A migraine is a complex neurobiological disorder with a multifactorial pathogenesis, and the problem of its treatment cannot be solved with the help of any single, even new and effective medication. To achieve success, it is necessary to take into account a number of aspects, both purely medical and psychological.
In the treatment of migraines, three problems can be distinguished: prevention of seizures, their treatment, and general prevention.
Prevention of migraine attacks. By teaching the patient to identify precursors, identify migraine triggers and avoid situations that trigger migraines, you can achieve prevention or a significant reduction in the number of seizures without the use of medications.
Treatment of seizures. Many patients suffering from a migraine disadapt the fear associated with waiting for an attack. In this regard, it is very important to work together with the patient treatment tactics in various scenarios of migraine development.
Preventive treatment of a migraine. If the migraine attacks are frequent (more than 2 times a week) and/or if behavioral and pharmacological measures are ineffective, the question of preventive treatment should be raised. Indications for preventive treatment are also some special forms of a migraine: a hemiplegic migraine or a migraine with aura with a stable neurological deficit.
Antidepressants and anticonvulsants, which occupy a leading position in the effectiveness of preventive treatment, still do not have this indication in the instructions for use. Of anticonvulsants, valproate and the new anticonvulsant topiramate are most effective. Clinical studies have shown that topiramate effectively prevents migraine attacks, significantly reducing their frequency. Its effect develops quite quickly – during the first month of therapy, there is a persistent long-term reduction in the number of seizures without the development of resistance. In comparison with other anticonvulsants, topiramate has a favorable tolerability profile.
Antidepressants have long been used to treat migraines. The basis for their application is the information accumulated in the treatment of chronic pain. Antidepressants reduce the concomitant symptoms of depression, which either is initially present in the patient or develops in connection with frequent migraine attacks. Antidepressants potentiate the action of analgesics and triptans, and some of them have independent antinociceptive or analgesic activity. The most favorable ratio of efficacy/safety is noted in antidepressants of a new generation, including Zoloft tablets and other similar tablets available in pharmacies.
Treatment of migraines is a complex task, requiring the doctor erudition, sensitivity to the patient, good communication skills, and patience. Currently, not only modern drugs have been developed, but also new approaches to treatment that allow it to be selected on the basis of objective criteria. Nevertheless, a physician who faces migraine treatment cannot be a simple implementer of the proposed algorithms. In order for the therapy to be effective and safe, it is necessary to be creative in choosing methods, taking into account the individual characteristics of patients.