How to get migraine under control: advice from a neurologist. Website marieclaire.ua

It is well known that women are more likely to suffer from migraines, that this type of headache “prefers” young people, and that there is currently no cure for this condition. However, it is possible to manage migraines and reduce their impact on quality of life. Margarita Sergeevna Prokhorova, a neurologist at the Bersenev Medical Center, answers the most common questions about migraines.

Migraines are mysterious and sometimes unpredictable. They have been known for over 3,000 years; even ancient doctors studied them and tried to control them. However, even today, this type of headache is familiar to about a quarter of the world’s population. What is a migraine? Why is this condition such a tough nut to crack for science? How can you manage it well enough so that it doesn’t prevent you from leading a full life? Let’s take a closer look.

• Are migraine attacks life-threatening?

It is and isn’t at the same time. Migraines themselves cause a great deal of suffering, but they are not considered life-threatening. However, if left untreated, there is a high risk of complications that can lead to significant changes in brain structure. Cases where migraines occur 15 or more days a month require special attention; this is a chronic form that undoubtedly takes a toll on the body. Therefore, the main rule is: under no circumstances should you endure the pain or self-medicate.

• Is it true that women suffer from migraines more often than men?

Both men and women are susceptible to migraines, but women do indeed suffer from them about 3–4 times more often than men. Although during adolescence, when migraines first manifest in most patients, boys are affected significantly more often. But then they “grow out of it,” while in women, on the contrary, the intensity increases, and the peak of migraine activity occurs between the ages of 35 and 45. Women’s greater susceptibility to migraines is explained by the characteristics of the hormonal system. For example, it is believed that testosterone protects against migraines, while the female hormones prolactin and estrogen contribute to them. Scientists identify estrogen specifically as a key factor in understanding the causes of migraines. They focused on it because migraines in women intensify during menstruation.

• How can you tell if it’s a migraine and not another type of headache?

There are indeed many types of headaches, and it’s not always possible to determine their cause. But for a neurologist, the picture of a migraine is usually clear; the diagnosis is made based on a patient interview, physical examination, and observation. If necessary, additional tests may be ordered. Therefore, you shouldn’t diagnose yourself; it’s better to trust a specialist.

There are many signs of a migraine, but the most common are:

— typically, the pain is on one side of the head;

— increased pain when changing body position or moving the head;

— throbbing pain;

— excessive sensitivity to light, sound, smell, and sometimes touch;

— the pain is often accompanied by nausea and vomiting;

— vision may be impaired.

• How can you tell the difference between a migraine and a tension headache?

That’s a perfectly valid question, because tension headaches are often mistaken for migraines. Tension headaches are very common in today’s world, which is full of stress and overload. And the intensity of these headaches often makes one wonder, “Could this be a migraine?” However, there is a difference. Tension headaches are usually bilateral and often feel like a “squeeze” on the forehead or temples; sometimes the pain starts at the back of the head. It feels like wearing a helmet or a headband. But unlike migraines, tension headaches aren’t accompanied by nausea, blurred vision, or vomiting. Also, with tension headaches, the pain does not worsen during physical activity or when changing position. But keep in mind that people prone to tension headaches may also experience migraines. Only a doctor can accurately determine the nature of your pain.

• Can migraines go away on their own if left untreated?

By the age of 55–60, migraines tend to subside in most patients. But, you must agree, waiting until that age—wasting a lot of time and opportunities—is strange and not entirely safe. As mentioned earlier, migraines can lead to irreversible consequences that may be misdiagnosed as other conditions. It is no coincidence that in 2000, migraine was included in the list of diseases of global significance, as it significantly impacts a person’s quality of life. It ranks among the top 10 disorders causing disability. The WHO identifies this condition as a risk factor for cerebral strokes, heart attacks, and damage to the brain’s white matter.

• How long does a migraine attack last, and how often does it occur?

This varies greatly from person to person. The duration of an attack in adults can range from 3–4 hours to 3 days. On average, it lasts 20 hours. If migraines are episodic, they may occur 1–3 times every few months. However, there is also a chronic form where migraine attacks occur more than 15 times a month! This, of course, significantly impacts quality of life and requires ongoing monitoring by a neurologist.

• What is a migraine with aura?

There are several types of migraine, but in everyday language, two terms are most commonly used: migraine without aura and migraine with aura. What does the term “aura” mean in neurology? An “aura” is what may precede a migraine attack. It is a subjective sensation experienced by a person, such as: seeing spots before the eyes, flashes of light, blurred vision, a peculiar taste in the mouth, numbness in part of the body and/or even the tongue, pins and needles, or a tingling sensation. An aura can last from a few minutes to an hour, after which a migraine attack begins. But the most common type of migraine is migraine without aura. This is a type of migraine that is not accompanied by any neurological symptoms either before or after the attack.

• Is it really impossible to cure migraines once and for all?

Migraines have indeed proven to be a tough nut to crack for generations of doctors; no method has yet been found to eliminate them once and for all. However, this is true of any other primary headache as well. But modern neurology is quite successful in managing migraines; that is, it is possible to prevent attacks and make them weaker and less frequent. It is believed that treatment is effective in 95% of cases today, and if there is still no improvement, the failure is most often due to the patient’s own behavior and a lack of discipline in following the doctor’s recommendations.

• Do children get migraines, and how can you recognize them?

Unfortunately, yes. More than half of adult patients report during initial consultations that their first attack occurred between the ages of 14 and 16. But today, there are well-documented cases of migraines in children as young as preschool age! Therefore, under no circumstances should you ignore a child’s complaints of a headache; instead, see a pediatric neurologist immediately. How can you tell if a child has a migraine? The symptoms are essentially the same as in adults:

throbbing pain in the temporal or frontal regions of the head—unilateral or bilateral,

excessive sleepiness, lethargy, nausea and vomiting, dizziness, pale skin,

cold sweat, rapid heartbeat. Of course, not all symptoms may be present.

• What tests do neurologists perform to diagnose migraines?

Migraine is a diagnosis made clinically, that is, based on the patient’s complaints and medical history. It is also important for the patient to keep a headache diary. This helps determine the frequency of attacks, their duration, and intensity. Additionally, by keeping a diary, it is possible to assess the progression of attacks against the backdrop of treatment and lifestyle changes. However, any recommendations for testing are made by the doctor only after a comprehensive neurological examination has been conducted.

• How to manage a migraine at home?

A migraine attack can strike anywhere and in any situation, but your main task is to ensure complete rest and follow the steps your doctor teaches you. Therefore, it’s best to get home. It is important to ensure complete rest and stop working, especially physical work. No “I’ll just finish writing this report” or “I just need to clean one shelf in the fridge”! If your condition allows, drink some hot sweet tea and have a light snack. Air out the room, turn off the lights, and close the curtains if the room is bright. Lie down comfortably and find a position that works for you. It helps if someone can gently massage your temples, forehead, neck, and shoulders. A cold compress can also provide relief. And under no circumstances should you endure the pain—take the medication prescribed by your doctor. You should always keep a supply of it on hand and within easy reach.

• Do people prone to migraines need to follow a special lifestyle?

It’s not just recommended—it’s essential! A consistent routine, understanding what triggers migraine attacks and avoiding those factors, and a healthy lifestyle are what will definitely improve the patient’s overall condition and reduce the number of attacks! What most often leads to migraines? Lack of sleep, stress, unbalanced diets and fasting, dehydration, consumption of milk and other foods high in sugar, alcohol, nicotine, working without breaks, long-distance flights and car trips, and much more. Therefore, plan your life and manage your workload. Remember that you absolutely need to rest and take breaks throughout the day.

To clearly identify your specific triggers, doctors recommend keeping a diary. After all, the factors that lead to headaches can vary greatly! For example, some people cannot tolerate certain smells, alcohol, and tobacco smoke, stuffy rooms, loud noises, and more.

Additionally, for migraines, doctors recommend a diet that excludes foods containing tyramine: it contributes to vasoconstriction and increased blood pressure. The highest concentrations of this substance are found in chocolate, overripe fruits, and certain types of cheese, such as Brie, feta, mozzarella, and Parmesan.