Main non-drug treatment methods used in the treatment of migraine; nerve blocks, neurotoxin applications, neurostimulation methods, trigger point treatments, acupuncture.
NON-DRUG INTERVENTIONAL TREATMENTS
1. Nerve Blockade Treatment
Nerve blockade method is an interventional treatment.
It can be used as a preventive measure in preventing migraine attacks, as well as methods that can be used during headache attacks.
It is the method responsible for migraine attacks. It is based on the principle of administering various drugs (such as bupivacaine, lidocaine, triamcinolone, etc.) to the nerves thought to be related to the brain centers (such as the trigeminovascular system) with special injection techniques and thus blocking the nerves.
There are many problems related to headache. It can be applied to the nerve (greater and lesser occipital nerve, supraorbital nerve, supratrochlear nerve, auriculotemporal nerve, etc.) at the same time.
However, it is most commonly performed on the nerve called the greater occipital nerve (GON), and this procedure is simply called 'GON'. It is referred to as 'Blockage'.
Because this nerve is directly related to the trigeminovascular system, which is the brain region responsible for migraine attacks.
GON Blockade
It has been shown to reduce the frequency, severity and duration of migraine attacks.
Therefore, it can be used as a preventive treatment during migraine headache attacks and to prevent migraine attacks.
Pregnancy and various diseases. It can be considered an effective and reliable treatment option for migraine patients who cannot use medication for various reasons.
How does it work?
With special techniques, sometimes with the help of ultrasonography, the greater occipital nerve is treated. The drugs administered block the reversible sodium channels in the nerve fibers.
Thus, the formation of pain stimuli in the (trigeminvascular) region to which the nerve is connected and associated with migraine headache is prevented.
Nerve blockages also prevent the formation of pain stimuli. A regulatory effect (modulation effect) is also provided in the nervous system against the mechanism that creates migraine pain.
How is it done?
GON Blockade is applied to the back of the head.
How is it done?
GON Blockade is applied to the back of the head. p>
Nerve, anatotomus at the back of the head It is detected with the help of microstructures.
It may sometimes be necessary to use ultrasonography to find the nerve.
After the greater occipital nerve is found, a mixture of local anesthetic and serum prepared in various doses is injected using special injection techniques.
It can be applied unilaterally or bilaterally.
After the injection, numbness and temporary loss of sensation occur in the applied area.
The procedure can be easily performed in a clinical environment.
>
How often should it be done?
Generally, it can be done for 3-5 weeks with a one-week break.
Afterwards, monthly applications can also be done.
However, it has been shown that 'repetitive GON Blockade applications significantly reduce the frequency, severity and duration of migraine attacks'!
For this reason, it can be used in migraine headache attacks as well as for the preventive treatment of migraine.
The neurologist should decide which patient and at what intervals it will be applied, on an individual basis.
Are there any side effects?
It can also occur in injections made to any part of the body. Side effects such as injection site infection, subcutaneous bleeding, fainting, low or high blood pressure, nausea may occur.
Very rarely, hypersensitivity, heart rhythm disorders, allergic reactions, etc. depending on the local anesthetic used. side effects may occur.
If steroids are used along with local anesthetics during GON blockade, side effects such as hair loss and skin thinning may also be observed.
If GON blockade will be used for the treatment of headaches in pregnant women, steroids may be observed. It is not recommended to use it.
2. Treatment with Botulinum Toxin
There are publications showing that it is effective in drug overuse headaches as well as chronic migraine.
To Whom Can It Be Applied?
Botulinum toxin treatment for migraine can be applied to chronic migraineurs who spend at least half of the month with headaches and more than half of this pain is in the form of migraine pain.
Its effectiveness has not been proven in patients who have a small number of migraine attacks within a month. It is not recommended for young patients.
Since the effect of botulinum toxin on pregnancy is not known, botox treatment of migraine in pregnant women is not suitable today.
How is it done?
With very fine-tipped special injectors, inject at least 31 points on the forehead, temples, nape, neck and shoulders, where the nerve endings of migraine-related brain areas are located.
Patients can easily tolerate the slight pain that may occur during the application.
At least 155 units of medicine are used during application. If the neurologist performing the application deems it appropriate, additional doses can be applied to other areas other than these points. In this case, a maximum of 195 units can be applied.
If performed by an experienced physician, the procedure can be completed in 20 minutes. After the application, the patient can immediately return to work and other daily living activities.
Where Should It Be Done?
Application of botulinum toxin treatment in migraine; It must be performed in a clinical environment, in accordance with hygiene and sterility rules, with the correct technique and in sufficient dosage, by an experienced neurologist. Botulinum toxin application in migraine is never a cosmetic application.
How Often Should It Be Done?
Treatment of migraine with botulinum toxin should be done at least twice with an interval of 3 months.
The physician should decide whether to perform another application after two applications, depending on the patient's condition.
Studies have shown that a large number of patients benefit from the first application, but very few patients do not benefit from the first application. Therefore, it is necessary to apply at least two times to be able to say whether a migraine patient will benefit from botulinum toxin treatment.
When and How Does Its Effect Appear?
The effect of botulinum toxin begins to appear 10-12 days after its application. It is observed that the frequency and severity of migraine attacks decrease. Pain attacks of patients who spend almost every day with headaches decrease to once a month, sometimes once every two months, or to a few attacks. Better results can also be obtained from this.
In migraine, attacks and pain decrease with the application of botulinum toxin It can reduce and end the consumption of drugs and drugs, as well as improve the quality of life.
What are the Side Effects?
When the treatment of migraine with botulinum toxin is done with the right technique and in the right dose, it is difficult to talk about any serious and permanent side effects. However, it should not be forgotten that it may cause side effects such as neck pain, weakness in the neck muscles and drooping eyelids, even if temporary.
How Does Botulinum Toxin Prevent a Migraine Attack?
Muscle The 'preventing muscle contraction' effect of botulinum toxin is used in diseases such as dystonia and spasticity due to contractions, and this effect is temporary.
However, its therapeutic effect on migraine pain is very different from its effect on preventing muscle contraction.
Botulinum toxin, which is injected into the nerve endings of the migraine-related brain regions in the forehead, temples, neck and neck, enters the nerve endings.
It progresses to the migraine-related regions of the brain through various mechanisms and is released from there, causing migraine headache. It prevents the release of neurochemicals (such as CGRP, Substance P).
It also eliminates sensitization by acting on pain receptors in these nerves that have become sensitive to pain stimuli.
How Long Does Its Effect Last?
The anti-muscle contraction effect of botulinum toxin can last up to 6 months. For this reason, the applications performed in diseases such as dystonia, spasticity and hemifacial spasm, in which we benefit from the muscle relaxant effect of botulinum toxin, may need to be repeated at certain intervals.
However, unlike these medical conditions, the effect of botox in migraine does not depend on the muscle relaxant effect! Its direct effect on the nerve cells in the brain regions that cause migraine and the nerve endings of these brain regions reduces the frequency of migraine attacks.
Considering the results of the PREEMPT study concluded in 2010, the application can be repeated at certain intervals according to the patient's condition and the decision of the neurologist doctor monitoring the patient.
Thus, patients can be helped out of the vicious cycle of chronic migraine. Medical precautions and age of patients who exit the chronic migraine cycle They can maintain this situation with am style changes. In summary, there is no obligation to apply botulinum toxin every six months in migraine, as in other medical conditions that benefit from the muscle relaxant effect of botulinum toxin.
3. Neuromodulation - Neurostimulation Methods
Drug treatments in the classical sense are still considered the first option in the treatment of migraine.
However, despite appropriate drug treatment, headache attacks do not decrease, side effects of the drugs occur. In case of drug interactions or another medical disease that prevents the migraine patient from receiving appropriate drug treatment, migraine can be treated with non-drug methods.
For this reason, 'non-drug methods' treatment options for migraine are becoming increasingly important.
Neuromodulation and neurostimulation can also be counted among these methods that are gaining importance.
Roughly defined, the neurostimulation method works on the nerves associated with headache with the help of specially developed devices. It is based on the principle of stimulating the nerves and brain regions associated with headache by applying electric current, magnetic current or direct current.
This application can be performed around the head, or some special devices can be placed near the nerves associated with headache using invasive methods. It can also be done by inserting special devices using invasive methods.
Supraorbital Transcutaneous Stimulation (STS)
and is applied on the nerve that is considered to be associated with headache.
It is a device that is attached to the head in the form of a band and gives electrical stimulation to the supraorbital nerve at certain frequencies.
It is applied 20 minutes a day for three months to achieve chronic It is thought to reduce the number of painful days in migraine.
Depending on the electric current, it may cause complaints such as numbness, tingling and skin reactions in the applied area. It has also been reported that it may cause changes in sleep patterns.
Transcranial Magnetic Stimulation (TMS)
TMS is mostly used as treatment for migraine patients. What they know and migraine treatment
Read: 0
