News from the 10th IHS New York Congress
(International Headache Society)

1. Epidemiology

Chronical headaches touch at least 40 % of the population. Migraine is one of the main cause, concerning 18% (the increase of the percentage of migrainous people in France - 12% in 1990 - is probably due to a better diagnostic of this illness in a population less inhibited and more encline to talk about migraine).

In 50 % of the cases, the first migraine occurs before 20 ; thus emphasizing the need for a better diagnosis for children and teenagers.

2. Migraine and children

Migraine can start as early as 2 years old and concerns 5% of 5 year old children ; around 15 years old, 8% of the children are migrainous, most of whom are girls. An early diagnostic and treatment should allow to reduce the risk of aggravation at adulthood.

A characteristic of children migraine is that it often appears, not through headaches, but through tummy aches and repetitive digestive problems which disappear when treated with painkillers and sleep in an calm and dark room.

For a migrainous child, it seems important, therapeutically speaking, to maintain a good physiological equilibrium in magnesium, thus encouraging the intake of this oligo-element.

3. Women and migraine

Menstrual migraines are more severe, longer and more resistant to classic crisis treatments than other migraines. As such, they should be treated more intensively. Also, the genetic origin of menstrual migraines has been proven.

4. Migraine mechanisms

German, Italian, Belgian, American and French team agree that there is, in migraine mechanism, a neurological physiopathology of calcium channels which could be genetic and may have an impact on cerebral metabolism. This fact should explain why anti-epileptic drugs are useful in migraine treatment.

5. Mixt headaches

Migraine patients often complain of neck pain which may proceed, accompany of follow their attacks. Migraine is commonly misdiagnosed as tension-type headache in clinical settings. In fact, cervicalgia commonly accompanies migraine headache. Tightness bilaterally or ipsilateral to the headache pain which is frequently reported suggest a shared pathophysiology ; this should be the reason for the necessity in acute or long-term treatments of migraine to act on both pain to be effective.

6. Non chemical long-term treatments

Several studies have underscored the importance of a good life hygiene for migrainous people. For example, they are more sensitive to stress factors, of whichever origin, and should thus strive to avoid or fight them. It is proven that avoiding stress is an excellent natural means of reducing the number and the intensity of migraines.

To have a relaxing physical activity (such as walking or cycling, for example), every week (for an hour minimum) should be part of all migrainous people way of life. And let's not forget that such an activity is also very good for your heart !

It is also very important to learn to take breaks regularly during work : at the chronobiological level, such breaks allow to limit the progressive increase in stress levels. Or stress appears in numerous studies as one of the main triggering factors.

A person susceptible to migraine should also learn to relax. Independently of the method used, relaxation can really help decrease the frequency of migraine crisis.

To learn ralaxation techniques can appear fastidious but it is worth the effort as a decrease of up to 50% in the number of crisis has been observed in patients practicing relaxation.

Eat regularly, without jumping meal and respecting simple nutritional rules.

To sleep well is extremely important : it's better to know your sleep patterns and adapt to them than to use sleeping pills. It is quite easy for one to know whether he/she is a " morning " or " evening " person, and to respect this cycle which is natural.
One should also avoid oversleeping in the mornings or very late nights.

Avoid heavy drinking and/or smoking if you want to avoid crisis (even if it is passive smoking : the migrainous person should be able to obtain respect from his entourage : migraine is not a shameful illness).

In fact, anything which can improve one's life hygiene is beneficial for migrainous people, even more than was thought.

Lastly, it is important to encourage a good knowledge of the illness through a better dialog between the practitioner and the patient ; it has been proved that well informed patients are more able to control their crisis, and are thus less afraid due to knowing what is happening and what to do : which medicine to take, when and how, the dangers of overdosing in painkillers, awareness of triggering factors to avoid.

This patient role in his own therapy is very important.

7. Crisis treatments

Now that the role of the trigeminal nerve has been well identified in the mechanism of pain, new treatments for crisis, acting directly on this nevralgic factor are being studied and tested : treatments based on stimulating the production of a substance called adenosine, which inhibit the trigeminal nerve, thus acting directly on the migrainous pain. Concerning the oral intake of " triptans ", it is recommended to take at the same time an anti-vomiting pill in order to increase the effectiveness.

8. Long-term treatments

The beneficial role of preventive treatments has been emphasised : quality of life is not impaired (as migrainous people do not resent a daily intake of medicine) and is even improved.

Some new products are under review and show great promises : recent anti-epileptic drugs, in very small dosage.