让我们来谈谈治疗偏头痛

你有最后一次偏头痛不一定了，你就会重新拥有。你的新的攻击可能与你看到的曲折，让视野狭窄，或悸动痛苦的头痛之前的感觉在你的手发麻开始启动20分钟后。或者你只是可能会得到一个头痛这是很糟糕，足以送你去床上画的色调。

And just as all attacks can differ, so can every treatment plan. Your doctor will go over your migraine history and offer recommendations based on the type of migraines you have, how many attacks you have a month, recent research, and their own experience. There are many more options now than even just a year or two ago—more preventative treatments and more meds to stop attacks, and even some alternative methods that are backed by science. This overview of potential choices can help you get a clearer picture of what you can do to stop the pain.

What Are Migraines Again?

认为偏头痛的脑部疾病。得益于强大的家族病史（你的爸爸妈妈可能有攻击，太），你继承了大脑对某些触发超级敏感，以至于掀起了大脑的不同部位变化的级联。

While experts don’t know for sure the exact interplay between the neural pathways and chemicals that produces the symptoms of migraines, they think that the hypothalamus, the part of the brain that regulates many of the body’s functions, and the brain stem are involved. At the beginning of an attack, these areas start to communicate with one another in an abnormal way. As the nerves in these areas start to fire more and more, they release chemicals that cause inflammation and dilate the blood vessels, producing pain.

These attacks happen at least once or twice a month for the 39 million people in the U.S. who have migraines. About 10% have attacks several times a month. Another 8% have them more than 15 times a month. Three times as many women have migraines than men. But even little kids can have them.

什么是最好的治疗偏头痛？

Basically, there are two types of treatment—the type that prevent attacks, or at least lower the number and intensity (known as预防); and treatments that you take during an attack (known as急性）。这些包括口服吃药以及注射和非药物的设备。也有包括补充和生活方式的改变，在海湾有助于保持触发补充治疗。

Most of these, except for one exception, work for every kind of migraine patient. A doctor will diagnose you with episodic migraines if you get fewer than 15 attacks per month. Chronic migraine patients are those who have more than 15 attacks. Sadly, both types of migraine patients don’t get the help they need. When they surveyed people with migraines in 2016, researchers discovered that fewer than half (40%) were seeing a provider for their migraines—and only a quarter of those folks had gotten an accurate diagnosis with the right treatment. The American Migraine Prevalence and Prevention Study, which also surveyed those with migraines, found that while 98% took medications during an attack, only one in five took drugs that could prevent migraines—and the majority of those discontinued using those preventative treatments because of side effects.

Doctors found that for many people with migraines the best treatment involves preventative remedies along with medications that you can take during an attack. And luckily, in the past two years, a number of new drugs that target specific pain receptors have become available to migraine sufferers. There are also non-drug devices that are also new to the market. Your best bet for the right treatment is to go to a dedicated headache specialist or clinic to find relief (you can find a list at偏头痛研究基金会）。但有没有那么多的专家，所以你可能会得到帮助，如果你去看神经科，或者从您的初级保健提供者提到一个。

我可以采取停止偏头痛发作？

有比以往更多的选择，它们包括药物从普通的止痛药，以新的，更有针对性的注射药物。如果你不能服用这些药物，然后有非药物的设备，你可以试试。通常情况下，医生会建议采取只急性治疗的人有偏头痛发作，特别是如果他们只有每月一个或两个的攻击。

你把急性药物以头痛为首发症状，而不是先兆阶段（如果你是谁与他们有偏头痛的20％的人之一）。理想情况下，任何治疗您使用停止偏头痛应该在工作两小时或更少，和你的痛苦不应该回来以后（甚至在一天后）。如果不是这种情况，它的时间切换的药物（或上预防那些移动）。

Migraine Medications

解救痛苦的人

这些药物多数偏头痛患者最终回吐，但他们的工作最好的，如果你没有太多的攻击和痛苦并不坏。他们通常在柜台交易（OTC）销售的，虽然有时医生可以写的Rx更有力的剂量。带他们头痛开始后不久，但不要超过一天的推荐剂量，并跳过他们，如果你一周有两个或更多的麻烦。

原因是:人们可以反弹时头痛these OTC drugs are overused, which then can be difficult to treat. Plus, taking too many NSAIDs like Advil (ibuprofen) could put you at risk for such gastric issues as bleeding or ulcers, which people with migraines are three times more likely to get. So if you’re popping over-the-counters like candy, ask your doctor about prescription options (including preventative meds).

OTC止痛药包括：

• NSAIDs的喜欢的Aleve（萘普生钠）和布洛芬（布洛芬），这往往效果最好，因为他们降低造成的攻击炎症
• 拜耳（阿司匹林）
• Tylenol (acetaminophen)
• Excedrin (aspirin, acetaminophen, and caffeine)—which can help because the caffeine can constrict the blood vessels

曲坦类药物

If your migraines are getting more frequent and intense and your OTC drugs aren’t helping, your doctor might recommend a triptan, which activates serotonin receptors in your brain. Experts think abnormal levels of serotonin, a brain chemical that helps your brain cells communicate with one another, may make you more sensitive to pain (as well as depression). Serotonin may also help activate another chemical called CGRP, which is released during a migraine attack.

来曲普坦类药物片剂，鼻喷雾剂和速溶片，你尽快把它们作为你感到偏头痛即将来临。他们通常在工作约30至60分钟，他们已经发现有效的一半左右所有偏头痛患者的80％。它们可以让你的呕吐不适的感觉更差（或送他们）和他们的人不建议患有高血压，那些谁患偏瘫偏头痛，在怀孕期间，或对于那些雷诺综合症。如果你是一个慢性偏头痛患者和更糟糕的是，您也可以依靠他们太多。

这些药物包括：

• Maxalt, Maxalt-MLT (rizatriptan), also comes in a dissolving tablet and is okay for kids 6 years and older to take, too
• IMITREX（舒马曲坦），还附带一个喷雾
• Zomig，Zomig ZMT（佐米曲普坦），也采用的是溶解片剂
• Amerge（那拉曲坦）
• Axert (almotriptan)
• Relpax（曲普坦）
• 弗罗瓦（夫罗曲坦）

麦角生物碱

如果曲坦类药物不适合你，你的供应商可能把你的这些药物，其工作由大脑收缩血管。同样，你带他们在攻击的第一个迹象。麦角生物碱确实有副作用（如恶心和呕吐），并且你不能把他们，如果你怀孕或哺乳期，有心脏疾病，胸部疼痛，或有中风的危险，因为它们可以提高这种风险。

这些药物包括：

• Migranal (dihydroergotamine), a nasal spray
• Ergomar (ergotamine), a tablet you place under your tongue

Drugs That Block CGRP Receptors

CGRP是一种肽（小蛋白分子）连接到神经末梢在大脑中负责传递感觉信息，而当你有一个攻击，其水平的提高。

这些吃药靶向CGRP受体，附着于神经末梢阻断蛋白。他们在平板电脑和一般的疼痛和如恶心和光敏感性的人大约60％的症状在两小时内提供救济。

五分之一的偏头痛患者，根据临床研究，是从痛苦中完全免费的。缺点？这些药物价格昂贵，并且为了获得保险覆盖它们，你必须尝试（和失败的）老药（如阿米替林）。副作用包括恶心和疲劳，但几乎每个人谁拥有发作或慢性偏头痛，包括那些患有心血管问题，可以服用这些药物。

• Ubrelvy（ubrogepant）
• Nurtec（rimegepant）

Non-Drug Options for Acute Migraines

神经调节装置是机器，你在家里使用时，你不能（或不愿）服用药物，他们通过在大脑中可减轻疼痛刺激的神经通路的所有工作。妇女谁是怀孕或准备怀孕以及老人们谁不能耐受药物或谁不能耐受副作用是这些在家里的设备都不错的候选人。这些在家里的机器有没有副作用，有时可以用来防止攻击以及阻止他们，不管你是什么类型的偏头痛。缺点？除非你是一个老手，并通过退伍军人管理局得到您的健康保险他们不属于医疗保险。

它们包括：

• Cefaly(经皮电神经刺激)- looks a bit like a heart monitor that attaches to your forehead via a sticky electrode. It’s used for both prevention and during an attack and works by buzzing the forehead and stimulating the nerves that go into the brain. When you feel a migraine coming on, you put it on and leave it for an hour. One small study found that it cut pain by more than half (57%) after one hour, and none of the patients needed to take other meds. This device costs $550 to buy, and about $25 every three months to replace the electrodes.

• sTMS-mini(single-pulse transcranial magnetic stimulation)—This device is about the size of a shoe and contains a magnet. You place the sTMS-mini at the back of your head, turn it on, and the magnet pulses four times, stimulating the electrical activity in the brain. It’s used both for prevention and during an attack. A study published in the Lancet found that more than one-third of patients were pain free after two hours. Only a doctor can prescribe the sTMS-mini, and the costs are hefty—$250 a month to rent (you may get a break through the manufacturer).

• GammaCore(non-invasive vagal nerve stimulator)—It looks like an electric razor and you place it on your neck for two minutes at a time, about two or three times in a row (so for about four to six minutes total), when you have a migraine. GammaCore stimulates the vagus nerve, which runs from the brain through your face and neck down to your abdomen, blocking pain signals. More than a third of patients are pain-free in an hour and many cut down the number of attacks per month. It too is costly—$600 a month to recharge it (and you need an Rx to do it).

• Nerivio- 这个高科技的选项仅适用于那些有偏头痛发作良好。它包括一个补丁，你穿对公司透过智能手机应用程序来控制你的上臂。你60分钟的攻击范围内开启设备，并将其发送信号到脑干从痛疼阻止你。The sooner you turn on the device, the greater the pain relief, a study published in Neurology found: For those who’d used Nerivio within 20 minutes of symptoms, 58% reduced the pain of the attack by half, and about 30% were pain free in two hours. The patch costs $99, and it can treat 12 attacks.

我可以采取预防偏头痛从第一名开始？

以下所有的药物都采取降低你有一个月的攻击的数量，如果运气好的话，让他们不那么严重。医生开他们对任何人谁都有偏头痛，阵发性或慢性，与光环或没有。通常情况下，你想，如果你每月有四个以上的攻击使用它们或他们的超级衰弱。

Just be aware that even with preventative meds or devices, you’ll need to take something else during an attack. So, for instance, if you decide on Botox shots, you’ll probably have fewer episodes a month, but you’ll probably need a triptan or some other pain reliever when you do get a migraine.

Medications

Off-label drugs.有时医生会开这意味着其他的东西，以防止头痛的药物。你每天服用这些药丸停止发作的频率。问题是，这些药物会带来一些严重的副作用，如疲劳，抑郁，或性欲减退，因此人们往往停止了一段时间后使用它们。

• 避孕药will prevent a quick drop in estrogen and are given to women who have attacks right before or during the periods. These aren’t the best choice for women who have migraines with auras, because their risk of stroke goes up four or five times—and if they’re on birth control it goes about seven times. And if you smoke, the risk goes up nine times, which is why most doctors won’t recommend them if you have auras.

• 抗抑郁药that raise serotonin levels, like Elavil (amitriptyline) and Effexor (venlafaxine)

• Blood pressure medications这可以收缩血管，如心得安（普萘洛尔）和Lopressor（美托洛尔）

• 抗惊厥药物that can work on glutamate receptors and block excessive, another neurotransmitter involved in migraine auras, like Topamax (topiramate)

Botox shots.同样的注射，可以使你的额头平滑和擦除线还可以防止偏头痛，但它们仅批准用于患有慢性偏头痛。医生肉毒杆菌内喷射在你的头部周围和颈部的几个点（多达十几个甚至更多）。该毒素阻断释出化学物引起疼痛。每一组注射持续约12周。

CGRP结合药物。这些预防注射是为了降低攻击的数量，你有一个月切割至少他们一半的患者在使用这些药物进行临床研究的50％。它们被设计以结合CGRP分子和附着于该受体阻止它们。你服用这些药物每月一次，你可以得到在医生办公室拍摄或者把它送给自己（后您的供应商展示了如何）。副作用包括注射部位（通常是你的大腿或胃），恶心，便秘疼痛和红肿。

The headaches are also less severe, so patients in studies reported a better quality of life—missing fewer days at work, not having to skip family or social events, having less trouble concentrating and feeling exhausted.

These meds include:

• Aimovig（erenumab）
• Ajovy（fremanezumab）
• Emgality（galcanezumab）

Neuromodulation Devices

可以治疗偏头痛的还可以减少偏头痛的天数，如果你使用它们的预防以及同样在家大脑刺激装置的两个。

• Cefaly转角它每天晚上20分钟。一项小型研究发现，攻击次数从平均每月7下降至略少于五个。

• sTMS-mini-Give自己在上午四个脉冲，晚上四个脉冲进行预防。一项研究发现，约46％的患者至少减少了一半偏头痛的次数。

互补或生活方式治疗

随着医学治疗，你也可以尝试调整你的饮食和可能引发的攻击，如失眠或压力的生活的其他部分。

获得更好的睡眠。失眠以及其他睡眠障碍等睡眠呼吸暂停已与偏头痛联，无论是作为触发器和作为另一伴随慢性病症。如果你醒来，头痛，睡眠的质量和数量可能是罪魁祸首。医生可能会与您合作，让你在睡眠时间表（睡前，并在同一时间起床），以及睡眠卫生的其他方面（比如说，保持你的卧室凉爽或保持您的手机上的另一面房间的）。或与治疗师谁可以教你专门设计用来帮助你入睡，更容易保持这样的认知行为治疗策略联系起来。

Eat healthier foods.There is some evidence to show that obesity can turn episodic migraines into chronic ones. There’s no one anti-migraine diet, but try to eat more plant-based meals and swap out unhealthy foods like soda and sugary treats for more fruits and veggies. And keep to a regular eating schedule to keep blood sugar fairly even. One trigger for many people is skipped meals or going too long before eating.

见一名针灸师。You can lop off an average of three-and-a-half days of migraine attacks with 20 sessions of acupuncture, according to Chinese researchers. The caveat: This small study was done on people with episodic migraines without auras. Either way, the therapy can be very relaxing, and there’s nothing wrong with having an excuse to lie quietly in a comfy, dark room.

Try magnesium supplements.If you want to prevent migraines from happening and aren’t keen on spending money on devices or other drugs, try taking 400 to 500 mg of magnesium oxide every day. It works best on those who have migraines with aura as well as people who have auras but have no or very mild headaches after their aura signs. Magnesium can block a receptor in the visual processing part of the brain that’s activated by glutamate, the area in the brain most implicated in auras.

Other supplementsthat may help (or at least are worth a discussion with a provider):

• coenzyme Q10
• 退黑激素
• 维生素B2（核黄素）

In studies, each of these supplements were found to cut down the frequency of migraines perhaps because of their anti-inflammatory, antioxidant properties. Melatonin can also help you sleep better, which can also help cut down the number of attacks, and it may also block CGRP release, which helps lessen the pain. Some of these supplements even come in combo form, like Dolovent (magnesium, coenzyme Q10 , and B2).

管理你的压力。喜欢睡觉，人患有偏头痛都在强调和有焦虑，以及可能导致其他不健康的应对策略就像吸烟，服用了太多药物，以及过食。因此，它是有道理的，任何可以让你放松将是你的整体健康以及你的偏头痛好。已经有一些证据为基础的技术，可以工作，以减轻偏头痛以及频率，包括认知行为疗法（CBT），无论是在线还是小组讨论，以及正念技术，这也为那些人，他们的偏头痛做工精良已经变得更糟，因为他们过度使用药物。还有一些证据表明，做瑜伽还可以减少发作次数和偏头痛的强度。