Migraine, is it preventable? Migraine Status, Characteristics and TreatmentNeurologist Byung-Gun Kim

 

 

1. Types of headaches

Are there different types of headaches?

 

Headaches can be broadly divided into primary headaches and secondary headaches. Primary headache is a headache that occurs without a specific cause, and includes migraine, tension-type headache, cluster headache, and other primary headaches. Other primary headaches include cold-induced headaches, which are headaches that are felt after eating cold food.

 

Secondary headaches are headaches that occur from other causes. It can be caused by cerebrovascular diseases such as head trauma, cerebral hemorrhage, meningitis or cold infections, brain tumors, and medications to prevent angina and stroke.

 

2. Current status of migraine headaches

Do migraines cause the most hospital visits?

 

 

As of 2012, the one-year average prevalence of migraine in Korea was 17.5%. If mild intensity migraine is included, the true prevalence can be as high as 50%.

 

Looking at the table, you can see that, overall, the prevalence of migraine in women is higher than in men. Statistically, after the age of 10, the prevalence of migraine headaches begins to rise sharply after women begin menarche. And then the prevalence drops in menopause. This means that female hormones are associated with migraines.

 

 

The graph above is the age-specific prevalence of migraine surveyed worldwide. However, the clinical prevalence of migraine in our country is a little different. In Korea, the prevalence of migraine remains high even among people over the age of 60.

 

3. Diagnosis of migraine

What are the diagnostic criteria for migraine?

 

There are several characteristics that can be identified as migraine.

 

First, repeatability

Headaches occur repeatedly.

 

Second, persistence

Headache lasts more than half a day

 

Third, headache patterns

It starts on one side of the head and is pulsatable. And when you move your body, your headaches get worse. This is why when you suffer from migraines, your quality of life decreases.

 

Fourth, accompanying symptoms

Migraine sufferers may experience nausea or problems receptivating light/sound stimuli. Symptoms such as blurred vision and pain in the eyes are some of them. In small children, symptoms such as car sickness and stomach aches may be repeated. And these symptoms are often caused by some kind of vestibular stimulation. This is why people usually come to the hospital for migraines.

 

4. Triggers for headaches

Why do migraines occur?

 

In the case of secondary headache, there is a clear disease that caused the headache, and primary headache can be caused by environmental causes such as seasons and genetic causes. It is virtually impossible to rule out all of these causes. However, the following triggers, which are known to trigger migraines, should be avoided if possible.

 

 

Coffee, oranges, chocolate, foods with added MSG, cheese, hot dogs, and processed meats trigger migraines. However, it can be difficult to realistically eat without all of the foods presented above. For example, it is difficult to get all migraine sufferers to quit coffee. If you drink more than 2~3 cups of coffee a day and have migraines, reducing your intake a little may help to some extent in resolving migraines. You can think of it as restricting the foods known as trigger foods as much as possible.

 

In addition to certain foods, fasting that lasts longer than 16 hours can cause an "hunger headache." It is said to occur most often during the Muslim month of Ramadan. The reason is that headaches can occur when blood sugar rises, but there is also room for them to occur when blood sugar drops excessively.

 

5. Treats migraine

How are migraines treated?

 

First of all, the stages of treatment of migraine can be divided into four stages.

 

Step 1: Identify your triggers

Step 2: Lifestyle Correction

Stage 3 Acute Care

4 Steps to Preventive Treatment

 

Step 1 is to identify what the triggers are. In women, birth control pills can be the culprit. This is because estrogen, progesterone are closely related to migraines. Alternatively, there may be problems with cerebrovascular circulation, which leads to headaches. People with sleep apnea chronically lose blood flow to the brain, making them more prone to dementia and migraines, which may be the cause. In this way, it is necessary to pick out the triggers that are appropriate for each patient's situation.

 

Step 2 is the lifestyle change stage. It's a step to get into a routine and a regular lifestyle. Eating regularly and not overeating, sleeping regularly, exercising, avoiding caffeine and alcohol, and controlling obesity and depression are steps to develop.

 

Stages 3 and 4 are the stages in which headaches are treated with the help of medications.

 

In stage 3, the immediate headache is present, so acute treatment analgesics should be used. Acute headache analgesics include simple analgesics, combination analgesics, and specialty migraine medications. You can use the type of pain medication that is appropriate for your individual condition.

 

However, there are precautions to be observed when using acute analgesics. Consuming it within 1 hour of possible headache onset will help with initial treatment. And if you take acute pain medications more than 8 days a month, you may experience a "drug overdose headache." If you suffer from chronic headaches, you can reduce the number of painkillers you take by taking oral preventative medications.

 

Finally, step 4 is to take oral migraine prophylaxis. Broadly divided, there are three types of medicines. They are epilepsy medications, depression medications, and blood pressure medications. The drug is used to treat migraines, not for its intended purpose. If you use the required dose for the original use, the side effects will be severe, so you should start taking it at a lower dose. It is an oral preventative medication that aims to reduce the frequency of headaches and prevent them from occurring, and is taken daily. During periods of frequent headaches, you can eat it every day, cut it off or reduce it if you feel remission, and moderate it. As a caveat, some types of epilepsy medications can cause weight gain, and pregnant women should not use them.

 

There are also non-oral prophylactic drugs, but also injection prophylactics. Oral prophylactic drugs are not developed for the treatment of migraines, so if you are reluctant to use them for their original use, you can use prophylactic drugs for injections. Injection prophylaxis includes Botox and CGRP antibody injections.

 

Botox, which is injected primarily to prevent wrinkles, can counteract CGRP, a substance in the body that causes migraines. It is injected in a total of 31 places in the forehead and temple area, and it is easy to access and has the effect of smoothing wrinkles as a secondary effect, but as a disadvantage, it is not effective for tension-type headaches, but only for migraines.

 

There are also CGRP antibody injections that act specifically on CGRP. CGRP antibody injections have the great advantage of having fewer side effects and good therapeutic effect because they only act on the target substance, but they have the disadvantage of being expensive. Also, as a caveat, CGRP antibody injections are a new drug, so pregnant women should avoid them as much as possible.

 

In addition, you can also try e-medicines, which are treatments that are applied to the forehead. It is the principle of blocking pain-inducing stimuli from entering the brain by giving other stimuli to the head. The advantage of this treatment is that it is a non-drug treatment and can be used in pregnant women.

 

In general, oral medications will be used first, and then Botox, antibody injections, etc. will be considered.

 

Migraine is a disease that cannot be cured and the degree of treatment is adjusted according to the intensity of the headache. It is an invisible, often painful and poor quality of life, but patients often struggle with it because it is a disease that is not recognized by those around them, so if there are migraine patients around you, it can be very helpful if you actively recommend rest and treatment. In addition, patients who have visited the hospital in the past due to side effects of medicines but have not been able to receive treatment are encouraged to receive appropriate treatment as there are many new solutions.