Chronic migraine

Migraine is a chronic neurological disease characterized by periodic attacks of intense headache, usually of a pulsating nature, which is most often localized on one side of the head, but can also occur bilaterally. Attacks are often accompanied by nausea, vomiting, sensitivity to light and sound. This is not just a “severe headache”, but a complex neurovascular process.

• Migraine is one of the leading causes of disability in the world according to the WHO.
• About 12–15% of the Earth’s population suffers.
• It occurs approximately three times more often in women than in men (due to hormonal factors).
• Most often, the disease begins between the ages of 20 and 40.
• In 70% of cases there is a family (genetic) predisposition.

Pathogenesis (mechanism of development)

Migraine is a neurovascular disorder that involves several interrelated processes:

1. Disruption of the excitability of the neurons of the cerebral cortex, which can cause the so-called cortical depression of propagation — a wave of electrical hypoactivity.
2. Activation of the trigeminal vascular system: stimulation of the trigeminal nerve leads to the release of vasoactive peptides (eg, CGRP), which causes inflammation of the meningeal vessels.
3. Expansion and inflammation of the blood vessels of the meninges causes pain.
4. Hormonal fluctuations (especially the level of estrogen in women) can increase the activity of these mechanisms.

Migraine symptoms

Main features:

• Throbbing headache, usually on one side.
• The duration of the attack is from 4 to 72 hours.
• Nausea and/or vomiting.
• Photophobia (sensitivity to light) and phonophobia (sensitivity to sounds).
• Aggravation with physical activity.

In addition, the following may occur:

• Dizziness.
• Diarrhea.
• Disruption of concentration, general weakness

Types of migraine

1. Migraine without aura (the most common type, ~75% of cases):
   • Pain attacks without previous neurological symptoms.
2. Migraine with aura (~25% of cases):
   • Before the attack, neurological symptoms appear: visual disturbances (lightning flashes, spots, “zigzags”), speech disturbances, numbness of the limbs, weakness.
   • The aura usually lasts 5–60 minutes.
3. Chronic migraine:
   • Headache ≥15 days per month, of which ≥8 with typical migraine symptoms, for ≥3 months.
4. Menstrual migraine:
   • Attacks are closely related to the menstrual cycle.
5. Ophthalmoplegic, basilar, hemiplegic migraine (rare forms):
   • Have specific neurological manifestations (for example, eye muscle paralysis, limb weakness).

Provocative factors (triggers)

• Stress, emotional overstrain.
• Insufficient or excessive sleep.
• Hormonal changes (menstruation, pregnancy, ovulation).
• Certain foods: chocolate, cheeses, wine, caffeine, smoked meats.
• Changes in weather, change in altitude, pressure.
• Bright light, loud sound, pungent smells.

Diagnostics

The diagnosis of migraine is established clinically, based on characteristic symptoms.
Instrumental studies (MRI, CT) are performed to rule out other causes of headache with an atypical course or a first-onset attack in people over 50 years of age. Additional examination methods are prescribed by a doctor.

Treatment of chronic migraine
In our medical center, you can undergo prophylactic treatment of chronic migraine with the use of botulinum toxin type A (Xeomin).

How does it work?

Botulinum toxin blocks the transmission of pain signals in nerve endings.
When it is injected into the muscles of the head and neck, it:

• relaxes tense muscles that can cause pain;
• blocks the release of substances that trigger inflammation and pain during a migraine attack;
• reduces the frequency and intensity of attacks.

Who is this treatment suitable for?

Botulinum toxin is indicated only for chronic migraine — i.e.:

• if the headache lasts 15 or more days per month,
• of them, at least 8 days have symptoms of migraine,
• and it lasts at least 3 months in a row.

How does the procedure go?

• The doctor makes injections in certain points on the head, neck, shoulders.
• The procedure takes 10–15 minutes.
• It almost does not hurt – injections with a thin needle.
• The full effect appears 2-4 weeks after the procedure.

How often should you inject?

• Injections are given once every 12 weeks (that is, once every 3 months).
• Several courses in a row are often required for a lasting effect.

Is it effective?

Yes. Many patients note:

• a significant reduction in the frequency of attacks (sometimes twice),
• lower intensity of pain, i.e. lighter attacks,
• decrease in the need for pills.

Learn more about treatment of chronic migraine or make an appointment for an initial consultation by calling the contact center: (044) 238-22-31.