[Medical Insight No. 67] Everything about "Migrain" that a neurologist tells us.

□ Broadcast date and time: January 17, 2025 (Fri) 10:20 p.m.
□ Producer in charge: Lee Siwoo
□ Author in charge: Kim Bae-jung and Kim Hyun-jung
□ Cast: Moon Hee-soo (Gangbuk Samsung Hospital neurologist)
□ Broadcast channel
IPTV - GENIE TV No. 159 / BTV No. 243 / LG Uplus No. 145
SkyLife Number 90
Cable - Delive No. 138 / Hyundai HCN No. 341 / LG HelloVision No. 137 / BTV Cable No. 152

* The text below may differ from the actual broadcast content, so please check the broadcast for more accurate information.


◆ Moon Hee-soo: Hello, I'm Moon Hee-soo, a neurologist. What I prepared in this time is to know the migraine of a disease that deteriorates the quality of life.

◇ Voice actor Park Sang-hoon: National disease headache that is experienced by more than 90 percent of the population. Six out of ten headache patients regularly experience headaches, most of whom experience tension-type headaches, which are mild headaches caused by stress, fatigue, and lack of sleep. However, most patients who visit the hospital are migraine patients who suffer neurological symptoms. Everything about migraine that has as many treatments as the risk factors for migraine. Let's take a closer look at migraine diseases where accurate diagnosis and treatment choice are more important than any other disease.

<Understanding Headache>
◆ Moon Hee-soo: A disease that you endure even if you are sick, a disease that you don't think of as a disease. However, a headache is the disease that everyone experiences at least once. The problem is that it's too common. About 65% of the people experience headaches regularly. About 2% of the people say they have a headache almost every day. Headache patients get into trouble whenever they have a headache. Do I need to take medicine? Should I hold it in? Do I have to go to the hospital? Do I need to get tested? Do you have a terrible disease in your head? Let's take a look at this concern with me.

<Type of headache>
◆ Moon Hee-soo: Headache is divided into two. Secondary headaches are when there are organic diseases in the brain, such as brain tumors, cerebral hemorrhage, and cerebral infarction, and headaches occur. However, even though there is no organic problem in the brain and there is no cause of the headache, the primary headache is called the occurrence of the headache. These include migraines that have severe headaches and repeated body temperatures such as indigestion, tension-type headaches that hurt heavily due to muscle tension, and primary stabbing headaches that poke one area like electricity.

<Danger Signal for Secondary Headache>
◆ Moon Hee-soo: This time, we will learn about the warning signs for headaches that suggest secondary headaches. If a person who did not originally have a headache develops a new headache over the age of 50, there can be dangerous signals. Second, lightning headaches that start like lightning strikes that you've never experienced before can also be a risk factor. In addition, tests are needed even if systemic symptoms including fever are accompanied, and headaches that occur after coughing, feces, and sexual activity are also needed. You should also pay attention to headaches that change depending on your posture. Standing headaches that disappear when you lie down and cause headaches when you wake up are also subject to examination. Cancer patients and pregnant women who take anticoagulants need to be tested if they have a headache, and they should also be tested if the headache continues to worsen for days or weeks. However, you don't have to worry too much about having a headache because secondary headaches are only about 5% of all headaches and most of them are 95% primary headaches.

<1st Headache>
◆ Moon Hee-soo: 1st Headache. It is a condition that does not have an abnormality in the brain but suffers enough to degrade the quality of life too much. That's why accurate diagnosis and treatment are needed. Let's take a closer look at the primary headaches. The most common headache among the primary headaches is the tension type headache. It's said that about 40% of the population experiences it. The way patients express tense headaches is because their head is heavy, heavy, tight, or pressed, their head is foggy, and they are not clear. You're expressing it like this. If it's severe, the stiffness down to the neck or shoulder goes down. You say it's annoying even if it doesn't hurt very much, and when you have a headache, you may forget it for a while if you focus on something, get some fresh air, and refresh. Just as the name is a tense headache, it is a muscular headache caused by excessive tension in the muscles around the head, neck, and shoulders, deteriorating blood circulation and accumulating pain-inducing substances. Most of them are caused by environmental problems. It can be caused by overwork, stress, emotional problems such as anxiety and depression, posture problems, sleep problems, and a perfectionist personality that requires doing everything well. Of course, there are medicines that help. However, before treatment, the movement to improve environmental problems is more important.

<Symptoms of migraine>
◆ Moon Hee-soo: Next, let's look at migraines that visit the hospital the most. Migraine is the second-largest disease burden by the World Health Organization. It's that difficult disease. It is said that the pain is much worse than the pain of childbirth, and it is a headache that not only you but also your family suffer. However, there are reports in Korea that it is more than 10 years before being properly diagnosed. Migraine is this headache. I usually have a headache on one side. As for the headache aspect, pulsating headaches are common, such as a throbbing head and heart beating, and the intensity of headaches is so severe that you can't live your daily life. Along with headaches, various accompanying symptoms occur. The most common symptom is gastrointestinal symptoms. I feel like I have an indigestion, and when it's severe, I throw up. Also, hearing bright light or loud sounds makes your headache worse. So if patients have a headache, I want to lie still in a quiet room. It is also said that when you suffer from severe migraines, your skin senses become sensitive to wind. Migraine headaches are called migraine headaches, so you might know that it's a headache in one head, but only about 60% of people have migraine headaches in one head. About 40% of people are sick on both sides.

<Migrain Progress>
◆ Moon Hee-soo: When migraine starts, it goes through four stages and it's over now. The first one goes through the bulb and proceeds to four stages: sign, headache, and hindgut. To migraine patients, "Do you feel your headaches start?" ’ If you ask like this, most people say, "I feel like my headache will start even if it doesn't start in earnest." There, those symptoms appear as the feeling of a light bulb. Signs are not experienced by all migraine patients. You only experience about 20% of that. Just because you have a sign doesn't mean you experience all the signs again whenever you have a headache. There are many signs, but the most common thing patients talk about is visual signs. There are also people who see bright light, such as dark spots that look black or afterimages that remain when they see very bright light. Some people now have zigzag lines that are like this, so they get bigger and bigger, and then you can see a castle-shaped flash. First of all, it comes from a small part, and it gradually increases and can usually last for up to an hour for about 2-30 minutes. As this visual sign ends, it often leads to headaches.

<Causes of migraine>
◆ Moon Hee-soo: Patients ask. "Why did migraines come to me?" When we ask, our doctors say, 'Oh, this is a genetic problem. It's a natural problem.' Migraine patients say, "From birth, the brain and cranial nerve vessels, and structures related to this pain are sensitively born." When stress-inducing factors come into patients with migraines, they touch the cranial nerves and cerebrovascular in the brain, and now the tertiary nerves around the meninges are stimulated first. When stimulated, neurotransmitters come out of the nerve. When the neurotransmitter comes out, inflammation occurs around it, and the blood vessels expand due to the inflammation. As blood vessels expand, the brain's pain circuit turns on the switch. As a result, pain is transmitted to the brain, and patients feel a pulsating headache like an vascular headache. Migraine headaches are three times more common in women than men. The prevalence rate of women is set at 18%, and that of men is set at 7%. This is because of female hormones. As the meniscus begins, the rate of headaches in women goes up, and then the headaches menstruate and go on the ovulation cycle. During that pregnancy, the headache improves considerably, and after giving birth, the headache worsens again. And when the menopause is complete, the female hormone's curvature disappears, so it is said that headaches improve a lot.

<Middle headache trigger>
◆ Moon Hee-soo: The triggers for headaches vary slightly from patient to patient. So you have to take a closer look at what your own trigger is. The most famous thing is stress. In addition, headaches can occur due to hormonal changes, so headaches often develop and improve depending on the menstrual ovulation cycle. In addition, external stimuli, especially strong smells, loud sounds, and bright lights often cause headaches. Then, I get a lot of headaches when the regularity of my lifestyle is broken. It has a lot to do with sleeping. Even if you sleep too little, of course, you can get a headache. But even if I sleep too much, I get headaches. I slept a little well because I was so tired, but that headache can cause a headache. It happens even if you take a nap or oversleep. Even if you starve and overeat, and people who don't eat late-night snacks sleep after a late-night snack, the probability of headaches the next day increases. Some people are related to the weather, and others are related to temperature changes. Excessive caffeine can also cause headaches. A person who has been drinking coffee all the time can get a headache even if they don't drink coffee on the weekend. Excessive exercise can also cause headaches. Yes, migraines are not caused by a single trigger for each patient. I have several and I think that if they accumulate together, it can cause headaches. Of course, physical factors are also involved. In the brain, there are thresholds such as the jaw and threshold that go to pain. When these triggers accumulate and cross this jaw, the headache begins. This jaw is called the pain threshold. If the jaw, which causes the brain to pass through the pain, is lowered, migraines can easily occur even with weak stimuli. When the jaw threshold increases in the brain, it becomes difficult to pass over to migraines even with any stimulus, so migraines do not occur well. If frequent headaches are left unattended, brain thresholds gradually decrease. This means that the brain is gradually turning into a sensitive brain. Even a weak trigger changes to a state that easily develops into a headache. This condition is called chronic migraine. Clinically, patients say that it got better when they woke up early, and that they heard it well with just one dose, but it gets worse even when they wake up, and they take more painkillers, and if the frequency of the gradual headache increases, depression and anxiety are accompanied, and it turns into an incurable headache that is increasingly difficult to treat.

<A exacerbating factor for chronic migraine>
◆ Moon Hee-soo: What are the factors that make chronic migraines worse? Doctors have a question when patients say that the frequency of headaches is increasing these days. It's a question of whether you've gained weight recently. When you gain weight, the frequency of headaches tends to increase together. There are also rumors that headaches cause headaches, but when you can't catch them effectively, you tend to get the next headache more easily. Also, taking too many painkillers will increase your headache. Headaches also increase when you have sleep disorders such as snoring or insomnia, or emotional problems such as depression and anxiety. Even if you are traumatized or have a chronic pain disease, your headache will worsen. When you consume too much caffeine, your headache increases.

<Drugs and Macalgia>
◆ Moon Hee-soo: I'd like to talk about painkillers here. I'm sure many of you have taken painkillers whenever you have a headache. However, not many people know that headaches can get worse because of headache pills. From the patient's point of view, 'I took painkillers because I had a headache, but this headache medicine can make my headache worse? ‘ You might think like this. These headaches are called medications and headaches. There are a lot of drugs that constrict blood vessels a little. Migraine is a headache caused by the slight expansion of blood vessels as the inflammation occurs in the brain, so if the headache medicine has the effect of constricting blood vessels, the effect is better. But what happens if you take a lot of these drugs? Blood vessels in the brain contract because of more medicine. But this medicine loses its effectiveness in about six to ten hours. When the drug's effectiveness is lost, the blood vessels stretch back into place, and the patient perceives it as a headache again. Then I take medicine again. It hurts again when the medicine doesn't work. Then take the medicine again. This becomes a vicious cycle. Treatment becomes increasingly difficult as you have to take the medicine again after taking it because of a headache and the effectiveness of the medicine is over, and it becomes difficult to live without this painkiller. So, how much of a headache pill can cause these headaches and overuse headaches? It depends on the medicine. You should think that all medicines can occur if you take a lot of them. Simple painkillers such as acetaminophen, aspirin, and nonsteroidal anti-inflammatory drugs can occur if you take them for more than 15 days a month, caffeinated compounds, migraine drugs such as tryptan and Elgothamine, and narcotic painkillers can occur when exposed for more than 10 days a month. What can I do to get better if I get a drug and a headache? Once you stop overdosing, you can get better. But it usually takes about two weeks to quit taking the medicine and get a better headache. As the drug that was overdosed becomes less effective, you can feel that the patient is getting better little by little. However, if you stop taking drugs and take full-fledged migraine prevention treatment together, your headache can get better faster. What's more important than treating it is not to make the drugs and the pain. Therefore, acute painkillers. Such painkillers that you can take when you have a headache should be limited to no more than eight times a month. Every time a patient takes a headache pill, he or she should write a record in his or her headache diary or calendar and count how many times a month he or she took it.

<∀>
◆ Moon Hee-soo: Next, let's look at treating migraines. The first step in treatment is to know immediately about my headache. And a headache diary helps. We educate you to systematically write down your headache diary. When you have a headache, write down the date first and write down the pattern of how the headache hurt. If you write down when you took the medicine, when it worked well, whether it was your menstrual cycle, or what kind of life you had since the day before you had a headache, you could find triggers, headaches, patterns of headaches, and reactions to the medicine can be accurately known whether you actually have a migraine or a nervous headache, which helps doctors diagnose and find the right treatment for you. The second is to change your lifestyle. "What kind of life should I do?" Patients are asking. The most important point is to live a regular life. Eat regularly, don't overeat, and sleep regularly. I regularly exercise the right amount, reduce caffeine and alcohol, and try to avoid the triggers I find because I have less. The third step is to seek acute treatment to eliminate the pain when you have a headache. There are medicinal ingredients that we take when we have a headache. The goal of the medicine is to control headaches so that they don't interfere with their daily lives within two hours of taking the medicine. It is important to find an acute drug that suits you. Headache experts recommend controlling migraine attacks with specialized medicines that stop migraine attacks, not just painkillers. This migraine drug is a little different from painkillers. You can understand that it is a medicine that stops at the stage of migraine and passes it to the recovery period. Therefore, the timing of taking it is very important. It's right to take it right away without holding it in when the headache starts. This medicine can also cause drugs and headaches, so be careful not to exceed 10 days as much as 8 days a month.

<Prevention of migraine>
◆ Moon Hee-soo : Nevertheless, if the frequency of headaches is too high, preventive treatment is needed to reduce the frequency of headaches. You shouldn't think of preventive treatment as a treatment that doesn't hurt when you have a headache. I have a headache 20 days a month, and you can think of it as a treatment to reduce this 20 days to less than 8 days when we allow acute drugs. Migraine prevention treatment is summarized in three main categories. The first is a classic oral drug, the second is a botulinum toxin injection, and the third is a targeted treatment for CGRP neurotransmitters. Fixed oral drugs are not originally developed as migraines. It is a drug that has been used for other purposes for a long time and has been found to be effective in preventing migraines, so it is used as a treatment for migraine prevention. That's what epilepsy treatments like beta blockers, calcium channel blockers, topiramate, and valproic acid are. All of them can prevent migraines because they have the effect of chemically stabilizing brain nerves and cerebrovascular to some extent, but since they are not migraine-specific drugs, other side effects such as dizziness and low blood pressure can also occur. The second is a botulinum toxin injection. A lot of people know it's a Botox injection. However, it is known that this injection has the effect of reducing the frequency of migraines by stabilizing the tertiary nerves and blood vessels if it is injected around the tertiary nerves that cause migraines, so it is used as a treatment for migraine prevention. The area where you get it will be injected to the brow, forehead, temporal muscles, occipital region, and shoulders. There are many advantages because there are few side effects and local effects can be expected rather than systemic effects. And once you get an injection, the effect lasts about 3 months is also a big advantage. It can be a very good option if you use oral drugs and it is not effective enough, if you have a lot of medical problems or diseases, or if you have a lot of drugs to take. The last treatment I'm going to introduce is a very sensational treatment these days. It is a treatment that targets CGRP, a key substance that causes migraines. I explained that CGRP secreted from the tertiary nerve is responsible for switching on the pain circuit in the brain, but if you block this CGRP, you can prevent it from connecting to migraines a lot. Even if it happens, you can see the effect of passing very lightly. However, because it is still a new drug, it is expensive and not all patients listen well to targeted treatment, so it is important to find a treatment method that suits you with a doctor.

<Medical AI Q&A>
◆ Moon Hee-soo: Viewers have sent me a lot of questions regarding headaches. Let me check with you.

◇ Y-ON (AI Anchor): I usually have migraines often, but I'm worried that I'll have cerebrovascular disease in the future. Will it be okay?

◆ Moon Hee-soo: Recently, such studies have been reported that migraines slightly increase the risk of cerebral infarction or vascular dementia. Studies have shown that chronic and repetitive headaches make brain and cerebrovascular structures vulnerable and eventually lead to degeneration, but there is no need to worry about cerebral infarction and dementia just because the risk is not so great numerically. However, with these studies, the importance of migraine management is increasingly highlighted. In particular, if you have migraines with visual signs and smoke or take oral contraceptives, the risk increases a lot. Therefore, patients with chronic migraines who need attention and have frequent headaches need to be controlled with drugs.

◇ Y-GO (AI Anchor): It says exercise helps prevent headaches, what exercises and how should I do it?

◆ Moon Hee-soo: Exercise increases your physical strength and helps with headaches. I think it has a preventive effect, but high-intensity exercise can cause headaches. In particular, exercise that increases abdominal pressure or requires holding your breath for a long time causes more. Exercise, especially such as swimming, and high-intensity weights can cause headaches. So, if you're looking for exercise for a headache, it's recommended that you do low-intensity aerobic exercise regularly for 40 to 50 minutes a day, four times a week.

◇ Y-ON (AI Anchor): Caffeine seems to improve when you have a headache, why do I tell my headache patients not to drink coffee?

◆ Moon Hee-soo: When you have a headache, you can feel a little better if you drink coffee. Caffeine is also used as a headache medicine. People who consume too much caffeine are similar to patients who take a lot of headache pills. If you drink a lot of caffeine, it can cause headaches, and when you don't eat it, it can cause headaches. Also, for those who drink a lot of caffeine, we may reduce the effectiveness of migraine treatments. Therefore, it is correct for migraine patients to control caffeine.

<Let's just remember this>
◆ Moon Hee-soo: Headaches can be controlled as much as you know. I would like to tell you that it is important to find a way to find and control my headache rather than to endure it unconditionally. I hope my story today helped you maintain a happy and healthy life. Thank you.