MIGRAINE'S THERAPPIES TRICKS TEN MISTAKES TO AVOID ...............   LONG TERM TREATMENT   ALTERNATIVE TREATMENT

Antalgiques périphériques

Acetaminophen
Has analgesic and anti fever power.

Central analgesics
Some analgesics working on pain receptors in the central nervous system can be used, as dextropropoxyphene (derivative of morphine) or codeine. More useful then aspirin or acetaminophen alone, they are often prescribed together. But there is a dependence risk which should not be underestimated.

• Ergotism : happens when maximal dose of 6 mg/day or 12 mg/week is not respected.
• State of continuous migraine : it is well known now that regular ergotamine's usage can maintain and increase migraine

Dihydroergotamine (DHE)
DHE has same pharmalogical properties that ergotamine but must be used by intravenous or intranasal way.

Others vasoconstrictors : "triptans"

Sumatriptan
70 to 80% of crises are cut within two hours after use. But 20% of patients show a reemergence of the symptoms in the following 24 hours. Its high price and frequent side effects do limit its use.

Zolmitriptan
Following sumatriptan's line of action on arterial's serotonine receptors, its aim is to stop painful dilatation of migrainous arteries during the crisis. A sublingual form now exists, avoiding vomiting problems.

Naratriptan
Similar to Zolmitriptan; doesn't exist in sublingual form.

1. Cold
it is a good antimigrainous factor that you can use with ice slipped in a glove applied on temporal areas.

2. Caffeine
Excellent anti migrainous. A strong coffee ingested very quickly in the beginning of crisis can stop it. Various kinds of soda containing caffeine can have the same effect.

3. Auto acupuncture
There is an anti-migraine and anti-stress acupuncture point between the thumb and the index which can be auto stimulated by massaging it strongly in the reverse direction of the hands of a watch.

4. Temporal vein auto massage
May obtain a temporary relief.

5. Always take an anti nauseas medecine
When you take your crisis's treatment, it makes it more quickly effective

To say: " nothing can be done against migraine" don't say this
On the contrary, a lot can be done for most kinds of migraine. Physicians know it, but you often have to ask them. Do it..

To confuse: "crisis treatment" and "long term treatment"
They are very different. To take every day a crisis treatment is risking serious health problems.

To decide to soon that a treatment doesn't work
A crisis treatment useless in a given dose may be useful with a different one. It's up to you to try and find the good one (your physician can't guess for yourself); for a long term treatment a minimum duration is necessary to evaluate its true effectiveness (2 or 3 months at least).

To keep by routine behaviour a useless treatment
However, do not stop your own treatments, that can have dangerous side effects.

To see nothing, to know nothing
If you don't look for what triggers your crisis and what relieves your pain; if you are unable to say if there is a connection between your migraines and your menstrual cycle, if you did try many medicines but do not remember their names, you will not be very helpful for your physician (who wants to cure you).

To be fanatic
By example someone who decides he has no migraine but a digestive problem and doesn't want to refer to a physician….

To demand a lot of complementary exams
Scans or lumbar ponction… to demand to be referred to ten specialists because you are sure you have a very serious health problems is not only useless and costs a lot of money, but it delays the moment when you will begin to be really treated.

To take ten medicines at the same time
To take ten medicines at the same time: effectiveness of this is not proved, furthermore, it may also be dangerous.

To proclaim in advance that you don't believe in alternative that you don't believe in alternative treatments
" contre les médecines douces "...
Why do you want to close yourself a potential relief source (which is harmless….) …

... or, in contrary to trust only that kind of treatment
this mistake is more frequent; followers of acupuncture, homeopathy or bio-feed back do not want to try any other means of treatment even if their methods do not relieve them. Are you sure your convictions deserve to suffer for them ?

To record shortly and precisely, every evening, all your headaches, of whatever length or nature, as well as all medecine taken, is the only objective means of progressing in the understanding and treatment of migraine.

• Dihydroergotamine (DHE) can be prescribed for not negligible effectiveness and inocuity; it needs a sufficient posology and at least 3 months of trial.
  
  
• Pizotifene : can be used alone (may be a cause of weight gain).
  
  
• Beta-blockers are now the mainstream of long term treatments; there are counter-indications: asthma, heart's rhythm trouble; propranolol is the reference but others can be tried: metoprolol, timolol, nadolol, atenolol.
  
  
• Alpha-blockers can be also used: verapamil, diltiazem, flunarizine Others: indoramine, oxetorone
  
  
• To be treated apart: methysergide; very useful for severe migraines; it has a side effect to be aware of, even if it is a little theoric at low doses: retro peritoneal fibrosis
  
  

To take more than one chemical for a long term treatment is not forbidden. Severe migrainous people are almost always treated by bi-or tri-therapy. But they can also be treated by detoxification in hospital with intravenous amitriptyline and psychotherapy. Amitriptyline can in fact be very useful at very low doses and it acts also on humor. It can be associated with diazobenzepine, at low doses also and for a brief time. Clonazepam such a depakine can be useful, although they were at first medicines used against epilepsy.

The Generalist practitioner is the best person to supervise the treatment of migrainous people; Patients should follow his advice if they trust him, which can only be obtained after a necessary long time of dialog, during the first encounters between physician and migrainous. Each one must be able to believe and understand the other: this is the foundation of trust and confidence.

Common good sense and simple principles lead to individual and particular treatments specific to each migrainous: this is the key of success. Specialists, called in if there is diagnosis indecisiveness, do aggree that a good treatment of migraine associate crisis and long term treatment and prevention of triggering factors.

1. Homeopathy : five great remedies do exist against migraine: Nux Vomica, Gelsenium, Iris Versicolor, Ignatia and Actaesa Racemosa, respectively for digestive, visual, stress and menstrual crisis.

2. Acuponcture : coming from Asia through more than three millenaries, acupuncture can be useful if a good specialised physician does it regularly.

3. Bio feed back : used in hospitals and pain center, it is based on visualisation of stress to help the patient to control it.

4. Herbal medicine : the use of plant in migraine is not recent; for a long time, it's been well known that plants such as Valeriane or Passiflore or mint can be useful.

5. Relaxation : yoga, sophrology, meditation, Schultz or Jacobson's methods, sports like swimming, archery or martial arts can help migrainous people, but all of this must be included in one's research of quality of life.