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"there is a strange light before the eyes, and objects will change their angle of light and be surrounded by glowing corners, like the corners of a castle fortress. dizziness, headache and nausea follow one after another..." this is how historian catherine foxhall described the symptoms of acute migraine in her book "migraine: a history". she suffered from migraine in the winter of 1778.

migraine is the second most common disabling neurological disease worldwide, manifested as moderate to severe, recurrent headaches, accompanied by nausea, vomiting, and extreme sensitivity to light and sound, and symptoms worsen with activity. in the 2019 ranking of the burden of neurological diseases, the disease burden of migraine alone ranked second, second only to stroke. migraine may also be accompanied by 21 comorbidities such as sleep disorders, anxiety, and depression. the high prevalence, high disability, and high disease burden make migraine one of the major public health problems in the world, especially the acute onset of migraine, which seriously affects the health and life of patients.

acute treatment of migraine is a key part of the overall management of the disease, and the treatment effect is related to the patient's prognosis"in the acute phase of treatment, there are common problems such as delayed medication, unscientific drug selection and unreasonable frequency of medication, resulting in up to 55% of patients with acute migraine not getting adequate symptom relief after existing treatment. therefore, standardized treatment in the acute phase is very important, not only to quickly relieve pain, but also to avoid increasing the frequency of headache attacks as much as possible." professor yu shengyuan, director of the department of neurology, pla general hospital, director of the international headache society, and chairman of the headache and disorders committee of the chinese society of research hospitals, introduced.

yu shengyuan, director of the department of neurology, pla general hospital, director of the international headache society, and chairman of the headache and disorders committee of the chinese society of research hospitals

in response to the current status of acute diagnosis and treatment, the chinese medical doctor association neurology branch and the headache and sensory disorders professional committee of the chinese research hospital association organized and published achina's first "guidelines for the acute treatment of migraine" (hereinafter referred to as the "guidelines") provides professional guidance for the acute treatment of migraine。

seek medical attention as soon as symptoms appear

timing of medication is key

studies have shown that within 60 minutes of a migraine attack, pain intensity increases rapidly, and the efficacy of medications may be affected at this time. therefore, the guidelines recommend using medications as early as possible in the early stages of a migraine attack, that is, after headache symptoms appear, to improve treatment effectiveness. "many patients choose to endure or self-medicate when they experience acute symptoms, resulting in delayed treatment. some patients take an overdose of painkillers and have developed chronic migraines when they come to the doctor. the disease attacks frequently and lasts for a long time, which has a great impact on life. migraine is not only a symptom, but also a dysfunctional disease of the central nervous system.patients should attach great importance to it, seek medical treatment as soon as possible, and receive standardized treatment” professor dong zhao, director of the department of neurology, department of neurology, pla general hospital, pointed out.

dong zhao, director of the department of neurology, department of neurology, pla general hospital

professor luo guogang, deputy director of the department of neurology at the first affiliated hospital of xi'an jiaotong university, said: "many migraine patients will experience prodromal symptoms 20-60 minutes before the onset of a migraine, which manifests as visual or sensory abnormalities, such as dark spots or flashes in front of the eyes, numbness of the head and face, and tingling. the guidelines point out that for paroxysmal migraine, drugs should be used as soon as possible after the headache occurs to improve the efficacy of acute phase drugs and quickly relieve disability. since triptans are not recommended during the prodromal phase,gepam and nonsteroidal anti-inflammatory drugs can be started during the prodromal period.。

luo guogang, deputy director of the department of neurology, the first affiliated hospital of xi'an jiaotong university

scientifically select drugs for "precise sniping"

and reasonably control the frequency of medication

currently, there are two main types of drugs to combat migraines: non-specific drugs and specific drugs. professor luo guogang explained that non-specific drugs work by suppressing inflammation and relieving pain, but long-term or excessive use may increase the risk of medication overuse headache (moh). through continuous in-depth research, the medical community has found that the occurrence of migraines is related to the increased levels of neuropeptides such as cgrp (calcitonin gene-related peptide) and substance p in our bodies.cgrp is a substance released during a headache. specific drugs such as gamma-glucose inhibit pain transmission by blocking cgrp receptors, which is like a "precision sniper", overcoming the problems of insufficient efficacy and safety of previous non-specific therapies, and will not cause medication overuse headache.

in addition, literature reports that cgrp receptor antagonists can not only control the acute symptoms of migraine attacks, but also effectively reduce the frequency of headaches and the number of days that migraine patients take nonsteroidal anti-inflammatory drugs and antiemetics. they may be more suitable for the acute treatment of patients with high moh risk and moh.

in order to avoid excessive use of drugs, the frequency of medication should be reasonably controlled.professor dong zhao said, "according to the guidelines, nonsteroidal anti-inflammatory drugs (nsaids) or acetaminophen are the first choice for acute treatment. if the treatment is ineffective, only partially effective or cannot be tolerated after taking the recommended dosage and timing of the drug, or if the patient has contraindications, specific drug treatment can be selected, such as triptans, gempanes, and lamiditan. if nsaids, acetaminophen, triptans, caffeine-containing compound analgesics, ergotamines, and opioid-containing analgesics are used more than twice a week, there is a risk of drug overuse, and gempanes are recommended for treatment.

professor yu shengyuan believes that it is crucial to improve the clinical diagnosis and treatment capabilities of migraine and provide standardized treatment for patients.the headache and sensory disorders committee of the chinese society of research hospitals launched the "construction of headache prevention and control bases and systems in china" project and introduced the "quality control standards for headache prevention and control bases and systems". as of july 2024, the project has built 397 headache centers and headache clinics in 30 provinces and cities across the country, and has initially established a point-to-surface, map-based network of chinese headache prevention and control bases to facilitate patients to receive standardized diagnosis and treatment services nearby. it is hoped that the goal of ultimately achieving 90% of headache patients receiving standardized diagnosis and treatment and disease management locally will be achieved.