There are many types of headaches. Migraine is certainly one of the most common. Even more so, a form that carries a high burden and far-reaching effects on the quality of life. Therefore, WHO also ranks the disease as the second leading cause of years of life with disability. Much research has been done in recent years and decades to develop effective therapeutic strategies. A current overview.
Headaches are – right after tooth decay – one of the most common human diseases. Among these, tension-type headache ranked second and migraine ranked third, with a one-year prevalence for all headaches of 86% in women and 71.1% in men. Not surprisingly, headache disorders account for more than 75% of all years of disability due to neurological disorders [1]. Nowadays, 367 different types of headache are classified according to the international IHS criteria [2]. Migraine is included in the group of primary headaches, which functions as a disease in its own right and is not due to other triggers. In Switzerland, more than one million inhabitants suffer from this form of primary headache [3].
High level of suffering requires effective therapy
The suffering of migraine patients is high. In a worldwide survey of 11,000 sufferers, the average pain intensity during a migraine attack was reported as 7.4 out of 10 [4]. The treatment of a migraine should therefore be comprehensive and effective and is built on three pillars:
- Behavior
- Prophylaxis
- Acute therapy
Behavior modification includes extensive knowledge about the disease, as well as progress and success monitoring, daily planning, stress reduction, diet and exercise. For example, aerobic endurance training, 45 minutes three times a week with a heart rate target of 120-140/min has proven effective. Behavioral and psychotherapeutic measures and relaxation therapies can also help to cope better with the disease. Also, noxious substances such as alcohol, caffeine or nicotine should be controlled and medications that do no good or even harm should be discontinued.
Quick and targeted relief of acute pain
The aim of acute therapy is to achieve rapid freedom from pain with good tolerability. Nonspecific-acting and specific-acting drugs are available for this purpose. If pain intensity is low, NSAIDs and other analgesics may be used. Migraine attacks with moderate to high pain intensity are mainly treated with triptans. These were developed specifically for migraine therapy and should be taken as early as possible. Depending on the preparation, they differ not only in their dosage form, but also in the onset and duration of action. Therefore, very differentiated and individually tailored to the needs of the patient can be selected.
Prevention is better than curing drug-induced headache
However, because acute therapy is not suitable for long-term use and the risk of medication overuse headache is high, migraine patients who suffer from frequent, severe and/or prolonged migraine attacks should resort to migraine prophylaxis. The indication for drug prophylaxis is therefore based on the particular level of suffering, limitations in quality of life, and the risk of medication overuse. There are a few treatment options available. Antidepressants, anticonvulsants, beta-blockers, or calcium antagonists have nonspecific effects.
Antibodies inhibit key function
In contrast, CGRP antibodies target calcitonin gene-related peptide (CGRP) in the trigeminal system. CGRP plays a key role in the development of migraine pain. Therefore, by blocking CGRP receptors, vasodilatation and vascular tone can be reduced and pain transmission can be inhibited, as well as vascular sensitization and pain sensitivity and neurogenic inflammation. In this way, the monthly migraine days can be effectively reduced in a large proportion of sufferers.
Literature:
- Global Burden of Disease Study 2016. Lancet 390 (10100): 1211-1259.
- International Classification of Headache Disorders, 3rd edition, ICHD-3. Available at: https://ichd-3.org/de/
- Merikangas KR, Cui L, Richardson AK, et al: Magnitude, impact, and stability of primary headache subtypes: 30 year prospective Swiss cohort study. BMJ 2011; 343: d5076.
- Martelletti P, et al: My Migraine Voice survey: a global study of disease burden among individuals with migraine for whom preventive treatments have failed. J Headache Pain 2018; 19(1): 115.
InFo NEUROLOGY & PSYCHIATRY 2021; 19(3): 30.
