Migraine is one of the most common types of headache, which can lead to a significant decrease in quality of life. Researchers identify migraine with aura, migraine without aura, and chronic migraine that substantially reduces the ability of patients to work and is frequently concurrent with mental disorders and drug-induced headache. The complications of migraine include status migrainosus, persistent aura without infarction, migrainous infarction (stroke), and a migraine aura-induced seizure. The diagnosis of migraine is based on complaints, past medical history, objective examination data, and the diagnostic criteria as laid down in the International Classification of Headache Disorders, 3 rd edition. Add-on trials are recommended only in the presence of red flags, such as the symptoms warning about the secondary nature of headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks and the amount of analgesics taken. It includes three main approaches: behavioral therapy, seizure relief therapy, and preventive therapy. Behavioral therapy focuses on lifestyle modification. Nonsteroidal anti-inflammatory drugs, simple and combined analgesics, triptans, and antiemetic drugs for severe nausea or vomiting are recommended for seizure relief. Preventive therapy which includes antidepressants, anticonvulsants, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide or its receptors, is indicated for frequent or severe migraine attacks and for chronic migraine. Pharmacotherapy is recommended to be combined with non-drug methods that involves cognitive behavioral therapy; progressive muscle relaxation; mindfulness; biofeedback; post-isometric relaxation; acupuncture; therapeutic exercises; greater occipital nerve block; non-invasive high-frequency repetitive transcranial magnetic stimulation; external stimulation of first trigeminal branch; and electrical stimulation of the occipital nerves (neurostimulation).

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Diagnosis and treatment of migraine: Russian experts' recommendations

The Russian experts’ guidelines on evaluation and treatment of medication-overuse headache are based on evidence-based medicine, the latest revision of the International Classification of Headache Disorders. Basic information about epidemiology, risk factors, pathophysiological mechanisms, evaluation, and the most effective pharmacological drug and non-pharmacological approaches to managing patients with medication-overuse headache are presented. 

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Evaluation and treatment of medication-overuse headache: Russian experts’ guidelines

OBJECTIVE To study and analyze the dynamics of stroke morbidity and mortality rates among men and women in the territories included in the Federal program for the reorganization of care for stroke patients. MATERIAL AND METHODS The study was based on data from the territorial-population register of strokes. The study included the following territories: Ivanovo region, Stavropol territory, the Republic of Bashkortostan, Sverdlovsk region, Irkutsk region, Sakhalin region, and the Republic of Tatarstan. Research period was from 2009 to 2016. A total of 29 779 stroke cases were analyzed. The age of the examined people was 25 years and older. RESULTS AND CONCLUSION In the study areas, a 2.2 - fold decrease in stroke mortality among men and a 3-fold decrease among women was found. The values of morbidity and mortality from stroke over the entire study period were higher among men. It was also revealed that in 2015-2016, the mortality rate was in a narrow range of values, which demonstrates the impact of comprehensive measures to reduce stroke mortality in all the studied territories. The results of cluster analysis of stroke incidence rates obtained from seven territories over an 8-year period indicate similar measures for primary stroke prevention among men. Among women, there are also similarities in primary stroke prevention measures, with the exception of two regions - the Stavropol territory (4.8 cases per 1000 population) and the Republic of Tatarstan (4.5 cases per 1000 population), where the highest values of the stroke incidence rate were found. The results of cluster analysis of stroke mortality rates among men indicate a fairly large variation in the indicator values. The dominant value of the stroke mortality rate among men was found in the Sakhalin region (1.61 per 1000 population). The significance of stroke mortality rates among women in the regions was similar: six territories with similar levels of values were identified. The exception was the Stavropol territory (2.48 cases per 1000 population), where the highest death rate from stroke was revealed.

Indicators of stroke morbidity and mortality from stroke in the territories included in the Federal program of caring for patients with stroke

In patients with chronic migraine (CM), the illness perception includes three main aspects: cognitive (thoughts, beliefs, attitude towards pain), emotional (mood) and behavioral (pain coping strategies). The patient’s perception affects the course of CM, the prognosis and personality of the patient, so its assessment, understanding and correction underlie a multidisciplinary approach to treatment. Objective : to evaluate the cognitive, emotional and behavioral characteristics of patients with CM. Material and methods . The study included 200 patients with CM (63 men and 137 women), mean age 33.1±7.1 years. All patients were interviewed and tested to assess their clinical, cognitive, emotional and behavioral characteristics. Results . High levels of indicators such as catastrophizing of symptoms (84%), autonomic sensations (89%), intolerance to bodily sensations (71%), overestimation of the severity of symptoms (91%), and bodily weakness (68%) were revealed. All patients had misconceptions about the causes of headache, the majority (80%, n=160) had misconceived negative ideas about the prognosis. Almost all patients had high situational (95%, n=190) and personal (90%, n=180) anxiety, depressive symptoms of varying severity (95%, n=190). Non-adaptive pain coping strategies prevailed: avoidance coping style (87%, n=174); emotion-oriented coping (76%, n=152). In a group of 20 patients significant (p&lt;0.05) associations were found between catastrophizing of symptoms, autonomic sensations, overestimating the severity of symptoms, anxiety and depression, and coping strategies. Conclusion . In most patients with CM, the illness perception includes negative and misconceived ideas about headache, clinically expressed symptoms of anxiety and depression, and maladaptive coping strategies. Significant relationships were found between cognitive, emotional, and behavioral characteristics, which emphasizes the validity and positive perspective of using the cognitive-behavioral model of pain in CM treatment. 

/pdf/illness-perception-in-patients-with-chronic-migraine-2lrs0zpe.pdf

Illness perception in patients with chronic migraine: cognitive, emotional and behavioral aspects

Patient needs, drug intake patterns, and adherence to therapy are significant challenges in the management of migraine patients. Objective : to identify drug treatment needs, drug use patterns and adherence factors in migraine patients. Patients and methods . An online survey was conducted among Internet users through social networks (Instagram, Facebook, Vkontakte) from 01/22/2020 to 02/22/2020. The selection of respondents was based on an anamnesis of headaches and passing the ID Migraine screener. One thousand five hundred ninety-eight individuals (93.8% women and 6.2% men) aged 18—39years participated in the survey. Results and discussion . Among 1598 participants, 1490 experienced any headache, 937 respondents noted migraine symptoms, and 542 (58.4%) had a migraine diagnosis. 899 (96%) of responders used medications to relieve headaches, and in 59% of them drugs were self-prescribed. 125 (13%) patients received prophylactic therapy for migraine, of which only 47 (37.6%) complied with the prescribed treatment. We found a significant (p=0.019) association between the degree of adherence to therapy and the number of days with migraine. Conclusion . The study revealed a low referral rate in patients with headaches. In addition, more than half self-prescribed the drug for headache relief, and only a third of patients complied with the prescribed prophylactic treatment.

/pdf/medication-adherence-in-migraine-patients-data-of-an-online-29ftsqtg0d.pdf

Medication adherence in migraine patients (data of an online survey)

The paper is devoted to the safe use of hormonal contraception in women with migraine, an urgent interdisciplinary problem daily faced by gynecologists, neurologists, and specialists in headache diagnosis and treatment. It gives information on the prevalence of migraine, the risk of ischemic stroke and other cardiovascular disorders in women with different types of migraine, including those receiving contraception and hormone replacement therapy. The paper presents the main provisions of the new interdisciplinary consensus «Hormonal contraceptives and the risk of ischemic stroke in women who have migraine», which are recommended to be taken into account by specialists of any profile when prescribing hormonal therapy to women with migraine in order to avoid cardiovascular events.

/pdf/hormonal-contraceptives-and-the-risk-of-ischemic-stroke-in-14trlkkb8j.pdf

Hormonal contraceptives and the risk of ischemic stroke in women with migraine: a new international consensus

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Diagnosis and treatment of migraine: Russian experts' recommendations

Hormonal contraceptives and the risk of ischemic stroke in women with migraine: a new international consensus