Mystery of migraine: scientists continue to look for mechanisms of the disease
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Experts call the prevalence of migraine frightening, but in many cases the disease remains undiagnosed. Due to the mistakes that doctors make, patients often receive the wrong treatment, which only aggravates their condition. Whereas every patient with excruciating bouts of this headache can be helped.
Novosibirsk hosted a medical conference on new approaches to the diagnosis and treatment of migraine, where well-known medical experts urged colleagues to be more attentive to this disease.
Anyone who has experienced a migraine at least once knows that it is more than just a headache. Acute throbbing, most often unilateral excruciating, incomparable pain, which is often accompanied by nausea, vomiting, painful intolerance to light, increased sensitivity to sounds and movements. A person with a migraine sometimes cannot be in bright sunlight. Many people have to give up a number of products so as not to provoke an attack. A number of patients develop phobias, depression, insomnia.
According to a well-known neurologist, academician of the Russian Academy of Sciences, RAMS, professor of the Department of Nervous Diseases and Neurosurgery of the Medical Faculty of the First Moscow State Medical University. I.M. Sechenov Nikolai Yakhno, migraine has become the third most common disease among diseases and is 10–12 times higher than the prevalence of stroke in our country. Every year, 40-50 people fall ill with it per hundred thousand of the population. “It would seem, well, my head hurts, I drank painkillers – that’s all. But migraine is one of the most common causes of temporary disability, and with such a frequent occurrence, it is also a socially significant and economic problem, since it entails the loss of many days of normal work. Very often, the very attack of migraine pain is preceded by a prodormal stage, which lasts from several hours to several days: the head still does not hurt, and it is already difficult for a person to work, he has a bad mood, problems with the cardiovascular system. No one dies from migraine, but patients suffer seriously. Attacks sometimes last 5 days a week for a month. It is completely impossible to cure migraine, but today it is possible to control the course of the disease with the right treatment, ”says Academician Yakhno.
Migraine was described by Hippocrates, but so far no one in the world knows the exact mechanisms of the development of this disease. Research is ongoing, because without discovering the causes of the disease, it is difficult to develop methods for its treatment. So far, only some signaling pathways that may be involved in the occurrence of pain have been found, but there is no certainty that they are its root cause, and not a separate link in the chain. And yet there are some achievements. If even 10 years ago only painkillers could be offered to patients, today they have begun to use a whole class of drugs that were previously used mainly in oncology, and in the last few years – in the treatment of covid. “Targeted drugs from the class of monoclonal antibodies help either completely eliminate seizures, or alleviate their course and make them rarer,” says Nikolai Yakhno.
“Migraine is a chronic disease, and not of the vessels, but of the entire central nervous system. The vessels are the arena where the spectacle is played, and the preparation for it begins in other parts of the central nervous system. Therefore, the search for drugs that affect those links of pathogenesis that we know continues, but so far we know very little about the mechanisms. Yes, there are targeted drugs that affect the mechanisms of migraine development known today, but they (the mechanisms) are not the only ones and, perhaps, not the most important ones. The time will come when we will know more about migraine than today, and it will become easier to fight. Like any chronic disease, migraine can be spontaneous – it can manifest itself either more severely or easier; the number of seizures can increase or decrease under the influence of various factors, and it is important to understand whether this disease itself flows like this or is it the doctor’s merit? Until now, we are looking for predictors of the effectiveness of treatment, but so far we have not made much progress, ”says Alexander Amelin, head of the Center for Diagnosis and Treatment of Headache at the First St. Petersburg State Medical University named after Academician I.P. Pavlov.
Experts emphasize the special importance of correct diagnosis of the disease. As Alexander Amelin says, as before, many doctors prefer to look for an organic cause of a headache: “It’s like looking for a black cat in a black room, and MRI findings often become a reason for making an incorrect diagnosis and prescribing an incorrect treatment, which not only does not helps, but also worsens the patient’s condition. Migraine occurs much more often than such diagnoses are made. Very often, instead of it, the patient receives a diagnosis of spondylogenic headache, that is, due to problems with the spine, but today we pay too much attention to the spine as the source of all problems in the world. The diagnosis of cervical migraine has not been used in the world for a long time, but in Russia neurologists often make it. The situation in the field of diagnostics needs to be changed. Recently, a new classification of headaches has been approved in the world, and if you follow the criteria indicated in it, there will be fewer errors.”
Experts emphasize that there is nothing complicated in making a diagnosis: since the time of Hippocrates, all that is required for this is a competent collection of the patient’s history. It is extremely rare for migraine-like pain to have a potentially dangerous cause, but a competent doctor knows how to suspect something is wrong and refer the patient for additional research. “But it is very important for the doctor to stop in time in search of the causes of the headache. The longer the pain exists, the more likely it is benign. In addition, attention should be paid to the psycho-emotional state of patients: it is difficult to find a person with migraine without concomitant anxiety disorders, and an attempt to stop a headache without their correction is a road to nowhere,” says Alexander Amelin.
Newspaper headline:
Migraine around the head
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