Migraine is cured-The world's best physicians uncover the pain and the right cure


It is said that one in four Japanese suffers from headaches. Migraine headaches, tension headaches, and cluster headaches are said to be the three major chronic headaches, but in recent years migraine headaches have progressed research into the mechanism and treatment of their occurrence, and medicines with efficacy have emerged.
Fumihiko Sakai, Director of Saitama Psychiatric Neurology Center and Saitama International Headache Center, who is the world authority on headaches, said: It tends to be considered as being It emphasizes the need to understand more that headaches, which are recurring and hampering lives, are a major social loss that only the individual knows about suffering.
Mr. Sakai has patients write "Headache Diaries" to make them effective in grasping and treating types of headaches, while in order to stabilize the rhythm of their body, they have devised their own headache prevention exercises to improve their effectiveness. There is.
Mr. Sakai, who just published the book "Graduating from" Migraine "in this May" (Kodansha Contemporary New Book), commented on the latest findings such as why headaches occur and how to overcome them Thank you.

There are 8.4 million people nationwide who are at least 15 years old and have migraine headaches.
-How many patients in the country have three major chronic headaches, migraine headaches, tension headaches, and cluster headaches? Are there any gender differences?

 According to Sakai's large-scale epidemiological survey, there are 8.4 million people over the age of 15 and over 10 million people including those under the age of 15 over the age of 15 with migraine. More than 24 million people have tension headaches and about 1 million cluster headaches. It is a ratio of
one person to four people in total. Migraine is characterized by many women, but the gender ratio of tension headache is almost the same. Cluster headaches have been overwhelmingly men, but recently it has been found that there are also many female patients.
In Japan, patients with headaches are often referred to as having a “headache” and tend to think of nervousness, weak intentions or being lazy, or personality problems. However, headaches are undeniably ill, as evidenced by the classification of 367 in the international standard. Therefore, many researchers in the world have studied causes and mechanisms, and treatment methods have advanced.

There are 8.4 million people nationwide who are at least 15 years old and have migraine headaches.

Migraine and tension-type headaches have opposite pain mechanisms
-Could you explain the symptoms and identification of each headache?

Sakai headaches must be carefully identified, as the mechanisms and treatments vary by type. Let's explain the difference in symptoms of headache with the figure of "Differences in how it happens and progress".

Migraine headaches are sore and pulsating on one side of the head, accompanied by nausea and vomiting. Responsive to light and sound, it occurs two to four times a month. The pain is quite painful, but I think it is cool and cool. The cause of pain is the dilation of blood vessels in the head and the spread of inflammation around it.

Figure 1 How to identify a headache (the difference between the way it happens and the course)

"Graduation from" Migraine "(Kodansha Contemporary New Book)
Source: "Graduating from" Migraine "(Kodansha Contemporary New Book)

Tension headache is characterized by weight and pressure on the head, tightness, and stiff shoulders and neck. It lasts almost every day. Desk work in an unnatural posture for a long time or mental stress such as human relationship causes blood vessels to contract and blood circulation to deteriorate, causing fatigue and pain substances to accumulate in muscles.

The mechanism of pain is the opposite in migraine headaches where blood vessels dilate and contractions like tension headaches. The distinction is important and can be understood by trying to move the body when a headache is occurring. Migraine headaches become sore when you move or massage your body, but tension-type headaches, on the other hand, improve your blood circulation and ease symptoms if you exercise lightly or take a walk.
It is common that migraine and tension-type headaches begin with pain in the back of the neck first. Do this for either type of headache, you must be careful not to make a mistake.

Cluster headaches occur once or twice a year, and headaches occur continuously for 1 to 2 months. The pain is so intense that one eye is deeply incised for one to two hours every day, and the hurting eyes are congested and tears come out.

Because headaches can not be diagnosed with test data, it is important for patients to organize and understand their symptoms. To that end, the "headache diary" described later is a very effective means.

Migraine and tension-type headaches have opposite pain mechanisms

Abnormalities occur in serotonin that controls physical rhythm
-By what mechanism does the vasodilatation that causes migraine occur? Could you explain the latest findings?

Sakai First, I would like to say that migraine is related to heredity. As with stroke families and diabetes families, migraine headaches are also families with a structure in which the brain responds sensitively to environmental changes, changes in mind-body rhythm, and hormonal abnormalities. It is multifactorial inheritance that occurs when such an inducer is added to the gene. Of course there are people who do not develop the disease even if they have the gene.

The mechanism of onset has been well understood by the recent advances in brain imaging techniques. The information on the inducer is first transmitted to the brain thalamus. Then, the hypothalamus immediately below it reacts and reduces the amount of brain substance called serotonin.
Serotonin has a function to control the rhythm of the body normally. When this decreases, the trigeminal nerve, one of the cranial nerves, gets out of control and excites, releasing a vasodilator called CGRP. As blood vessels dilate in this way, substances that cause inflammation exude into surrounding tissues and cause pain. This is the mechanism of migraine.
People who work hard for a week often experience migraine headaches if they go to bed at weekends or go to bed twice and relax too much. This is caused by the fact that the brain no longer needs to release serotonin, and the amount has been reduced. So it's better not just to relax at weekends, but to do something like refreshment to prevent migraines.

Abnormalities occur in serotonin that controls physical rhythm

The center of drug treatment is triptan drugs that work on the trigeminal nerve
-It turned out that migraine is a complex mechanism involving the brain, nerves, and blood vessels. What kind of medicines do you treat this?

Some Sakai patients use anti-inflammatory analgesics that are marketed. If you have a mild migraine, you can go over it, but it's just like putting out the front blazing without putting out the fire source.
Recently, triptan drugs have been widely used as drugs to eliminate vasodilation which is the source of fire. Triptan is a substance similar to serotonin, which acts on the trigeminal nerve instead of reduced serotonin to suppress and stabilize excitation. As a result, the release of CGRP, which dilates blood vessels, is suppressed and the pain is eliminated. This is a groundbreaking drug born from the study of the mechanism of migraine, and if it works, it is definitely a migraine.
There are four types of drugs in the triptan system, but the effects differ depending on the patient due to differences in genetic constitution. It is a good idea to try which one suits you.

At the same time, development of anti-CGRP antibody preventive drugs for antibody therapy is also in progress. A drug that blocks CGRP, which causes blood vessels to expand, was approved in June in the United States. In Japan, clinical trials are taking place, and it will take one to two years for commercialization. This drug will work for 1 to 2 months when injected subcutaneously. Because it has a large molecular weight and does not enter the brain, liver, or kidney, it has the advantage of reducing side effects such as dizziness.
Migraine headaches, once memorized in the brain, are prone to repeated episodes and memories, leading to a vicious cycle, but if prevention is continued with the injection of anti-CGRP antibody, pain memory becomes faint and forget migraine headaches You can expect the effect of

In addition, research is also being conducted on treatments that send electrical signals from the nerves of the neck to the hypothalamus to stimulate the parasympathetic nerves and restore the normal functioning of the body.

In tension type headache, massage the back of the neck to improve circulation
??Please tell us the treatment method for tension headache and cluster headache that remain among the 3 major chronic headaches.

Sakai tension type headache is generally called "stiff neck headache". The poor posture and stress cause lumps in the muscles that support the neck. An unpleasant signal transmitted from the nerves of the neck to the brain is stored in the brain, which is thought to cause chronic tension-type headaches.
When muscles become hard, blood vessels contract and blood does not flow easily, so it is best to massage by yourself and loosen the muscles. The place to massage is the side of the cervical spine behind the neck, from the lower edge of the skull to the muscles in the shoulder. Gently massage to improve circulation and wash away fatigue and pain substances accumulated in the muscles of the neck with the bloodstream.

In tension type headache, massage the back of the neck to improve circulation

On the other hand, cluster headaches are caused by dilation of the thick blood vessels (carotid arteries) in the neck that enter the brain. The place is just behind the eye. This vasodilation squeezes surrounding pain nerves and sympathetic nerves, and inflammatory substances exude from blood vessels and cause pain. I do not know well why swarming occurs.
It is a treatment, but because the cause is vasodilation, triptan drugs are as effective as migraine. Recently, it has also been found that taking corticosteroids, which reduce the exudation of inflammatory substances, can prevent attacks of cluster headache.

Beware of headaches caused by subarachnoid hemorrhage and brain tumors
?? Please also comment on secondary headaches caused by other illnesses.

Sakai : A head headache that should not be overlooked due to a secondary headache is subarachnoid hemorrhage. A cerebral aneurysm ruptures and occurs, causing a sudden and severe headache that is struck by lightning, so-called "lightening headache". If a patient complains, "This is the first time such a terrible headache," you must first doubt. The presence of hemorrhage can be determined by MRI (magnetic resonance imaging) and CT examination.

Headaches caused by brain tumors, chronic subdural hematomas, etc. often increase gradually over a week or two. Tumors and hematomas increase and the pressure in the brain increases, and it gradually compresses the surroundings. It is characterized by symptoms such as paralysis of hands and feet, gait disorder, non-rolling, etc. appearing first. To identify primary headaches, it is important to know what symptoms other than headaches.
In chronic subdural hematomas, bleeding from the head continues to make the hemorrhage larger and headaches begin. Attention is required because many elderly people do not notice the symptoms.
Headaches may also occur due to sinusitis (spondylitis), which is common in children.

Patient and doctor can share information for the first time with headache diary
?? Your teacher has the patient record a "headache diary", and it is said that it is effective in understanding and treating the type of headache. What is this?

The Sakai Headache Diary is now widely used. It is because the content recorded there is indispensable for the diagnosis of headache. No matter how much your headache is examined, it can not be understood except by the person. The patient and the doctor can share information for the first time by reading the headache diary record. You will be asked to record daily what kind of headache a headache occurred in the morning, afternoon and night with a brief note.
When the doctor reads this, the first thing he said “the difference between the way it happens and the progress” will be visible, which will help identify the type of headache and decide when to take the medicine.

In some cases, drug abuse headaches may prove to be caused by overdose of over-the-counter analgesics. The main reason is that you are worried and drinking just because you feel a headache. Substance abuse can undermine the body's inherent resilience. For migraine headaches, the trick is to drink early after a headache occurs. Make use of your headache diary and set your cap to 10 times a month.

Patient and doctor can share information for the first time with headache diary

Erase the memory of brain pain with migraine prevention exercises
--- The teacher has devised a "hands-on-the-shoulder exercise" that eliminates the pain of migraine headache prevention exercises and tension-type headaches. Could you introduce me about this?
Sakai migraine shows the first pain behind the neck (third cervical nerve). This place is called a migraine headache. When a pain signal comes from the circuit of the brain that memorizes the chronic pain, it is transmitted through the nerve to the back of the neck, and the pain is dissipated at the tender point.

Fig. 2 Position of migraine headache
Location of the migraine headache
? The mark indicates the position of the migraine headache.
It hurts when it squeezes the exit part of the cervical nerve (No. 3) in the back of the mitral muscle and the plate-like muscle part. It is a window to know migraine signals from the brain.
? The mark is the position of a tender point due to the presence of tension type headache.
Because the mitral muscles are generated, it makes me feel good when I receive a regular massage.
Source: "Graduating from" Migraine "(Kodansha Contemporary New Book) Illustration / Toru Nakagawara
Migraine prevention exercises aim at stretching the muscles that support the head and neck (inner muscle). If you continue this exercise while migraine is not occurring, the tender point will disappear. The information is sent back to the brain by reversing the nerve, and eventually the pain signal is not transmitted from the brain. This is the idea of ??migraine prevention exercises.
Shoulder exercises are stretches that you perform when you have a tension headache. The point is to turn the shoulders, not the arms. The purpose is to loosen the muscles supporting the head, such as the mitral muscle, shoulder muscle group, and large pectoral muscles, to improve circulation.

Figure 3 Migraine prevention exercise method
(Up) In a standing position:
Open your legs shoulder wide, face the front, do not move your head, turn both shoulders extensively.
Rotate the shoulder 90 degrees to the left and right around the cervical spine and return. Let's continue this rhythmically for up to 2 minutes.
(Bottom) Sitting on a chair:
If you sit in a chair at the office etc., the same effect can be obtained by rotating the left and right shoulders alternately with the head facing forward as with A. . Even if the foot is closed or opened slightly, it is OK.
Source: "Graduating from" Migraine "(Kodansha Contemporary New Book) Illustration / Toru Nakagawara

Figure 4 Tips for migraine prevention exercises
Migraine Prevention Exercise Tips
Source: "Graduating from" Migraine "(Kodansha Contemporary New Book) Illustration / Toru Nakagawara
The basis of migraine treatment is to stabilize the rhythm of the body

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