In essence, medication "treatment" of migraines is reduced to the relief of its attack, since the "illness" itself, being a constitutional anomaly of the nervous regulation of blood vessels, is not curable. The prevention of migraine is to use funds that prevent the development of migraine attacks.

Preventive treatment should not only reduce the frequency, intensity and duration of attacks and improve the quality of life, but also preventing the progression of migraine into its chronic form. In this article we will talk about the prevention of migraine drugs.

Who is the drug prophylaxis shown?

Preventive treatment of migraine is prescribed to patients suffering from frequent and severe attacks. As a rule, this situation arises if a person is subject to the frequent influence of provoking the migraine factors, some of which can be eliminated. Medicate prevention is focused on preventing the development of a cascade of pathological reactions in intracranial blood vessels arising during the attack of migraine.

You need preventive therapy if:

Spectrum of funds for drug prevention of migraine

Several groups of drugs are used, because the universal means does not exist, and each patient requires an individual selection of the medicinal product, its dose, the duration of the preventive course.

• vazoactive drugs (calcium channel blockers, beta adrenoblays);
• serotonin antagonists (drugs containing derivatives - Vasdamil, Bellataminal, Cafe, Sandomigran);
• NSAIDs (non-steroidal anti-inflammatory means);
• antidepressants (amitriptyline, selective inhibitors of serotonin reverse seizure);
• anticonvulsants (topiramate, gabapenten, carbamazepine, clonazepam, hollows).

In the absence of the desired therapeutic effect, the use of a combination of drugs is shown. A.V. Yelinin and its co-authors recommended the following:

• antidepressants + vasoactive drugs;
• antidepressants + Valproic acid preparations.

Only a doctor may pick up the therapy adequate to your state!

Characteristics of individual drugs

Amitriptyline Refers to a group of antidepressants. To prevent migraine attacks, this drug allows you to use the central analgesic effect of amitriptyline (that is, anesthesia at the level of the receptor pain brain system) and the normalizing effect on the exchange of serotonin in the central nervous system. Perhaps in some cases an improvement is noted due to the elimination of amitripilin sluggish the patient's current depression. This drug should not be taken to persons who are not able to abandon alcohol - the effect can be fatal! Most patients note the positive effect of amitriptyline (in the sense of a significant demolition of migraine attacks), but the side effects of it are not forced to wait.

Vaswork - The drug is very "friendly." Let me name it in mind:

• extremely rare manifestations of people who took this medicine of unpleasant side effects, which were also light and eliminated themselves;
• High combination of vasual with other medicines received by the patient;
• And, most importantly, high prophylactic activity against migraine. Already a month after the start of reception, I vasilaged the majority was the positive dynamics. Particularly effective was the treatment of patients of young age (due to the smaller death and severity of attacks)
• Significantly improved overall health improves efficiency

Vasdal is a combination of alkaloid of the ardines and caffeine necessary for better suction of the first in the stomach, as well as an independent effect.

The drug vasogram is successfully used in the prevention of migraine (both independently and in the complex), residual phenomena after a brain circulation disorder; dizziness of various types, noise in the ears, worsening hearing of ischemic origin; diabetic and hypertensive retinopathy; Disorders of peripheral arterial circulation (Sindrome and Reino disease). And such unwanted "satellites" of our susceptible to life stress as irritability, the deterioration of memory, the decline in the attention and mental activity of the brain vasogram is also able to warn! This pleasant effect allows students before or during the session to arrange a certain "preventive course" by this drug ..

Many who took this medicine note the greater efficiency of the solution vasographed compared to the form of vase-pills.

Topiramat preparation (he is Topamaks) It is an antiepileptic agent. What does he have to do with migraine?

The feasibility of using anticonvulsants (antiepileptic means) in the prevention of migraine is considered due to their ability to reduce the increased excitability of the brain neurons. The effect of the Topiramate is based on the effects of it on the ionic channels of nerve cells and the biochemical correction of neuronal excitability, as well as direct effects on pain cerebral disease receptor systems. Thanks to this, Topiramat (Topamax) eliminates the prerequisites for the development of an attack.

Topiramat (Topamax) is shown to patients with frequent and heavy migraine attacks, resistant to other types of treatment, patients with chronic migraine, as well as in chronic head pain.

Currently, Topiramat and Topamaks are the most promising prophylactic means of migraine according to multicenter studies.

So, let the pharmacological group of the drug: if the doctor prescribes Topiramat (Topamaks), it means that it considers it pathogenetically reasonable

Means, "paraclusive" migraine

There is such a "medical wisdom" that the difference between poison and healing means is ... at a dose. Man is endowed with an amazing ability to use for good, it would seem not intended for this phenomenon. This peculiarity of human manifested itself with respect to the deadly botulinical clostridium: its poison (toxin) is now known as a botulinical toxin type A or abbreviated - Botox.

Recent years, the possibility of using Botox drugs to relieve various pain syndromes is actively studied in view of its very attractive characteristics:

• security
• good tolerability to patients
• long period of action
• lack of side effects

It should be noted that the beginning of the study of the anti-observation action of botulinum-toxin type A was putting a surgeon that eliminated the mimic wrinkles with it. Grateful feedback from patients did not make himself wait, but they concerned mostly ... demolitioning headaches.

How can Botoks serve as a prophylactic treatment of migraine?

Botulo-cellin, relaxing muscle fibers after their lengthy reduction, thereby reduces the release of active substances irritating muscle pain receptors. But, the main thing, Botoks eliminates neurogenic inflammation, playing his insidious role in the development of the attack of migraine.

The Botox Injection Procedure for Migraine Prevention provides for the introduction of it in several points, which determines the doctor after collecting anamnesis and a thorough objective examination of the patient. Points of injections are more often projected on the protrusion, the temporal areas, less often the frontal and occipital shares.

So, Botoks can become a real salvation for people suffering from frequent, grave attacks of migraine, bringing them out of order by several days, for patients with a chronic migraine form; Awareness by the patient of control over this disease significantly improves the quality of his life and cannot but please the attending physician.

Many people are familiar with migraine. The painful headache makes you forget about home affairs, work and plans for the weekend. Most often helps only sleep with closed curtains. Patient annoying any sounds. But it is bad that the attack may not pass within a few days. It bothers it greatly, because most of us need to go to work with almost any circumstances. This symptom is treated hard, so drugs for the prevention of migraine are good output for most people.

General characteristics of migraine

This is a neurological disease for which the development of a strong, pressing headache is typical. About drugs for the prevention of migraine heard not all. Usually we start thinking about the tablets during an attack. But with migraine such a number will not pass. Often, patients complain that during an attack the stomach does not take either food or pills. Attempt to take the drug causes vomiting. It remains only drugs for intramuscular or intravenous injections.

Disappointing forecast

Cure migraine, unfortunately, it is impossible. This is a complex disease, the reason for the appearance of which can be a whole range of reasons, including psychological and physiological. Therefore, a very important point is the prevention of migraine. Preparations for this may pick up a neuropathologist or therapist.

If we cannot cure a disease, then you need to prevent attacks or at least make them less pronounced. To do this, find out the causes of migraine and identify irritating factors. It was not possible to determine exactly the reasons yet, but it is known that the ailment develops against the background of constant stress, unbalanced diet, bad habits and hormonal changes. The mechanism for the development of the disease is associated with the expansion of the vessels. Preparations for the prevention of migraine today are sold in pharmacies in large numbers, but before their use you need to refer to the doctor.

Reasonable prophylaxis

You can tell how much you like to constitute that you do not have enough time. But the attacks of migraine, especially if they are frequent, you have much more resources and forces. Reasonable prophylaxis provides long-term remission and eliminates the development of long pathology. Timely preventive measures will help cure the first symptoms. It is necessary to understand well that drugs for the prevention of migraine will not work if they are not complemented by vitamins, drugs for external use and folk remedies from headaches.

Food

We are what we eat. This famous saying becomes even more relevant if it comes to migraine. Attacks provoke certain nutritional supplements that are included in the menu. These are not empty words, but a proven fact. That is, you can select drugs as you like to prevent migraine attacks, but if you eat a lot of fatty and sweet, they will be non-integral.

Therefore, prevention is starting with the fact that we exclude fatty dishes and a large amount of sweets. Galented cookies and a couple of caramels with tea, but cream cakes are best to leave only the most solemn days. A large number of spices can also provoke attacks. Headaches may be caused by chocolate and smoked, alcoholic beverages and caffeine.

Your behavior

Also a very important point. As is known, migraine is a neurological disease. That is, stress and experiences, serious loads - all this affects the frequency of attacks. Such regularity confirm the reviews of doctors. Preparations for the prevention of migraine have auxiliary effect. In prevention, a huge role is played by human behavior.

The patient should know what attacks him, and be attentive. This may be a reaction to weather changes, stress or phobias. After a conflict situation, no drugs are helped. That is, this is a neurological problem, and first of all need to calm down.

The basis of prevention is the correct routine of the day. It is necessary to work productively, but in moderation. Be sure to take breaks, switch to other business on weekends and take a vacation. Sleep less than 6 hours will cross all prevention. But long to sleep is also not recommended, because it provokes headaches.

Experts recommend maximum planning their output and working day. You need to get up and go to bed at the same time. An excellent means is a contrasting shower, strong and very morning gymnastics. You need to drink more pure water so that the vessels are filled with liquid constantly.

If a person feels that the symptoms are approaching, preventive measures do not help. Usually there are symptoms of aura, fear of light and sounds, smells and nausea. Reviews about preparations for the prevention of migraine confirm that at this moment there is something like that is already late. It is necessary to take a horizontal position and put a cold compress on the forehead. The best way out will be disconnected from problems and exclude annoying factors. Sometimes neurologists offer to take an antidepressant.

Preparations for the prevention of migraine

The list should be in every house where there is a person who suffers from this disease. Please note: when the head hurts, drink them late. And be sure to pay attention to the psycho-emotional state. Frequent susceptibility to stress not only provokes headaches, other organs suffer.

If a person suffers from diabetes mellitus, it can also be caused by headaches. Therefore, you need to monitor sugar levels. Overvoltage mental and physical becomes the reason more often than the rest. In this case, it is resorted to soothing drugs.

Let's consider the names of drugs for the prevention of migraine, which can help prevent a serious attack:

• "Ibuprofen". This is one of the universal painkillers and anti-inflammatory drugs. After about 10 minutes, the medicine blocks hormones, which brought painful sensations.
• "Aspirin". It is used in migranes with aura. Anti-aerated drugs are combined with it. After about 4 hours, the pain is completely passed.
• "Paracetamol". Its effectiveness can not be called high, but in some cases can help.

In fact, it is quite difficult to choose drugs for the prevention of migraine. Names and reviews of designated medicines say that most of them can help directly to relieve or weaken the attack. Moreover, the earlier you felt his approach and took pills, the faster you feel relief. If attacks are concerned often, you should consult a doctor who will prescribe more serious and effective medicines:

• Beta blockers. They are appointed by courses for prevention. But the mechanism of action is still not clear, so it is difficult to say whether the drug really has a significant impact on the body. This medicine such as Atenolol, Metoprolol, "Nadolol" and others.
• Serotonin antagonists. Provocate selection of serotonin and theoretically can be used as prevention.
• Triptans. They are responsible for preventing pain. That is, drugs of this group are accepted at the moment when the first symptoms feel: nausea, aura. This is "Zomig", "Imigran", "Sumysks". Reviews doctors recommend these drugs as the most effective, they do not cause addiction and can be used for a long time.

• Hormonal preparations. Used if attacks are associated with the menstrual cycle.
• Combined anti-spasmodics. Combined drugs are used to treat and prevent attacks, as they affect a number of symptoms immediately. The basis is paracetamol.
• Antidepressants. According to the reviews of doctors, they are effective for the treatment and prevention of chronic migraine. Independent uncontrolled use is extremely undesirable, as it leads to psyche disorders. Often, such drugs as "amitriptyline", "Venlafaxin" are prescribed. Of course, antidepressants have a range of side effects, but in some cases help return to normal life.

Preventive treatment with folk remedies

This method requires more time than using tablets. But otherwise this is a gentle way to remove a migraine attack:

• Infusion of clover. It is effective for any headache. For the preparation of infusion, 1 tablespoon of inflorescences pour glass boiling water. Take 1/3 cup after meals.
• A similar way to the soul is spawned by an already developing attack.
• Strong sweet tea perfectly helps to cope with the attacks and increase immunity.
• Mentholic ointment. When applied to whiskey, it enhances blood circulation and relieves pain.
• Baths with sea salt. Only 15-20 minutes - and you can relax.
• Massage. Effective with starting headaches.

Instead of imprisonment

We reviewed the basic drugs for the prevention of migraine. The list of names can be saved so that at the right minute it was at hand. If the bouts of pain happen more often than two times a week, it is required to consult a doctor and pass the survey. Preventive treatment Sometimes requires the appointment of quite serious vascular drugs. If you regularly undergo such a course, you can avoid strong attacks. Of course, you can not forget about the right nutrition and routine of the day.

A. V. Amelin, St. Petersburg State Medical University. Acad. I.P. Pavlova

In recent years, there has been an increasing interest in the problem of prophylactic (intergreacy) treatment of migraine. This is due to an increase in the number of patients suffering from frequent and severe attacks of headaches and in need of prophylactic treatment of migraine. The main objective of preventive treatment is to reduce the frequency and severity of migraine attacks. Effective intergovernmental treatment contributes to the reduction of the number of analgesics consumed, prevents the development of drug dependence and dosage form of headaches, improves the quality of life of patients.

The basis for the appointment of preventive treatment is the following indications:

• two attacks of migraine and over a month over the last 6 months, with a significant limitation of the patient's legal capacity;
• low efficiency of drugs used to treat the attack and / or the presence of contraindications to their use;
• the use of drugs used to relieve migraine attack more than 2 times a week;
• special circumstances: Hemiplegic form of migraine or migraine with rare attacks, but with sustainable focal neurological symptoms and high risk of stroke development.

Objectives of preventive treatment First of all, must be achieved by modifying the lifestyle (Table 1) And only if necessary by adding medicines. If a lifestyle change has not led to a decrease in the frequency and intensity of migration attacks, medication treatment can be applied. Despite the significant arsenal of drugs used for the prophylactic treatment of migraine, the highly efficient prevention of its attacks present to the present difficulty. This is due to the insufficient study of the pathogenesis of migraines, specific mechanisms of the action of drugs, as well as the individual sensitivity of the patient for drugs.

Medical prevention of migraine attacks It can be carried out episodically or permanently, for a long period of time. An example of episodic preventive treatment is a situation where the factor is well known to the migraine attack (physical activity, defined food, etc.), but it does not occur regularly. In such cases, for preventing an attack of headaches, the drug is accepted immediately before the action of the provocation factor. Another example of the periodic prevention of a migraine attack is an application for 3-4 days before the upcoming monthly non-steroidal anti-inflammatory drugs (NSAIDs) during the menstrual migration form. In the presence of a large number of provoking factors, a frequent occurrence of migration attacks, it is impossible to foresee their appearance preventive treatment is carried out regularly, for several months and even years.

If according to the algorithm (see drawing) It was decided to begin prophylactic drug therapy, the primary choice of the drug is carried out taking into account the concomitant pathology, compatibility with drugs used to relocate the attack, as well as the available data on its clinical efficacy and the spectrum of side effects.

In most cases, the first medicine used for prophylactic treatment should be prescribed in a minimum dose, and then slowly increase it, "titrating" dosage to obtain a positive therapeutic result or the appearance of side effects. The dose of the first drug increases if the desired reduction in the frequency and the intensity of the headaches fails for 1 month. Usually in patients with migraine to obtain therapeutic effect, lower doses of the medication are required, compared with the doses necessary for the treatment of other diseases. For example, the tricyclic antidepressant amitriptyline during depression is commonly used in a dose of 100 to 200 mg / day, while in migraine it is effective in a dose of 10-20 mg / day. In addition, in patients with migraine, side effects often appear when prescribed even relatively small doses of drugs. Thus, the dose of amitriptyline 25-50 mg is the homepage for the treatment of depression, but may cause serious side effects in a patient with migraine. Valproic acid preparations are usually effective in migraine at a dose of 500-750 mg / day, while to treat epilepsy and mania are used in significantly higher doses. Anti-kvulsant Topiramat is effective in migraine at a dose of 50-100 mg / day, and when epilepsy in a dose of 200 mg / day and above.

To obtain the maximum effect of prophylactic treatment, patients should not abuse the intake of analgesics or alcoholoids of the ardines in large doses. In addition, oral hormonal contraceptives, hormonal replacement therapy, vasodilators (nifedipine, nitrates) may interfere with the action of prophylactically appointed drugs. Women receiving preventive treatment of migraines should take care of reliable non-coronal contraception, in the event of pregnancy, it should be warned about the possible negative effects of drugs on the fruit.

The result of prophylactic treatment is considered positive in the event of a decrease in the frequency of migration attacks or the number of headaches by 50% or more, compared to the initial period. To achieve a positive result, without the development of side effects, it may be necessary for several months. The final conclusion on the effectiveness of the first selected drug and the need for its replacement or combination with another drug can be done in the absence of a therapeutic effect for 3 months of treatment. It should not be abandoned from the selected drug if its dose has not been raised to an individually maximum and well-portable. In the absence of a positive reaction to the treatment or appearance of side effects, the selected drug is recommended to replace to a means of another class. In case of insufficient efficiency, but good tolerance of the primaryly selected drug can be added a second medicine from another class. Combinations of two funds from different classes, but at low doses, can give a more pronounced therapeutic effect with a lower probability of side effects.

The decision to increase or decrease the dose of the drug should be made on the basis of a critical assessment of the ratio of the effectiveness of the treatment and degree of risk of side effects. An attempt to reduce the dose and / or the amount of drugs used is justified only after the positive therapeutic result is maintained at the desired level for 1 year. A sudden treatment interruption can lead to a migraine relapse, cancellation syndrome development (B-blockers, clonidine, antidepressants).

Principles for the selection of drugs for intergovernmental treatment

Almost all the drugs used today for intergreacy treatment of migraines were revealed by chance, as a result of their clinical use, and not created specifically for this testimony. For preventive migraine therapy, B-adrenoblays, calcium channel blockers, topiramate, hollow acid, antidepressants, antiserotonin, clonidine, NSAID, female sex hormones are used.

As noted, when choosing a medication, the effectiveness of the drug, concomitant pathology, the range of side effects of the drug, the previous experience of using drugs (Table 2).

In some cases, patients with hardly treatable headache can be recommended combinations of several drugs. (Table 3). Some of them are highly efficient and safe (for example, B-blockers and cinnarizin, B-blockers and antidepressants). At the same time, with caution, it is necessary to apply to the joint use of B-adrenoblasts with verapamil and diltiazem, since the combination with verapamil increases the risk of bradycardia and an intracardiac blockade. Due to the high risk of developing hazardous side effects, a combination of Mao inhibitors with serotonin injecting inhibitors is contraindicated.

Clinical experience shows that the majority of Russian doctors for the prevention of migraine seizures are used by calcium antagonists, B-blockers, topiramate or combination of B-blockers with antidepressants or calcium antagonists (zinnarizine) with anti-wurals. The combination of valproic acid with antidepressants is logical in patients with a concomitant depression or mania. The combination of methisrigid and some calcium channel blockers (fluornarized, cinnarizine) can reduce the vasoconstrictor side effects of the first.

Preventive treatment can have a significant impact on the choice of drugs used during an attack. Some combinations are mutually useful, and a number of combinations are unacceptable. For example, alkoloids of the arcs and the agonists of 5T1B / 1D receptors can enhance the vasospatic properties of methisrigid and B-blockers, but at the same time there are clinical evidence that the efficiency of alcoholoids of the ardines during the attack is significantly increased against the background of the preliminary use of Metisrigid. In this regard, on the one hand, the combination of these drugs is possible and even efficient, and on the other, it will require a close control over the progress of treatment.

To eliminate or significantly limit the consumption of products containing thiramine (cheese, chocolate, cocoa, coffee, tea, marinades, citrus, nuts, eggs, tomatoes).

Maintain an adequate power mode (exclude diets, a long break in meals).

Limit alcohol consumption, especially red wine.

Stop or significantly reduce smoking.

Avoid physical overwork, sudden lifestyle change. Entering aerobic physical activity (walking 30-45 minutes at least 4 days per week).

Normalize sleep mode (harmful both insufficient and redundant sleep).

Prevent situations resulting in excessive emotional tension.

Maintain magnesium consumption at the level required for your health (food, magnesium preparations).

Women do not use hormonal contraceptive means.

Treatment of concomitant arterial hypertension.

Limit contact time with bright light sources (sunlight, computer monitor, TV), sharp smell (paint, perfumery), intensive noise.

Table 2. Selection of the drug for intergreactive (preventive) treatment of migraine

A drug	Clinical Efficiency *	Side effects*	Concomitant disease
			not recommended	recommended
b-blockers **
Propranolol Atenolol	++++	++	Asthma, depression, heart failure, diabetes, Reino disease	Hypertensive disease, ischemic heart disease
Antiserotoninovye
Metisrigid Pisotype Tsiprogeptadin	++++	++++	Ischemic heart disease, hypertensive disease, peripheral vessel diseases	Hypotension
Calcium channel blockers
Verapamil Flanarizin Cinnarizin	+++	+	Hypotension, bradycardia, constipation (for verapamil) Sedation, Parkinsonism (for Cinnarizin)	Migraine with aura, hypertension, asthma, ischemic heart disease
Antidepressants
Tricyclic antidepressants	+++	++	Urine delay, manic syndrome, heart blockade	Chronic pain, depression, anxiety, sleep disorders
Serotonin Reverse Capture Inhibitors
	++	+	Maniacal syndrome	Depression, obsessive state syndrome
Inhibitors of Mao.
	++++	++++	Patients violating medication	Refractory depression
Anticonvulsants
Valproic acid	+++	+++	Liver diseases Hemorrhagia	Manic syndrome, epilepsy, anxiety
Topiramat	++++	++	Reducing body weight Nephrolithiasis
Npvp
Naproxen Diclofenak Indomethacin	++	++	Ulcerative disease, gastritis	Arthritis, Other pain syndromes

Note: * - severity of the feature from + (minimum) to ++++ (maximum);
** - when migraines are effective B-blockers without internal sympathomimetic activity.

Table 3. Combining drugs for intergreactial treatment of migraine

Rational combinations
Antidepressants	b-blockers
	SA channel blockers
	Valproic acid
	Topiramat
Metisrigid	SA channel blockers
Inhibitors of serotonin reverse seizure (fluoxetine)	Tricyclic antidepressants (amitriptyline)
Topiramat	SA channel blockers
Permissible combinations
b-blockers	Channel Blockers (Zinnarizin)
	Metisrigid
Inhibitors of Mao.	Amitriptyline, Northriptyline
Invalid combinations
Inhibitors of Mao.	Inhibitors of serotonin reverse seizure (fluoxetine)
	Most tricyclic antidepressants (with the exception of amitriptyline, nodriptyline)
	Carbamazepine
Npvp	Lithium

Mao inhibitors increase the half-life and distribution in the tissues of Sumataptan, adopted inward, which increases the risk of cumulation of the drug and the development of side effects when it is repeated. Metheridine and sympathomimetics included in a number of combined drugs used to relieve the attack potentiate the effect of Mao inhibits and increase the risk of developing serotonin syndrome or hypertensive crisis.

Simultaneous reception of the NSAID, including aspirin, for the prevention and binding of the attack significantly increases the risk of developing side effects from the gastrointestinal tract. The joint use of valproic acid and barbiturate preparations will potentiate their suppressive effect on the central nervous system.

There is a significant number of foreign and domestic studies indicating efficiency calcium antagonists With prophylactic treatment of migraine. 45 controlled clinical trials of calcium antagonists were carried out during migraine. The results of double-blind placebo-controlled studies have shown that the purpose of fluunarizine at a dose of 10 mg per day was effective in 46-48% of patients. However, a comparison of fluunarizin with propranolol and metoprolol did not reveal the advantages of calcium antagonist before B-blockers. It should be noted that the main side effect of flunarizine is the development of Parkinsonism syndrome, muscle weakness and depression. In a double-blind multicenter study (Nimodipine European Study Group), it was shown that the effectiveness of nimodipine (120 mg / day) in the treatment of migraine with aura and without aura does not differ from the placebo efficiency. The results of three placebo-controlled studies indicate that verapamil in a dose of 320 mg / day turned out to be reliably more than a placebo in the treatment of migraine, and in a dose of 240 mg / day reliable differences were received.

Foreign publications about the treatment of migraine by calcium antagonists are devoted mainly to fluunarizin who has not been widespread in domestic medical practice, while most domestic studies are dedicated cinnarizin. Accumulated clinical data show the effectiveness of this calcium antagonist about 48% of patients, which corresponds to the results of treatment with such drugs as B-blockers and antidepressants. However, the use of cinnarizine for the prevention of migraine is limited by its sedative effect, especially often developing with prolonged use of the drug.

Attempting the leveling of the sedative effect of cinnarizin was implemented in the preparation "Fesame". The drug is a successful combination of the pharmacodynamic effects of two known drugs - zinnarizin and piracetam - in therapeutic doses of 25 and 400 mg, respectively. Fesame has antihypoxic, metabolic and vasodilatory action. The activating effect of piracetam reduces the sedative effect of cinnarizine and allows the flasham to exert a normotimic effect, providing good tolerability of the drug during its long-term use. The mutual potential of the pharmacodynamic properties of two drugs provides a pronounced antihypoxic effect of the flasham.

The effective effect of the drug is due to the metabolic and vascular effects of piracetam and zinnarizin. The dilatation of brain vessels caused by cinnarizin does not lead to a decrease in blood pressure, and incoming piracetams increases intracellular metabolism, optimizes the intracellular consumption of glucose and energy exchange, inhibits platelet aggregation, stimulates cholinergic neurons, improves intermetrous transmission. It is not known which of the listed mechanisms of action ensures the effectiveness of the drug during migraine.

We carried out a comparative study of the Fesame efficiency (1 capsule 3 times a day) and cinnarizine (75 mg / day) in the preventive treatment of migraine for 3 months. The results obtained showed good food efficiency and confirmed the effectiveness of cinnarizin in the treatment of frequent migraine attacks. After 3 months of treatment, the number of patients with positive results of treatment (decrease in the frequency of attacks by 50% or more) was 49 and 47%, respectively, which is comparable to the effectiveness of B-blockers and antidepressants in the treatment of migraine. It should be noted a good tolerability of the long-term use of Fesame and a reliably smaller number of complaints about drowsiness and muscle weakness in the group of patients who received this drug compared to a group receiving cinnarizin. In the same group of patients, a reliable improvement in attention and memory was revealed, an increase in stress tolerance. Thus, the combination of cinnarizine and piracetam (flames) confirmed its effectiveness and safety in the treatment of patients with migraine.

It is well known about the connection of female sex hormones (estrogen, progesterone) and migraine. In the pre-period period, the migraine occurs with the same frequency of both boys and girls, but after the age of 15, it significantly prevails in women. The first attacks of migraine appear with the first menarh in 33% of women. In the future, migraine attacks can appear a few days before menstruation, during it and less often during ovulation. Migraine, which occurs only in the period of menstruation, is often combined with dismenoria and is called menstrual.

Migraine appearing a few days before menstruation, is considered as one of the symptoms of premenstrual syndrome. For this period are also characterized by a dysphoria (changes in mood, depression, anxiety, tension, seizures of federation); feeling of fatigue or exhaustion; drowsiness; Pain in the lower back; sweeping syndrome; nausea; Bulimia; Use of excessive salt, sugar. The appearance of premenstrual syndrome and menstrual migraines is associated with a disadvantage of progesterone at the end of the lutein phase of the menstrual cycle, as well as an increase in the level of prostatenins and violation of endorphins. Therefore, the prevention of premenstrual and menstrual migraine is based on the principle of reimbursement of estrogen and progesterone before menstruation and the suppression of prostaglandin synthesis. NSAIDs suppress the synthesis of prostaglandins and are effective means of preventive therapy of menstrual migraine. Migraine hormonal therapy is carried out in the absence of a therapeutic effect from the use of the NSAID or in order to strengthen their action, but only after consulting with the gynecologist.

Thus, today, a wide range of drugs with varying degrees of efficiency and tolerability is offered for preventive treatment of migraines. Therefore, the choice of one or another should be based on the results of evidential clinical studies and the personal experience of the doctor and the patient.

Literature

1. Amelin A.V., Ignatov Yu. D., Spear A. A. Migraine (pathogenesis, clinic, treatment). St. Petersburg Medical Publishing House. 2001.
2. Vane A. M., Kolosova O. A., Yakovlev N. A., Slyusar T. A. Migraine. M., 1995.
3. Peroutka S. J. The Pharmacology of Current Ant-Migraine Drugs. Headache, 1990; 30 (1): 5-11.
4. Ramadan N. M., Schultz L. L., Gilkey S. J. Migrain Prophylactic Drugs: Proof of Efficacy, Utilizatin and Cost. CEPHALALGIA, 1997; 17: 73-80.
5. Silberstein S. D. Preventive Treatment of Migraine: An Overview. CEPHALALGIA, 1997; 17: 67-72.
6. Silberstein S. D., Merriam G. R. Estrogens, Progestins, and Headache. Neurology, 1991; 41: 786.
7. TFELT-HANSEN P. Drug Treatment of Migraine: Acute Treatment and Migrain Prophilaxis. CURR OPION NEUROL, 1996; 9: 211-3.

Since migraine attacks can provoke various factors, it is necessary to determine them for each patient and decide how it is better to eliminate or weaken. It is important to rationally organize the mode of work and recreation, including sufficient, but not excessive sleep.
Since stressful and conflict situations affect the development of migraine attacks, despite the fact that many patients do not give them significant importance, it is important to discuss this aspect with them. If negative circumstances can not be eliminated, consulting a psychologist, who may appoint psychological treatments (autogenic training, treatment according to the method of biological feedback, etc.). The latter are especially shown at elevated anxiety and deterioration.
In some women, the reception of oral contraceptives causes the first in the life of a migraine attack or participates previously having previously. In these cases, a different type of contraception should be recommended. Sometimes, on the contrary, the use of oral contraceptives reduces the frequency and intensity of attacks.
Many patients note that certain foods and drinks provoke from them to migraine attacks and therefore exclude or limit their use. Such products include cocoa, chocolate, cheese, milk, nuts, eggs, tomatoes, celery, citrus, oily food, alcohol, especially red wine and beer. Some patients are advisable to wear light-protective glasses, especially in the summer, since the bright light can provoke the attacks.

Migraine Prevention with Preparations

The use of drugs in order to prevent migraine seizures is shown only with frequent (two or more per month) and severe attacks and, therefore, it is only a small (no more than 10%) of patients. In most cases, the duration of treatment for several months.

Group of pharmacological preparations used to prevent migraine:
- beta blockers;
- tricyclic and four-cyclic antidepressants;
- blockers calcium channels;
- anticonvulsants;
- Non-steroidal anti-inflammatory funds;
- Serotonin antagonists.

Beta blockers are first-order preparations for migraine prevention, The mechanism of their action is not clear. The effectiveness of beta-adrenoblockers in the prevention of migration attacks is associated with the braking of dilatation of cranial arteries and arteriols arising from the decrease in serotonin concentration. They have a hypotensive effect and therefore are particularly effective for the prevention of migraine flowing against the background of arterial hypertension. Because of its anxiolytic action, beta-adrenoblays are also effective in migraine on the background of severe anxiety, it is necessary to prevent patients about the main side effects of beta-adrenobloclars (increased fatigue, drowsiness and depression) in order to recognize them as early as possible.

Migraine Migraine attack Treatment of migraine Migraine Prevention Popular treatment of migraine Ayurveda about the treatment of migraine

Those who have exercise should be prevented about a possible reduction in the pulse rate so that they do not dose the load depending on its indicators. Preparations of this group contribute to hypoglycemia, which leads to an increase in appetite and increase weight. This causes additional concern in women with overweight. Basic contraindications for the use of beta-adrenoblockers: bronchial asthma, heart failure, atrioventricular conduction disorders, arterial hypotension. Beta-adrenobloclars can not be abruptly abolished in patients with coronary heart disease, as it can exacerbate ischemia and cause arrhythmia.
If one beta-adrenoblor is ineffective, one should try another, it may turn out to be more efficient. In other words, the lack of reaction to one beta-adrenoblocator does not exclude the use of the other.

Preparation Beta Blocker for Migraine Prevention: Propranolol

The operation of propranolol is due to the effect on the vessels of a soft cerebral shell having beta-adrenoreceptors. It penetrates well through the blood-brain barrier, has antiserotonergic activity, affects platelet aggregation. For the prevention of migraine, the drug is taken in the initial dose of 40 mg 2-3 times a day; If necessary, the dose gradually increase to 160 mg per day. Side effects: Slowing of cardiac rhythm, arterial hypotension, heart failure, dry mouth, nausea, sleep disorder, depression, violation of visual acuity, skin rash. Contraindications: atrial stomach blockade, slowdown of cardiac rhythm less than 55 blows per minute, arterial hypotension, acute and chronic heart failure, Reino disease and other obliterating diseases of the vessels. Release form: 40 mg tablets, package 30 pcs.
Similar drugs are produced under the names:
Anaprilin (Ai Si En Lexers, Russia); Inderal (ICN Galenika, Yugoslavia); Inderal (Astra Zeneca, United Kingdom); Obizant (AWD, Germany); Schwarz Pharma, Germany); Proper (Ludwig Merckle, Austria); Propranolol (Weimer Pharma, Germany); Propranur (Henning Berlin, Germany); Propranolol (Sicomed, Romania).

Preparation Beta Blocker for Migraine Prevention: Atenolol

It is selective beta adrenanblerocatar. When used in medium therapeutic doses, there has a less pronounced effect on the smooth muscle elements of peripheral arteries than non-selective beta blockers. It is used in the initial dose of 50 mg 1 time per day. With insufficient expression of the effect, the dose increases to 100-150 mg per day. The drug is recommended to take before eating, not chewing, drinking water. Side effects: At the beginning of therapy, fatigue, dizziness, depression, sleep disorder, nausea, skin itching are possible; In some cases, the deceleration of the rhythm of the heart, hypotension, the conductivity disorders of the heart may occur. Contraindications: Violation of atrial and ventricular conductivity 2-3 degrees, slowing down the heart rhythm below 55 beats per minute, acute and chronic heart failure, bronchial asthma. Release form: Tablets of 50 mg and 100 mg.
Similar drugs are produced under the names of APO-Atenol (Apotex, Canada); Atenolol (Lupin, India); Atenoben (Ludwig Merckle, Austria); Atkardil (Sun Pharmaceutical, India); Betakard (torrent, india); Dignobet (Luitpold Pharma, Germany); Katel (Cadila, India); Prurry (ICN Galenika, Yugoslavia); Tepolol (Izza, India); Tenornmin (Astra Zenes, United Kingdom): Falitonsin (Salutas Fahlberg-List, Germany); Atenolol (Aii Ein Marbiofarm, Russia).

Preparation Beta Blocker for Migraine Prevention: Kourgad (Bristol-Myers Squibb, USA)

Contains the active ingredient - pesol - non-selective beta adrenobloclocator of prolonged action. It is used in the initial dose of 40 mg, if necessary, a dose of the drug can be increased to 160 mg. Side effects: slowdown in heart rate, atrial stomach blockade, bronchospasm, heart failure, dizziness, nausea, skin allergic reactions. Contraindications: atrial and stomach blockade 2-3 degrees, slowdown of heart rhythm below 55 shots per minute, acute and chronic heart failure, Rhino disease, pronounced violations of liver and kidney function, diabetes, pregnancy. Release form: Tablets of 40 and 80 mg.

Antidepressants for Migraine Prevention

Preparation Antidepressant for Migraine Prevention: Amitriptin (Polfa, Poland)

Effective preparation for the prevention of chronic headaches, especially mixed forms, such as combinations of migraine and tension head pain. The drug blocks the reverse seizure of serotonin from the central synapse and has a central painful effect, since it reduces the frequency of discharges in the spinal core of the trigeminal nerve - the main zone of craniofacial pain sensitivity in the central nervous system. The anti-solid effect of tricyclic antidepressants does not depend on their antidepressive action, although the latter is undoubtedly important for patients with migraine in combination with depression and sleep disorders. In addition, amitriptyline has a sedative effect, which is important for concomitant disturbing disorders. For the prevention of migraine, as a rule, small doses of the drug are required. Amitriptyline is prescribed at the beginning at a dose of 12.5-25 mg / day at night, gradually increasing it by 12.5-25 mg every 3-6 days to 75-100 mg / day. Therapeutic action begins with 2-3rd weeks, which you need to warn the patients. It should be remembered about the side effects associated with the anticholinergic effect of the drug: dryness in the mouth, constipation, accommodation disorders, contraindications for the use of amitriptylin: recently transferred myocardial infarction, cooking inhibitors of MAO and period for two weeks after their cancellation, glaucoma, prostate hypertrophy, Chronic heart failure accompanied by tachycardia. Release form: Dragee 25 m.

Similar drugs are made under the names of amitriptyline (Slovakofarma, Slovakia); Amitriptin (Weimer Pharma, Germany); Amitriptyline Lechiva (Lechiva, Czech Republic); Amitriptyline nicomed (Nycomed, Norway); Amitriptin (Ai Si En Polfa Rzeszow, Poland).

Preparation Antidepressant for Migraine Prevention: Lerivon (Organon, Netherlands)

Active substance - mianserin. Blocks 5T2 and alpha2-adrenergic receptors. Enhances adrenergic transmission in the brain, stimulating the removal of the mediator into the synaptic gap. Unlike most tricyclic antidepressants, no cholinolitical activity is manifested. Quickly absorbed from the gastrointestinal tract. The maximum concentration of the drug in the blood after receiving 15 mg is reached after 2-4 hours. Lerivon is recommended to prescribe overnight, starting with a dose of 15 mg, followed by an increase of 3-5 days to 30 mg. Maximum daily dose - 120 mg. The main side effects of the drug drowsiness, arterial hypotension, violation of the liver function, swelling. Contraindications: manic syndrome, liver dysfunction, sharp period of heart attack, age up to 18 years. Release form: Tablets at 10, 20, 30 and 60 mg.
Similar drugs are produced under the names of MIANSAN (Zorka-Pharma, Yugoslavia); Seridak (Cadila, India).

Antidepressants, as, however, and beta-adrenoblays are effective in migraines (or tension head pain), accompanied by psychogenic vegetative crises (panic attacks). When appointing antidepressants, as well as other psychotropic agents, it is necessary to systematically monitor the patient's condition.

Calcium channel blockers for migraine prevention

This group of drugs are firmly established as a means of preventing migraine despite the fact that their therapeutic efficacy is not so expressed compared to beta adrenoblockers and antidepressants. It is advisable to apply them in migraine, accompanied by neurological manifestations, for example, with basilar or hemiplegic migraines, migraine with an ophthalmic, ophthalmoplegic or prolonged aura. Calcium channel blockers also slow down the release of serotonin, change slow potential shifts and prevent extending depression, which is considered as one of the mechanisms for the development of a migraine attack.

Drug of calcium channel blockers for migraine prevention: verapamil

Calcium antagonist, blocks both activated and "closed" (prevents their activation) calcium channels. Ultimately, tissue perfusion increases, the extensibility of the arteries increases, the disproportion between the need and supply of tissue with oxygen is reduced. Verapamil is usually used at a dose of 40-120 mg per day. Side effects: dyspeptic disorders, bradycardia, hypotension, heart failure, allergic reactions. Contraindicated in hypersensitivity, severe bradycardia, heart failure, acute myocardial infarction, heart rate impaired. Release form: Dragee for 40 and 80 mg.

Similar drugs are produced under the names: Verapamil (Hemopharm, Yugoslavia); Verapamil (Weimer, Germany); Verapamil hydrochloride (Ai SI EN October, Russia); Verapamil hydrochloride (Akrikhin, Russia); Isopin (KNOLL, Germany); Isopin (German Remedies, India); Calan (Vitas Corporation, United States); Falikard (Solutas Fahlberg-List, Germany); FINONDTING (Orion Corporation, Finland).

The drug of calcium channel blockers for migraine prevention: nonhot

Active substance of the drug is nimodipin - Selective calcium antagonist 2 generations from a group of dihydropyridines, which has a selective effect on the smooth muscles of the brain arteries. Eliminates vessel spasms, improves the blood supply of the brain, has a systemic antihypertensive effect. When applying the drug does not develop the "Obligation syndrome". The uncompletened is successfully used for the prevention and treatment of ischemic violations of cerebral circulation, the treatment of brainwater disorders in elderly patients (reduction of memory, concentration, emotional lability), as well as the treatment of residual phenomena of brain circulation disorders and states after surgery about subarachnoid hemorrhage. Warns the development of strokes. Effective in chronic cerebrovascular insufficiency and migraines, disorders of the spinal circulation. Well tolerated patients. From side effects, arterial hypotension can sometimes develop, hyperemia of skin cover, headache, heart rate disorders. In some cases, sleep disorders are possible, increased psychomotor activity, aggressiveness, depression. During periods of pregnancy and breastfeeding, it is not possible only for life indications. With caution, the drug is used in patients with impaired kidney function. Available in tablets containing 30 mg of active substance.

Drug of calcium channel blockers for migraine prevention: nimotop

Active substance - nimodipin. Calcium antagonist, has a vasodilatory effect mainly in terms of brain vessels. It stops and prevents the spasm of the brain arteries, causes their expansion and improvement of the blood supply to the brain, has a neuroprotective action. It is used inside of 60 mg 4 times a day. Side effects: feeling heat, tachycardia, hypotension, dizziness, sleep impairment, hypercines, violation of the kidney function, peripheral swelling. Contraindications: a pronounced violation of the liver function, a pronounced increase in intracranial pressure, pregnancy. Release form: 30 mg tablets.

Drug of calcium channel blockers for migraine prevention: Nimotop S

Blocks calcium channels, has a selective vasculating effect on the brain, normalizes its blood supply, improves ischemia tolerability. It is used intravenously at the beginning of treatment 2 mg (10 ml of solution) for 2 hours, then 2 mg per hour, a daily dose - 10 mg. Side effects: hyperemia, tachycardia, hypotension, dizziness, hypercines, impaired kidney function, peripheral edema. Contraindications: pronounced liver function and pregnancy. Release form: A solution for infusions of 10 mg in 50 ml in a 50 ml bottle.

Drug of calcium channels blockers for migraine prevention: octidipin

A drug nitrendipine. Strengthening coronary blood flow, the drug improves the blood supply to the stylish zones of myocardium without the development of the phenomenon of "trusting", activates the functioning of collaterals. Does not oppress the conductivity of myocardium, reinforces the renal blood flow. Occidipine is available in the form of 20 mg tablets.

Flunarizin (10 mg / day) and nimodipine (60-120 mg / day) are also effective. Side effects are possible: dizziness, increased fatigue, nervousness. Contraindications for the use of this group of drugs: bradycardia, atrioventricular blockade, Wolf Parkinson-White syndrome, chronic heart failure. Calcium channel blockers can be combined with tricyclic antidepressants.

Anticonvulsants for Migraine Prevention

The use of anticonvulsants in migraine is based on the fact that they reduce the painful sensitivity of the vascular wall receptors, conducting pain impulses and enhance the effect of antinocyptive systems, especially with associated migration forms.

Anticonvulsant drug for migraine prevention: Anteltexin

Contains 1 mg in tablet klonazepama. It has anticonvulsant, central Miorolaxing, sedative effect. Reduces the excitability of subcortical areas of the brain (Talamus, hypothalamus, limbic system) and inhibits the interaction between these structures and the bark. It is used as an additional means in the treatment of migraine and other pain syndromes. Daily dose for adults - 3-6 mg; For breastfeeding - 0.551 mg, from 1 year to 7 years - 1 mg. The daily dose should be distributed evenly on 3-4 receptions. Contraindicated in miastic, acute poisoning psychotic drugs, alcoholism. From the side effects are possible inhibition, confusion of consciousness, with long-term use - violation of speech, dizziness, nystagm, muscle weakness. Release form: 1 mg tablets.

Anticonvulsant drug for migraine prevention: carbamazepine-acry

The most frequently used anticonvulsant drug, which has an analgesic effect with neurogenic pains. The mechanism of action involved gamma aminobutical acid receptors, which can be associated with calcium channels, is important and the effects of carbamazepine on the system of neuroration modulators. The initial dose is 100-200 mg 1-2 times a day. If necessary, the dose can be increased, but not more than 200 mg per day. After reaching the maximum therapeutic effect, the dose of the drug is gradually reduced to supporting, which is adopted for a long time. Contraindications: atrial and ventricular blockade, simultaneous reception of Mao inhibitors, increased sensitivity. The side effects of the drug are manifested in the form of dizziness, drowsiness, headaches, sharpness, dryness in the mouth, nausea, vomiting, violations of the function of the blood formation, myocardial conductivity disorders. Release form: Tablets of 0.2 g.

Anticonvulsant drug for migraine prevention: Finlepsin

It is used to facilitate neurogenic pain under different states, increasing the threshold of excitability of nerve cells. The initial dose is 100-200 mg 1-2 times a day. Then the dose is slowly raised before reaching the maximum healing effect; It is usually achieved at a dose of 400 mg per day in 2-3 receptions. Contraindicated in disorders of bone marrowing, simultaneous reception of Mao, lithium preparations, hypersensitivity. Side effect: drowsiness, headaches, dizziness, sane gaits, vision disorders, atrial and ventricular blockades, less often - violation of speech, muscle weakness, hallucinations, aggressive behavior, skin itching, rash. Release form: 200 mg tablets.

Valproat preparations for migraine prevention

Relatively recently, hipproauts (depair, convalex, etc.) began to be used in the prevention of migraines. Their effectiveness is due to the ability to increase the concentration of gamma-amine oil acid in the central nervous system, followed by the influence on the state of calcium and sodium membrane channels. In addition, they mediate their anti-imagine effect through the influence on the serotonergic neurotransmission in the core seam kernels, as well as through countering glutamativating amino acids. Initial dose - 20-30 mg / kg body weight with increasing it every 3-4 days, but not higher than 50 mg / kg. Conventional side effects: asthenia, tremor, increase in body weight, in part - baldness. Despite the lack of explicit hepatotoxic effect in adults, the hollows are not recommended for the accompanying active liver pathology. When treating hollows, it is not recommended to assign preparations containing barbiturates. Recent studies have shown that the Valproauts compete in efficiency with beta-adrenoblockers in the prevention of migraine and chronic daily headaches.

Depaakin for Migraine Prevention

The active substance is sodium salt of valproic acid. Valproic acid increases the content in the central nervous system of gamma-amine-oil acid, which causes an increase in the trigger of the excitability of the brain neurons, affecting the state of calcium and sodium membrane channels. It easily takes place histohematic barriers, including the hematosphalic. The drug is quickly absorbed when taking inside with the achievement of the peak of the blood concentration in adults in 2-4 hours. Appointed in the initial dose of 200-300 mg 2 times a day. The dose gradually increases 200 mg per day until the clinical effect is reached. Contraindications: disorders of the liver and pancreas function, hemorrhagic diathesis, intolerance to the drug. Side effects include nausea, vomiting, liquid chair, stomach pain, drowsiness, step-down when walking, tremor, with long-term reception - hair loss. If necessary, caution is used during pregnancy and lactation (although it is better not to apply). Release form: 300 mg tablets.

Convalex for Migraine Prevention

Sodium salt of valproic acid. The mechanism of action is associated with an increase in the level of the GABC in the brain, which leads to an increase in the incident rack of nerve cells, reduce the pain sensitivity of the vascular wall receptors, strengthening the action of antinocyptive systems, especially with associated migration forms. The drug is quickly absorbed, the hematosphalic barrier is easily passed. The average daily dose of the conludlection is in adults 8-12 mg per kg of body weight, the time to achieve equilibrium with the stabilization of the sodium valproate concentration in the blood is 2-4 days. Exit to the average therapeutic dose should be carried out gradually. The side effects of the drug are dyspeptic disorders, drowsiness, apathy, tremor, nistagm, disorders of coordination of movements. Contraindications: disorders of the liver and pancreas function, hemorrhagic diathesis, intolerance to the drug. Release form: Capsules 150, 300 and 500 mg per pack 100 pcs.; drops for intake (300 mg / ml) in a bottle of 100 ml; Syrup for children (50 mg / ml) in a bottle of 100 ml.

Serotonin Antagonists for Migraine Prevention

Preparations of this group, apparently, act as partial agonist antagonists serotonin, potentiate the effect of biogenic serotonin and cause narrowing the arteries of the outer carotid artery basin during their paroxysmal expansion. At the same time, these substances, like false mediators, are likely to occupy serotonin receptors and provide functional protection of vessels in the excess of serotonin content in the blood and tissues.

Preparation of serotonin antagonist for migraine prevention: Divascane

Active substance - iPRAZHROM - It has an antagonistic effect on the reactions caused by serotonin, reduces the permeability of the vessels increased by this amine, affects the phase of local metabolic disorders in the preterminal rush of the brain circulation, warns or dismisses the effect of various vascular and platelet damaging factors. Effective for the prevention of many forms of migraine. The average dose is 1-2-3 tablets 3 times a day. Allergic reactions are possible from side effects. Release form: Tablets of 0.25 mg.

Preparation Serotonin Antagonist for Migraine Prevention: Dysryl

Contains an active substance metisrigid. It has been proven to high efficiency in migraine during the intergreacy period. It is important to note that influencing the serotonergic transmission in the central nervous system of dysryl normalizes the conduct and perception of pain, and also has a sedative soothing and antidepressant effect. Dysryl inhibits platelet aggregation, the strengthening of which plays, apparently, a certain role in the pathogenesis of migraine. When appropriate, the drug is almost completely absorbed from the digestive tract. One of the products of its transformation is methyl ergonavine, which has a vasoconstrictor action. When using the drug, dyspeptic phenomena, insomnia, euphoria and other side effects are possible. Sometimes, especially with long-term reception, there is an arrangement of a fibrous junction tissue of peritoneum, pleura. Therefore, the drug is prescribed not too long courses with interruptions by 3-4 weeks.

Preparation Antagonist Serotonin for Migraine Prevention: Sandomigran

Active substance - pisotype - shows antagonism towards biogenic amines and, first of all, to serotonin. The drug eliminates the narrowing of vessels caused by serotonin, vasoconstriction, and in large doses, the effect of amine on the vessels of the outer carotid artery basin is enhanced. It also has antihistamine activity and eliminates the vasodilating effect of histamine, and also has an atropine-like influence. In the chemical structure of pisotyphene is close to tricyclic antidepressants. The initial dose is 1 tablet per day, then gradually increase the dose of up to 3 tablets per day. With persistent migraines, the dose can be increased to 6-9 tablets per day. Side effects: drowsiness, nausea, fatigue, increase the appetite with an increase in body weight. The drug should not be prescribed by transport drivers and other persons whose work requires a quick mental and physical reaction. Release form: Dragee 0.5 mg.

Contents for migraine profylation

A drug		Side effects
Beta blockers
Propranolol	80-160 mg 1 time per day	Hypotension, bradycardia
Metoprolol	25-100 mg 1-2 times a day	Hypotension, bradycardia
Atenolol	25-100 mg 1 time per day	Hypotension, bradycardia
Calcium channel blockers
Fluernarazine	5-15 mg 1 time per day	Weight gain, trigal dyskinesia
Verapamil	80-120 mg 1-3 times a day	Hypotension, bradycardia
Amlodipine	5-10 mg 1 time per day
Lysinopril	20 mg 1 time per day
Kandesartan	16 mg 1 time per day
Antidepressants
Amitriptyline	25-75 mg 1 time per day	Anticholinergehetic effects
Northriptyline	10-100 mg 1 time per day	Anticholinergehetic effects
Fluochetine	10-40 mg 1 time per day
Venlafaxin	75-150 mg 2 times a day	Drowsiness, urine delay
Anticestrokey drugs
Valproat	250-500 mg 2 times a day	Weight gain, tremor, hair loss
Topiramat	50-100 mg 2 times a day	Nephrolithiasis, glaucoma
Gabapentin.	300-1200 mg 3 times a day	Drowsiness, dizziness
Laxigin	50-300 mg 1 time per day	Stevens-Johnson Syndrome
Zonisamide	25-400 mg 1 time per day	Nephrolithiasis, allergies to sulfonamides
Food additives and herbs
Riboflavin	200 mg 2 times a day
Coenzyme ku-10	100 mg 3 times a day	Stomach upset
	400-600 mg 1 time per day
Other drugs
Metisrigid	2 mg 1 time per day	Retroperitoneal fibrosis
Botoululovoxin A.

Patients suffering from migraine complain of periodically emerging attacks of one-sided, pulsating headache, moderate and expressed in gravity, accompanied by photophobia and phoby. Usually attacks for the first time appear up to 40 years, often in children's and youthful years, the peak of their frequency falls on the second-honored dozen life. If the attacks occur within 15 days in a month or more often, such a migraine is typing chronic.
Population studies show that more than 10% of the population of the Earth suffers migraine. Statistical data on the morbidity of migraine in the United States are as follows: Women - 18%, men - 6%, the whole population is 12%. It is clear that women suffer from migraine more often men, in addition, in the etiology of migraine plays the role of the hereditary component. WHO put the migraine on the 19th place among diseases causing disability. Despite the progress in the development of methods of treatment and prevention of migraine, these methods are not fully used, which increases the suffering of patients and takes the negative economic effect of migraine.

Classification criteria for migraine without aura (international headache society) must have at least five bouts of headaches satisfying at least one criterion:
A. Headache, continuing without treatment or despite treatment
4-72 hours
B. Headache having the following characteristics
One-sided localization
Pulsing Character
medium severity or strong
caused by ordinary daily activities or makes it abandon conventional daily activities
B. Headache is accompanied by nausea and vomiting and / or photophobia and phosphobia. Other causes of headaches are excluded.

When preventive treatment of migraine is shown

Different countries use different criteria for the start of preventive therapy. Typically, a high frequency of attacks, a violation of everyday activity, insufficient effectiveness of abortive contamination drugs is taken into account.

Criteria of the European Federation of Neurological Societies and the American Academy of Neurology for the start of preventive therapy :

• Migraine prevents the duties in everyday life at work, in study
• Migraine attacks arise twice a month or more
• Migraine attacks do not treat abortive contamination drugs
• Migraines precede frequent, long-lasting or uncomfortable auras.

To prevent migraine, the same drug can be used as for interrupting the attack. In the choice of the drug, it is necessary to take into account possible concomitant diseases and the psychological state of the patient. Doctors often underestimate the importance of discussing possible options for preventive therapy with patients. A joint decision makes a patient to understand the reason for the choice of a drug and contributes to a more accurate consequence of the prescriptions. The uncontrolled intake of analgesics and other abortive drugs reduces the effectiveness of preventive therapy, so patients should be instructed to restrict their reception. If possible, simple analgesics should be used less and less than 15 days a month, and combined analgesics and other abutment drugs - less often than 10 days a month.

Objectives of prophylactic treatment of migraine

The objectives of preventive treatment correlate with the criteria for the start of therapy are to reduce the severity and frequency of attacks. It is important to explain to the patient that migraine is an incurable disease, and that the purpose of therapy is not to eliminate the disease, but to facilitate its flow. Another purpose of preventive treatment is to reduce the frequency of adult drugs and visits to the doctor. Also, patients should be explained that the full effect of the preventive use of the drug is developing after 2-3 months of its adequate dose. To monitor the success of treatment, it is useful to ask the patient to keep a diary of headaches.

How preventive treatment works migraine

The pathogenesis of migraine is not fully studied. The study of prophylactic antipheral drugs show that they suppress the spread of cortical depression.

Preparations used to prevent migraine

In addition to the pharmacological methods of the prevention of migraine, there are also non-farmacological, but the latter will not be discussed in this article. Preparations of choice for the prevention of migraine are beta blockers, calcium channel blockers, tricyclic antidepressants and anti-epileptic agents, there are also preparations of the second and third line.

Beta blockers

In randomized, placebo-controlled studies, the effectiveness of propranolol and metoprolol was studied. Kohranov's review of 2004 showed the short-term efficiency of propranolol in the prevention of migraine, it was impossible to conclude about its long-term efficiency due to a lack of data. Controlled release preparations are more convenient for patients, because They are used once a day. Beta blockers for the prevention of migraine are especially shown to patients with hypertension, anti-asthmatics are contraindicated, they should be cautiously prescribed to patients with accompanying depressions.

Calcium channel blockers

Fluernarazine - this drug is still not available in Russia - causes some decrease in the frequency of attacks. Some patients help more widespread amlodipine and verapamil. Calcium blockers are usually well tolerated, the most frequent side effects are hypotension and feet swelling.

Other antihypertensive drugs

As prophylactic drugs, ACE blockers and blockers of angiotensin receptors were also studied, due to insufficient learning, these prepators are still related to the means of the second and third row. In one randomized, placebo controlled study it was shown that the leaser reduces the frequency, and the severity of migraine attacks by 20%. In another randomized study, it was shown that the Kandesartan, an angiotensin receptor blocker, reduces the frequency of days without migraine for five days a month compared with placebo. Both grade preparations can be used as a prophylactic agent in patients with hypertension and without it in the intolerance or inefficiency of beta-blockers and calcium channel blockers.

Antidepressants

In several randomized controlled studies, the effectiveness of amitriptyline, tricyclic antidepressant was shown. In the United States, amitriptyline is considered a drug selection in migraine prevention.

Amitriptilina dose for the prevention of migraine is less than the usual dose for the treatment of depression. Other tricyclic antidepressants (Pripriptylene and Northriptyline) are also used successfully, but their effectiveness in large studies has not yet been studied. Tricyclic antidepressants can cause side effects - constipation, dry mouth, urine delay.

Selective inhibitors of serotonin reverse capture were not effective.

A drug venlafaxin (The inhibitor of the inverse seizure of serotonin and norepinephrine) showed its effectiveness in comparison with placebo and with pure inhibitors of serotonin reverse capture. Venlafaxine can be particularly shown to prevent migraine to patients with chronic pains, for example, with fibromyalgia.

Antiepileptic drugs

In randomized controlled studies, effectiveness was proved in the prevention of migraine of several anti-epileptic drugs. Valproat and Topiramat since 2008 after Kochran Review, which has proved their effectiveness, is considered to be the preparations of the first line. In the same Kohranov review it was shown that these drugs are well transferred and reduced the frequency of migraine attacks. Women of childbearing Valproat should be appointed with pricing, since it can cause defects in the development of a neural tube. Other side effects that need to be prevented by patients before the start of reception of the Valproat is as follows: an increase in body weight, hair loss and tremor.

Topiramate, on the contrary, can cause weight loss. Renal-stone disease in history is the relative contraindication for the purpose of the topiramate. Topiramate can be used in patients who abuse the intake of abutient contamination.

There is evidence that Gabapentin is also effective in the prevention of migraine, but it does not apply to the preparations of the first line. Gabapentin is prescribed three times a day, it can be useful in treating patients with chronic pain.

Latchin can be shown by a patient suffering from a migraine with aura.

Food additives and herbs

Fielder hybrid - Petasites Hybridus reduces the frequency of attacks by 50%, but has a carcinogenic effect.

Coenzyme Ku-10 (Coenzyme Q-10) also reduces the frequency of attacks, but does not affect their severity and does not reduce the frequency of using abortive drugs.

A decrease in the frequency of attacks was also proved when using magnesium and riboflavin oxide (vitamin B-2).

Ineffectiveness was proven in Cokhran reviews Pyremum (Chrysanthemum Parthenium).

Other drugs

Metisrigid, ergotamine derivative, is an effective drug for the prevention of migraine. It should not be used longer than 6 months without interruption, due to the potential danger of the development of retroperitoneal, pleural fibrosis and heart valve fibrosis. Recently, the drug methyl ergonoviqwd n is metabolite metabolitis appeared.

Botoululovoxin A.

Botoululus toxin in recent years is enjoyed high attention. Currently, evidence of its effectiveness during episodic migraine has not yet been received, it has been proven that it is ineffective with a headache of tension. In the United States and England, he is approved as a means of treating chronic migraine. It is introduced 1 time in three months at a dose of 155 units distributed by 31 injection points. Injection points are localized on the forehead, in the temporal muscles, the occipital region, the top of the rear cervical muscles and the trapezoid muscles.

Combined treatment

In some cases, when one drug does not work, a combnation can help, for example, amtipelin + propranolol.

When can you stop the prevention of migraine?

There are no clear criteria for preventing prevention (if the drug has proven its ineffectiveness, it is certainly canceled). Patients need to be periodically observed, the decision on the possibility of termination of prevention is accepted individually. In some cases, when the preparation for prophylaxis also treats a concomitant disease, its reception does not stop at all.

It is necessary to stop the reception. Patients often react negatively to a sharp change of destination.

Please Enable JavaScript to View The