? Please try to stop!

You can take painkillers no more than twice a week. During a migraine attack, this must be done on time and strictly in a therapeutic (not underestimated!) Dose. You cannot repeat the intake earlier than indicated in the instructions, drink more pills per day than recommended, or instead take other pills, guided by the fact that you have not exceeded the dosage of each individual drug. They will poison you all together, and they will not relieve the pain if they could not do it right away.

Important: According to international medical standards, without the risk of addiction, one-component analgesics can be taken no more than 15 days a month, and combined, semi-narcotic and triptans - no more than 10 days a month.

This is all, of course, wonderful, you say, but what to do if it hurts ?! And nothing helps? And the attacks are only getting more frequent? We will try to answer these questions in the next chapter.

How to reduce the frequency of migraine attacks?

The successful solution of this issue depends equally on yourself and on your doctor. What can you personally do to make migraine attacks more rare and less painful? At the very beginning of our conversation, we discussed triggers - external and internal factors that provoke the onset of seizures. It's a pity, but neuropathologists state that almost none of the patients with migraine keep a diary on their advice and do not try to identify their triggers. Everyone says something like “I have seizures when I'm nervous” or “I just didn't get enough sleep”, but they don't do anything to protect themselves from these risks!

Try to stop thinking on the principle “we are not like that, life is like that”. You are quite capable of organizing the correct regime of work and rest, learning how to relax after stress, instilling in yourself a love for light, healthy food, sports and an active lifestyle. If attacks are provoked by external factors (prolonged loud noises, polluted air, allergens), simply eliminate them from your life. Well, if even the most careful attitude towards yourself still does not allow you to reduce the frequency of migraine attacks, it is time to consult a doctor for serious treatment.

After the examination, you will be prescribed a course of taking special medications aimed at reducing the sensitivity of the vessels of the brain. They do not relieve a headache, but prevent its occurrence. Anyone with a severe migraine is recommended to undergo such preventive treatment every 2-3 years, which usually last 3-6 months.

Be sure to see your doctor if:

• Every month you have 3 or more severe migraine attacks, and in the intervals between them you are tormented by a background, pressing headache;
• You are forced to exceed the recommended dosages and frequency of analgesics because they are no longer effective and your migraine is out of control.

To reduce the frequency of migraine attacks, drugs of various classes are used:

• Antiepileptic drugs - Topamax at a dosage of up to 100 mg, valproic acid (Depakin), gabapentin (Neurontin, Tebantin). These drugs reduce the excitability of the brain, so triggers do not easily and quickly trigger a migraine attack;
• Antidepressants are drugs that increase the concentration of the hormones serotonin and norepinephrine in the blood, such as venlafaxine (Velafax, Efevelon, Venlaxin), paroxetine (Paxil, Reksetin, Tsipramil), and the tricyclic antidepressant Amitriptyline. All of them are aimed at strengthening the anti-pain protection of the brain. Used in minimal therapeutic doses;
• Beta blockers - Propranolol, Anaprilin, Obzidan, used to lower blood pressure. Such drugs also slow down the heart rate, so they are prescribed for the treatment of migraines only for those whose blood pressure is almost always kept at 120/80, and the pulse is stable;
• Calcium channel blockers - Verapamil and nimodipine (Nimotop) are used for migraines. To lower blood pressure, rather high doses of these drugs are required, but in general they stabilize vascular tone well;
• Drugs that improve cerebral circulation - for example, Vasobral in drops and tablets. In the treatment of migraines, it has moderate effectiveness, but it is completely safe and suitable for almost everyone;
• Magnesium preparations - to strengthen blood vessels and maintain the heart.

The attack begins: what to do?

Let's summarize our conversation about migraine treatment, put together the entire arsenal and draw up a clear plan of action so as not to lose a single precious minute when you are overtaken by an attack again.

So, if the headache started:

• Go home immediately, take time off from work;
• Take a warm shower, use aromatic oils that help you cope with pain (lavender, patchouli, bergamot);
• Make a cup of sweet tea or coffee, dissolve 2 effervescent aspirin tablets in a glass, eat something light, if you haven't eaten for a long time, take a Motilium tablet, and if you feel sick, then Cerucala;
• Lock yourself in the room, draw the curtains, lie under the covers, relax and try to sleep;
• If after 45-60 minutes the pain does not begin to subside, use a temperature contrast: put a cold wet towel on your forehead or under your neck, and lower your feet into a basin of hot water. Ask someone close to give you a massage, or resort to acupressure yourself, the schemes of which are easy to find on the net;
• After 2 hours, if pain is still not relieved, take triptan or a combined analgesic with a sedative component;
• If after 2 hours after this the attack has not stopped, vomiting has begun, do not take any more pills - call an ambulance or inject Baralgin / Ketorolac at home, if possible.

When to call an ambulance

There are situations when an ambulance must be called without fail. Although migraine is not a dangerous disease, in very rare cases it takes on threatening forms and can lead to serious complications. Read the list below carefully: even if you are used to dealing with attacks on your own, some deviations from the usual scenario should make you grab the phone immediately.

Call an ambulance if:

• The attack lasts more than three days, that is, you have a so-called "migraine status", the result of which, especially in adulthood, may be a stroke;
• You have repeated vomiting, diarrhea, and dehydration;
• Migraine aura lasts more than 1 hour;
• Violations of vision, speech, touch and smell persist throughout the attack, and not just precede it;
• Previously, your migraine was never accompanied by an aura, but now it suddenly appeared;
• You have severe dizziness, darkening of the eyes, curvature of objects, complete blindness, loss of consciousness, disorientation in space;
• The course of your migraine has changed dramatically, and you have had your second or third attack in the last week;
• You are over 55 years old, have had migraine for a long time, and suddenly you again have a severe headache similar to a migraine.

We hope that today we were able to answer all your questions about migraines, help you gain hope and suggest ways to take this insidious and mysterious disease under your control. Take care of yourself and be healthy!

Author of the article: Sokov Andrey Vladimirovich | Neurologist

Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".