Anyone who has never had a headache episode in their life, especially if it’s a woman, consider yourself very lucky! According to the estimates of a study published last year in «The Journal of Headache and Pain», more than one in two adults would have headache problems.
And headaches, unfortunately, do not seem to spare even young people. Paola Torelli, professor of Neurology at the University of Parma and doctor in the Neurology department of the Parma University Hospital, explains that there are two categories of headaches: the “secondary” forms, in which the headache is a symptom of another pathology, and the “primary” forms, in which the headache is the pathology itself.
«Headaches as an expression of another pathological condition are frequent and often not linked to serious illnesses; in fact, it occurs in the course of trivial infections, during fever, when blood pressure is high, in the presence of severe anemia. Migraine, on the other hand, is a pathology in itself and is one of the most frequent forms of primary headache.
What triggers the migraine attack?
«Migraine is a neurovascular pathology: it involves the nervous system and the arteries that are located inside the braincase, but outside the brain, more precisely in the meninges, those sheets that surround the central nervous system. During the attack of migraine, in predisposed subjects, in particular conditions, there is an excessive dilatation of the small meningeal arteries and a release of inflammatory and vasoactive substances by the endings of the trigeminal nerve. These events determine the transmission of information, through pain fibers, to the parts of the brain responsible for pain coding and this determines the perception of the migraine attack. It is believed that some areas of the brain of migraine sufferers are particularly sensitive and are therefore activated by stimuli that do not cause pain in non-headache sufferers. It should be emphasized that the brain of the migraine sufferer is normal and free from structural lesions.
How to treat the most common forms of migraine?
«The migraine attack is managed with the use of drugs defined as “symptomatic”. They are those medicines taken at the beginning of the attack that block the pain and the symptoms associated with it, such as, for example, excessive sensitivity to sounds and lights, nausea and vomiting. We have multiple categories of symptoms available. Some have a generic action on pain, others, triptans, are drugs designed to specifically block the migraine attack; in fact, they act at the level of serotonin receptors located in the small meningeal arteries and in the peripheral endings of the trigeminal nerve and block the cascade of events which we have seen to be the starting point of the migraine attack. Symptomatic drugs are more effective if they are taken at the onset of pain, even if it is still mild. They must be prescribed by a doctor after the diagnosis of migraine has been made. But to reduce the symptoms it is better not to postpone the intake ».
Can prevention be done?
«The first step in prevention is to identify the possible factors triggering the attacks. These do not represent the cause, but conditions in which it is easier to trigger the cascade of events that leads to the onset of the migraine crisis. It is important to recognize them because some are modifiable: these include changes in routine, changes in sleep schedules and the intake of wine. This does not mean that the migraine sufferer should not have a “normal” life, but awareness of the possible triggering factors allows for better management of the disorder”.
Returning to drugs, is there no definitive cure?
«No, to date we don’t have a curative, “definitive” therapy for migraine. However, we have many drugs available, which belong to various pharmacological categories which, if indicated, are taken continuously (for a few months or a few years) and are used to reduce the frequency with which headaches occur, the intensity of attacks and their duration, to improve the response to symptomatic drugs. The goal of a preventive therapy is to improve the quality of life of the subject suffering from migraine so that he can lead a “normal” life, with the least negative impact on the activities of daily life, work and personal life».
Antonella Cortese