Diagnosis and treatment of migraine: Recommendations of the Russian experts

Abstract

These recommendations on the diagnosis and treatment of migraine were elaborated by Russian headache experts in accordance with the evidence-based practice. Together with the latest classification, diagnostic principles and criteria of different clinical sub-forms the consensus contains basic data on migraine epidemiology, pathophysiological mechanisms, differential diagnosis and most effective and evidence based approaches to pharmacological and non-pharmacological management of migraine patients.

White Matter Hyperintensity in Different Migraine Subtypes

“…Universal differentiating features for all types of migraine were: predominance of WMH within the frontal lobe and a lower incidence of lesions within the parietal and temporal lobes and their absence within other lobes; equal incidence of juxtacortical and deep location along with less frequent periventricular localization; small (2.5 [1.5; 3] mm) lesion size; the absence of a tendency to merge. Previous studies have reported not only the localization of WMH within frontal, parietal and temporal lobes 9,13,12,18,26,[30][31][32] , but also their infratentorial and occipital location 11,18,30,34 , the involvement of periventricular white matter 6,8,10,13,26 , various sizes of WMH, including con uent lesions 31 .…”

“…However, recent epidemiological studies have established that in 29-73% of migraine cases, T2 and FLAIR MRI scans reveal white matter hyperintensities (WMH) [4][5][6][7][8] . Most studies demonstrated WMH predominate in migraine with aura 5,6,9,10 and in chronic migraine 11,12 . The high incidence of WMH became one of the reasons to consider migraine as a risk factor for their development 9,11,[13][14][15][16] and highlighted the problem of the diagnostic and prognostic value of WMH in different types of migraine.…”

“…Several studies demonstrated the association between the WMH burden and the frequency of pain attacks 13,14,18 , duration of disorder 11,19 , its progression over time 6,16,20 , the risk of ischaemic stroke 21,22 and CI 23 , while other studies did not establish any relationship between WMH and severity or duration of migraine 4,[24][25][26] , risk of stroke and other vascular events 11,24 , CI 9,16,27,28 , and progression of WMH over time 29 . WMH in patients with different types of migraine are predominantly located within the frontal and parietal lobes 9,12,13,18,26,[30][31][32] , in deep and periventricular 6,8,10,13,26 , and sometimes juxtacortical white matter 20,31,32 , with sizes varying from small single to con uent larger lesions 20,[30][31][32] . WMH may be found along with asymptomatic small cerebral infarctions, mainly in the vertebrobasilar system 5,13,18,…”

Practical use of non-steroidal anti-inflammatory drugs in relieving recurrent headaches

“…Перед началом ГБ у пациента могут возникать очаговые неврологические симптомы (мигренозная аура). Возникновению приступа способствуют следующие факторы (триггеры): стресс, нарушения сна или избыточный сон, пищевые продукты (сыр, орехи, шоколад), менструация, яркий свет, укачивание, путешествия, сильные запахи (бензина, духов); часто отмечается провокация приступа употреблением красного вина [12]. Односторонние вегетативные проявления во время боли (слезотечение, покраснение глаза, заложенность уха, носа, ринорея, повышенная потливость, отечность века, миоз, птоз) являются характерными чертами тригеминальных цефалгий [13].…”

Rehabilitation of patients with chronic headaches

“…Профилактическая медикаментозная реабили тация. Имеются определенные различия в осуществлении профилактической медикаментозной реабилитации при хронической мигрени и хронической головной боли напряжения [9][10][11][12][13][14]. В профилактиче-ской реабилитации хронической мигрени большое место занимают некоторые противосудорожные (антипароксизмальные) препараты: препараты вальпроевой кислоты (Депакин) по 600-1500 мг/сут, карбамазепин (Тегретол, Финлепсин) по 400-600 мг/сут, габапентин (Нейронтин, Тебантин) по 300-600 мг 2-3 раза/день, прегабалин (Лирика) по 75-150 мг 2-3 раза/день.…”