Rev Neurol France
-
The target of non-drug treatment of migraine is to reduce attack frequency and intensity. To reach this goal, the general relationship between the patient and the physician, i.e. the drug consumer and prescriber, has to be changed fundamentally. ⋯ Today, we have access to effective methods that prevent inherited migraine from coming to an effect, or to effectively arrest an attack if it has nevertheless broken out. There are three available strategies: prevention by avoiding trigger factors, prevention via reduction of attack readiness and treatment of the acute effects of the migraine attack.
-
The diagnosis of tension-type headache (TTH), a heterogeneous syndrome, is mainly based on the absence of typical features found in other headaches such as migraine. However TTH is the most common headache as about 80 percent of the general population suffer from episodic TTH and 3 percent have chronic TTH (CTTH). The underlying pathophysiology is complex. ⋯ Tricyclic antidepressants are the most widely used first-line therapeutic agents for CTTH (amitriptyline is the most widely used). Other preventive treatments such as relaxation, muscular biofeedback and behavioural (cognitive) techniques have also showed efficacy. It is demonstrated that the combination of stress management therapy and a tricyclic is more effective in CTTH than either behavioral or drug treatment alone.
-
Migraine is a heterogeneous condition both clinically and genetically. Genetic and environmental factors are involved in migraine with and without aura. In most cases, genetic susceptibility has a polygenic pattern of inheritance with the exception of familial hemiplegic migraine (FHM) which is a mendelian, autosomal dominant, condition. ⋯ These two genes do not seem to be involved in the other forms of migraine. A number of association and linkage studies have pointed to several loci and/or genetic variants. However most of these data need confirmation.