WHAT DOCTORS SAY

An article published in number 25 (April) of Neurology, the official publication of the American Academy of Neurology, and one of the most prestigious in this field, recommends a more "aggressive" and radical treatment for headaches caused by migraine, whilst also calling on all doctors treating patients with common migraine to consult the new practical guidelines that are available on the website www.neurology.com.

Although these practical guides approach the problem of headache in general, not just migraines, three of them deal specifically with the common migraine: Pharmacological guidelines for the prevention of migraine, behavioural and physical (non-pharmacological) treatments and the pharmacological handling of acute attacks. Apart from improving diagnosis, the main goal of this type of practical guide is to offer guidelines on how to administer available treatments more efficiently.

Since the introduction of the triptan family,a group of drugs with analgesic and abortive action against migraine attacks, in the nineteen nineties (first sumatriptan and then others such as zolmitriptan and naratriptan) there have been no further therapeutic breakthroughs in relation to migraine. Current efforts to improve the treatment are therefore focused on the design of new guidelines and combinations of analgesics (a type of drug that alleviates or eliminates pain from any cause without changing other sensations), and other available drugs, to achieve the maximum benefit with the minimum number of side effects.

One of the breakthroughs seen in recent years, described in 1998 in the journal Archives of Neurology, was a simple cocktail of analgesics using three time-honoured substances; including aspirin (a drug that belongs to the salicylate medication group. It is used to alleviate pain and to reduce fever. The cocktail also contains paracetamol and caffeine, and it is much cheaper than any of the modern drugs.

Migraine. According to neurologists,

only patients suffering from migraine know what a nightmare this condition can be. Attacks occur periodically, without warning. The side effects of the drugs (chemical compounds use in therapy. Refers to an agent or chemical substance, simple or compound, administered for therapeutic purposes) currently available, backed by researchers searching for new alternatives hidden behind the physiopathology (part of the pathology that studies functional disorders without looking at the possible anatomical lesions) of migraine.

Migraine is a neurovascular disorder (change in the nervous and vascular systems all at once) which is quite common, and involves headache as well as autonomic and neurological symptoms. The onset of migraine is related to individual as well as environmental factors. In patients with migraine we observe Cortical hyperexcitability (an increase in nervous activity in the cerebral cortex) related to defective oxidative mitochondrial function (the principal function of the mitochondrion, in bringing the final phase of aerobic metabolism to a close: oxidative phosphorylation. This means that it achieves an ATP benefit thanks to the passage of protons through the membrane of the mitochondrion, by means of a transmembrane protein that functions as ATP-ase) , low levels of intracellular magnesium (a bioelement that is essential to life. It activates all reactions in which ATP is involved. Excesses or deficiencies can lead to pathologies), high levels of neurotoxic amino acids (aspartic acid and phenylalanine, without the other amino acids in the protein, are neurotoxic and damage the neurons in the brain), the hereditary alteration of the calcium channels or a combination of several of these factors.

In patients presenting with frequent attacks (more than two per month) and not responding well to treatment, preventive treatment can be useful. Once an attack has started, there are non-specific and specific drugs available (ergotics- the name for alkaloid derivatives of ergot of rye, and triptans - a group of drugs with analgesic and abortive action against migraine attacks), whose side effects cannot be ignored. Based on what we currently know about the pathophysiology of migraine, researchers are looking into the effect of using substances such as riboflavin or vitamin B2, the precursor to certain coenzymes that act on oxidoreduction reactions in the transfer of proteins and glucides to amino acids and fatty acids , which increases the energy efficiency in the mitochondrion during prophylaxis (a set of measures serving to protect individuals or society against diseases). Preventive treatment of migraine.

In vitro and in vivo trials have indicated that magnesium deficiency could have a role in pathogenesis(the source and development of diseases) of migraine in more than 50% of patients.

The results of a single clinical trial reveal that an intravenous infusion of magnesium sulphate lead to sudden and sustained remission from migraine in half of the patients involved. In this trial, 85% of the patients who responded to treatment with magnesium sulphate had low levels of ionised magnesium in the plasma, while 85% of those who did not respond had normal levels.

Curiously, prophylactic treatment with oral magnesium supplements worked in some double blind trials using a placebo, and was ineffective in others. The lack of a response could, however, be attributed to poor absorption, which varies greatly according to the preparation used.

Based on the safety profile and the low cost of the treatment, as well as the clinical and experimental data, the authors of this study recommend the administering of magnesium supplements (magnesium diglycinate, which is well absorbed, at 600 mg/day) in patients with migraine