Drug prophylaxis is indicated for severe or frequent (3 times a month or more) migraine attacks, in which the means for stopping attacks are ineffective.
Propranolol, nadolol, metoprolol and atenolol have been shown to be effective, but are contraindicated in bronchial asthma, COPD, insulin dependent diabetes, AV block, heart failure and peripheral arterial disease and are undesirable during pregnancy. Nadolol and atenolol are excreted by the kidneys; they have fewer CNS side effects than propranolol.
Only one drug from this group, which is selected empirically, can be effective. The drug is canceled gradually; otherwise, an increase in headache and an increase in adrenergic activity is possible. Beta-blockers are always prescribed at a minimum dose, which is gradually increased until the onset of effect.
Calcium antagonists do not begin to act immediately (sometimes after several months) and, in addition, have many side effects. Flunarizine and verapamil are commonly used. They are contraindicated in arterial hypotension, heart failure, cardiac arrhythmias and pregnancy. They are used with caution in Parkinson's disease and in combination with beta-blockers. Flunarizine is not recommended for depression and extrapyramidal disorders.
Pizotifen blocks serotonin receptors and has a mild non-blocking and M-anticholinergic effect. It may prevent migraine attacks, but causes weight gain and drowsiness.
Methysergide (ergot alkaloid) is used to prevent severe migraine attacks when other drugs have failed. It is contraindicated in arterial hypertension, diseases of the heart, lungs, liver, kidneys, collagenosis, thrombophlebitis, peptic ulcer and pregnancy.
The drug often causes side effects: nausea, muscle spasms, myalgia, intermittent claudication, weight gain and hallucinations. Due to the risk of retroperitoneal fibrosis, methysergide should not be taken for more than 6 consecutive months.
You can resume taking the drug only after a break of 1-2 months. Cancel the drug gradually.
Amitriptyline - effective remedy migraine prevention; in this case, its action is not associated with antidepressant activity. It is especially indicated in the combination of migraine with psychogenic headache. The initial dose is 10 mg at night by mouth. The dose is increased by 10 mg weekly to a maximum of 50 mg/day. Occasionally, the drug is prescribed in higher doses.
Nortriptyline and desipramine (at about the same doses) have less hypnotic and M-anticholinergic effects. Tricyclic antidepressants are contraindicated in diseases of the heart, kidneys, liver, prostate and thyroid glands, glaucoma, arterial hypotension, epilepsy, and also taking MAO inhibitors. In connection with the M-anticholinergic action of the elderly, these drugs are prescribed with caution.
The effectiveness of these drugs for the prevention of migraine has not been proven.
Valproic acid, sodium valproate, and sodium divalprex are effective migraine prophylaxis agents. They interfere with blood clotting, so if the patient is taking aspirin or warfarin, they should be used with caution. In addition, aspirin displaces valproic acid from its association with plasma proteins, thereby increasing the risk of its toxicity.
Side effects of valproic acid: nausea, alopecia, tremor, weight gain. It has a hepatotoxic effect, especially in children. It is contraindicated for pregnant women and women planning a pregnancy, as it causes neural tube defects in the fetus. Women of childbearing age taking valproic acid should use reliable methods of contraception.
Naproxen is an effective means of preventing menstrual migraine attacks. However, due to side effects on the gastrointestinal tract, NSAIDs cannot be used for a long time.
Means for the prevention of migraine, ineffective when taken with analgesics, may begin to act after the latter is discontinued. Some drugs (mainly calcium antagonists) begin to act only after 1-2 months. With the exception of the most severe forms of migraine, prevention is carried out with only one drug. If even a combination of drugs from different groups does not help (for example, propranolol with amitriptyline), a consultation with a neurologist is indicated. Analgesics, including over-the-counter medications, should be limited because they reduce the effectiveness of migraine prophylaxis agents. When prescribing treatment, it is always necessary to take into account the cost of the drug.
Prof. D. Nobel
Migraine - neurological disease, which most often manifests itself in severe headaches that are not caused by other causes. It deprives people of all the joys of life and exposes them to suffering and depression. But, adhering to simple rules, anyone can easily reduce the number of migraine attacks. To do this, you just need to carefully monitor your body to find out what and when provokes new attacks.
Some doctors find it helpful to prevent migraines from keeping a diary of what you ate during the day, what you drank, what the weather was like, how your body reacted to weather changes, whether you took any medications the day before and after the first migraine attack. him. As for women, they must write down on what day menstrual cycle severe headaches began. Such important details allow you to quickly determine what caused migraine attacks.
Sometimes migraine attacks can come out of nowhere. But in most cases, migraines are provoked by certain food ingredients, fatigue, strong external stimuli (for example, noise, bright lights). In this regard, anyone who is prone to migraines (rare or persistent) is advised to follow the tips below.
Migraines contribute to dark chocolate and food supplement monosodium glutamate. Headaches do not cause white chocolate, so if you have a weakness for sweets, you can safely eat it without worrying about your health.
Chinese dishes should be avoided because they contain a lot of additives and preservatives. Also avoid eating dry soups, instant vermicelli, seasoning cubes and other non-natural types of seasonings, instant mashed potatoes, low-quality sausages, and much more containing non-natural additives. Migraines can be provoked by citrus fruits, shellfish, cheeses (in particular, feta cheese, parmesan and mozzarella) and processed cheese. Dutch cheeses and cottage cheese do not usually cause health problems.
As a prophylaxis for migraine, it is recommended, first of all, to take magnesium in an amount of up to 500 mg per day. Some doctors believe that in order to prevent migraines, 50 mg of niacin in the form of vitamin PP or nicotinic acid should enter the body twice a day. Niacin is found in animal products (beef liver, fish, eggs, milk, meat). There is also it in plants - potatoes, tomatoes, cornmeal, etc. Brewer's yeast or chamomile tea will also help you get it quickly.
Migraine attacks usually occur after drinking red wine, sherry and port wine. Phenolic compounds found in alcoholic beverages often cause headaches.
Avoid noisy discos, listen to music more through headphones. Shopping is best done in the morning when shopping malls or the market is not so noisy. During the rest, carefully close the windows so that the light and street lights do not irritate.
In modern medicine, there are many drugs that will help get rid of pain, as well as migraine attacks. But such means for the prevention and relief of migraine should be prescribed by a specialist, since many of them can cause harm, incl. become the cause. A visit to a doctor (usually a neurologist) will make it possible to find out which medicines can be purchased at a pharmacy without a prescription, how and in what quantity they can be taken when an attack strikes again. If the drugs used are too weak, you can ask the doctor to write a prescription for stronger ones.
It is necessary to take into account the fact that migraines are provoked by strong sun, wind, cold sea, high pressure in the mountains, mountain wind and humid tropics. Therefore, in the prevention of migraine manifestations, one should try to avoid those natural phenomena, which, according to the observation of the person himself, act negatively on him.
It is important to remember that hunger can trigger a migraine attack. Also overeating. Migraines are also promoted by acute weight loss diets and attempts.
Doctors recommend being proactive and trying to relax. To do this, eat or have a snack, drink sweet tea, coffee, brew a decoction of medical primrose or chamomile. If possible, lie down in a dark, quiet room, dim the lights, and rest.
For some people, relaxing head and neck massages and rubbing essential oils, such as rosemary, can help relieve migraine headaches. Essential oils help relieve daytime stress, relax and avoid the need for medication.
You should try to relax as soon as possible, in case of an emotional overstrain. Very useful are sports, light physical activity, walking on fresh air. For anyone suffering from migraines, yoga and meditation are recommended. It is also useful for people prone to migraines to observe the daily routine. Full is always much better than lounging in bed and not resting.
Sharp and strong odors can not only irritate the olfactory organs, but also cause migraines. Therefore, in order to avoid migraines, it is better to avoid the smells of harsh perfumes, especially those based on musk. You should not completely abandon cosmetics, you should just choose fragrances with delicate floral notes. In the house, especially in the kitchen and in the bathroom, it is recommended to install modern hoods and ventilation units that purify the air. Do not use incense or scented candles.
Migraine is the strongest headache which is very difficult to get rid of. This disease is hereditary, so it cannot be prevented. However, there are certain migraine prevention measures that can help the patient to normalize the condition and control attacks.
For occasional seizures migraine, the best thing to do is start regular preventive measures. The goals of migraine prevention and treatment are:
So, let's start with simple preventive actions that are suitable for combating migraines:
You should be careful about taking medications. Particular attention should be paid to the choice of drugs for migraine prevention in children. Many medicines that help adults are contraindicated in babies, and can increase the pain attack.
To help relieve pain can cold lotions on the temples and acupressure. Use all of these remedies and they will help you cope with painful and prolonged migraine attacks.
Migraine is neurological disease, which is characterized by the development of a strong, pressing headache of various localization. Migraine pills are used to solve the following therapeutic problems:
Patients should be aware that any migraine medication has an extensive list of contraindications and possible side effects. Before you start taking any drug, be sure to consult your doctor and read the instructions for the drug.
| Pharmacological group | Name of the drug | Characteristic |
|---|---|---|
| Non-steroidal anti-inflammatory drugs, non-narcotic analgesics | Preparations, which include such active ingredients: ibuprofen, ketoprofen, nimesulide, diclofenac, acetylsalicylic acid. | Used for migraine and mild to moderate intensity. Disadvantages: ineffective for severe pain, with prolonged use there is a risk of developing disorders of the gastrointestinal tract. |
| Medicines with a combined composition | Nomigren, Citramon, Solpadein, Sedalgin. | Vasoconstrictor drugs that have a calming and analgesic effect are dispensed without a doctor's prescription. Among the shortcomings, one can single out the risk of developing chronic headaches with regular, uncontrolled use. |
| Antiemetic drugs - prokinetics | Metoclopramide, Cerucal, Domperidone, Motilium, Motilac. | Eliminate nausea and vomiting, increase the absorption of anti-migraine drugs. |
| Triptans | Sumatriptan, Eletriptan, Sumamigren, Rapimed, Zomig. | Vasoconstriction, prevention of the development of aseptic inflammation, elimination of pain. They are the drug of choice for moderate to severe pain. Modern triptans are well tolerated and are used when sumatriptan is ineffective. |
| Narcotic pain relievers | Medicines based on codeine and butorphanol. | They are second-line drugs after triptans. |
| Corticosteroids | Dexamethasone | It is used in the case of the development of migraine status and as a rescue therapy in the event of an intense attack. |
You must always remember:
Patients develop headaches different intensity and most of them are able to recognize the severity of the attack in advance. Doctors can prescribe several drugs at once, having previously given recommendations on which drugs should be used in a particular case.
In case if the duration of the attacks does not exceed 2 days and the patient is concerned about mild to moderate headache, the doctor may prescribe simple analgesics and drugs from the NSAID group, as well as combined drugs that include caffeine.
Patients should be aware that when PSAIDs and analgesics, as well as combination drugs, are ineffective, agents containing ergotamine or triptans may be prescribed.
You should carefully listen to the body's reaction to a particular drug, learn to independently assess the severity of an attack, evaluate the results of the therapy.
In the case of the development of intense headache, migraine tablets from the triptan group are used. These drugs are the gold standard of care.
In some cases, narcotic analgesics may be required to eliminate severe pain. Data medicines used in exceptionally severe cases when the means of other groups are not able to have the desired effect, have become addictive, etc.
It is very important to choose the right medicine for an emergency, as this will eliminate the patient's fear of another attack. Intense headache is often accompanied by the development of nausea and vomiting. In this case should take an antiemetic tablet half an hour before using the pain reliever.
A severe and persistent attack is stopped with the use of corticosteroids. If opioid analgesics and triptans do not work as expected, the doctor may change the treatment regimen and additionally use anticonvulsants, as well as beta-blockers.
According to reviews, migraine remedies from the triptan group have the most pronounced therapeutic effect. The drug begins to act a few hours after taking the pill. When using sumatriptan, 50 mg (1 tablet) of the drug is sufficient, take zolmitriptan at a dose of 2.5 mg, eletriptan - 160 mg once. The drug should be washed down with plenty of plain water.
The mechanism of action includes the provision of such positive effects:
Migraine tablets from the triptan group are used to treat migraine with and without aura. These medicines cannot be used more than 2 times in 7 days.
Contraindications for admission are: the development of coronary heart disease and other serious functional disorders of cardio-vascular system and an increase in blood pressure. Combination with antibacterial agents, antiviral and antifungal drugs is not recommended.
Against the background of the use of funds of this group, there is a possibility of developing such adverse effects:
In most cases, drugs of this group are well tolerated, possible side effects are short-term and transient. In order to prevent the development of adverse reactions, you should not exceed the recommended dose and use the remedy without a doctor's prescription.
Migraine remedies are recommended to be used even before an attack has begun. Conditions that usually develop just before a migraine include mood changes, dizziness, increased appetite or extreme thirst, and drowsiness.
Approximate treatment regimen:
If the patient is concerned about migraine with aura, then you can take a Papazol tablet in the first few minutes of the attack.
If the attack is provoked by stress, then you can take a tablet of Amitriptyline at night.
For prevention, the following drugs can be used:
Patients of older age groups may be recommended to take nootropic drugs (Piracetam, Nootropil, Phezam).
Published in the magazine:To achieve the best effect, these drugs are recommended to be combined with non-drug methods of therapy.
G.R. Tabeeva, Yu.E. Azimova
First MPMU them. I.M. Sechenov
Migraine is a chronic disease characterized by recurrent attacks of unilateral throbbing headache (GB) accompanied by autonomic and emotional disturbances. Despite the paroxysmal course of the disease and a relatively favorable prognosis, migraine significantly impairs the quality of life of patients. The reasons for the significant maladaptation of patients suffering from migraine are the high intensity of pain and its accompanying symptoms, high frequency and duration of migraine attacks, symptoms preceding migraine (prodromal period) and a sharp decrease in performance over the next few days.
Migraine is a disease that accompanies a person for most of his life, and the peak incidence occurs at the most able-bodied age. On average, each migraine patient loses 3.2 working days per year. Some patients who are forced to continue working at the time of an attack of GB are characterized by a decrease in labor activity by more than 46%.
Migraine treatment has two directions:
1. Relief of a directly developed migraine attack.
2. Prevention of the development of migraine attacks.
The role of prophylactic treatment of migraine is currently underestimated. The traditional view of migraine practitioners as a prognostically favorable form of AH needs to be revised, as it becomes clear that frequent migraine significantly affects the daily activity and quality of life of patients. The role of preventive therapy should be not only to reduce the frequency, intensity and duration of migraine attacks, improve the response to attack relief and reduce patient maladjustment, but also to prevent the progression of the disease, primarily the development of chronic migraine. Prevention is considered justified with frequent migraine attacks (more than 2 times a month) or with severe attacks or other indications. The main indications for preventive therapy are:
1) frequent (2 or more per month) seizures over the past 6 months, a sharp deterioration in health, disability;
2) low efficiency or the presence of contraindications to the use of drugs that stop the attack;
3) the use of drugs used to stop a migraine attack more than 2 times a week;
4) special situations (migraine attacks with a persistent neurological defect, a history of migraine stroke, migraine-trigger of an epileptic attack);
5) the desire of the patient to reduce the frequency of seizures. It is well known that it is almost impossible to cure a migraine patient. The main goal of preventive therapy is to reduce the frequency of headache attacks, which significantly affect the daily activities of patients.
For the prevention of migraine, it is recommended to use the following drugs: β-blockers (atenolol, metoprolol, propranolol), anticonvulsants (topiramate, valproic acid), antidepressants (amitriptyline), calcium channel blockers (flunarizine). These drugs have been proven effective in a number of large clinical trials and are recommended for use by leading HD experts. However, there are 10-20% of patients for whom the traditional preventive treatment of migraine is ineffective. Reasons for the ineffectiveness of traditional preventive therapy:
1) low patient compliance;
2) inadequate dose of the drug or duration of therapy (less than 6-8 weeks);
3) incorrect initial diagnosis of migraine;
4) excessive use of funds to stop the attack.
Another important aspect in assessing the effectiveness of preventive treatment of migraine is the realistic expectations of patients. It is necessary to discuss with the patient that treatment is considered effective, which allows to reduce the number of days with HD per month by at least half, while the remaining attacks will be milder.
However, even if all the rules for the use of funds for the prevention of migraine are observed, not all patients can achieve an effect. AT recent times the concept of refractory migraine appeared, i.e. migraine resistant to traditional drug therapy. The development of refractory migraine seems to be based on genetically determined features of the pharmacodynamics of drugs for the prevention of migraine. Therefore, in the arsenal of the practitioner should be means with an excellent mechanism of action. Among the requirements for drugs for preventive treatment, the spectrum of side effects, such as sedation or weight gain, is extremely important, therefore, when choosing a preventive therapy, its safety should always be taken into account.
One of the drugs widely used in the Russian Federation by practicing neurologists for the prevention of migraine is Vasobral, which is a combination of α-dihydroergocriptine and caffeine. This is largely due to the extensive experience of its use, including for the treatment of GB. Although the effectiveness of the vast majority of vasoactive and metabolic drugs in relation to the prevention of migraine is very limited, nevertheless, Vasobral represents an exception in this series. The mechanism of anti-migraine action of Vasobral is associated with the active ingredient α-dihydroergocriptine. α-dihydroergocriptine causes desensitization of central dopaminergic, serotonergic and noradrenergic receptors, therefore, it has a central analgesic effect. The nootropic and vasoactive effect of Vasobral does not affect the frequency of migraine attacks, however, due to these effects, the drug can significantly improve the condition of patients with a combination of migraine and chronic cerebral ischemia or asthenia. The effectiveness of α-dihydroergocriptine in the prevention of migraine has been proven in several controlled studies. It has been shown that α-dihydroergocryptine is significantly more effective than propranolol, dihydroergotamine, flunarizine. According to the conducted controlled studies, the effectiveness of α-dihydroergocriptine (the percentage of patients with a decrease in the frequency of migraine attacks per month by 50% or more) is 51-66%. The aim of this study was to summarize the clinical experience of using Vasobral by doctors in different cities of the Russian Federation.
Materials and methods
The study involved 5475 patients from 27 cities of the Russian Federation (Moscow, St. Petersburg, Novosibirsk, Kazan, Samara, Voronezh, Chelyabinsk, Nizhny Novgorod, Irkutsk, Krasnodar, Perm, Volgograd, Barnaul, Ufa, Yekaterinburg, Krasnoyarsk, Ryazan, Rostov- on-Don, Magnitogorsk, Kursk, Togliatti, Zelenodolsk, Kurgan, Semiluki, Novoaltaysk, Orekhovo-Zuevo, Zhukovsky). Patients were followed up by 271 physicians from 170 centers. The inclusion criteria were:
A total of 4886 patients out of 5475 met the inclusion criteria and constituted the ITT population (intent-to-treatment - a population of patients interested in treatment). Of the 5475 patients, 589 did not meet the inclusion criteria (migraine diagnosis was not confirmed, attacks were rare), nevertheless they completed the course of Vasobral and entered the drug safety evaluation population. Patients in the ITT population received Vasobral 2 ml twice daily for 2 months. The condition was assessed in the background, after 1 and 2 months of treatment among patients of the ITT population. The main indicator of effectiveness was the percentage of patients with a reduction in the frequency of migraine attacks by 50% or more (proportion of respondents) after 2 months of therapy. Additional indicators of effectiveness were the dynamics of the intensity of the pain syndrome, the duration of attacks of AH, the presence of concomitant symptoms (nausea, vomiting, photophobia and sound), the general condition and performance of the patient, the number of doses of drugs to relieve AH. Patients also evaluated the effectiveness of the therapy. Side effects were noted at visits 2 and 3.
Dosing regimen
Assign 1/2-1 tablet or 2-4 ml of solution 2 times a day. The duration of the course of treatment is 2-3 months; if necessary, it is possible to conduct repeated courses.
The drug should be taken with food, with a small amount of water. The solution should be diluted with a small amount of water before use.
Results and discussion
Average age patients in the ITT population was 40.1±11.9 years; 80% (3904) of the patients were women, 20% (982) were men. 4114 (84.2%) patients had migraine without aura, 772 (15.8%) had migraine with aura. The duration of the disease averaged 9.7±7.3 years. The frequency of migraine attacks was 3.8±2.9 per month, the duration of attacks was 11.5±14 h. 28.2%, weak - 1.6%. Nausea was noted in 79% of patients, photophobia - in 64.4%, sound phobia - in 52.3%. Bed rest was required during an attack in 15.2% of patients, in 56.6% the general condition and performance were significantly impaired, in 25.4% - slightly impaired, in 2.9% there were no disorders general condition and working capacity. For the relief of seizures, patients took an average of 5.8 ± 9.7 doses of drugs per month. Previously, 70.1% of patients already had experience in preventive treatment of migraine with other drugs, while 40.2% were dissatisfied with the treatment, 29.4% were satisfied only to some extent.
A total of 74.5% (3640 people) of patients were responders, 25.5% (1246) were non-responders. The dynamics of the frequency of migraine attacks is shown in fig. one.
Rice. one. Dynamics of the frequency of migraine attacks in the background, after 1 and 2 months of treatment.
From fig. Table 1 shows that a significant regression in the frequency of migraine attacks is observed already after 1 month of taking Vasobral, while a significant decrease continues to be observed after 2 months of taking it. The duration of seizures also significantly decreased from 11.7±8.7 to 10.9±12.8 hours during the 1st month and to 5.3±7.3 hours during the 2nd month of taking Vasobral (p<0,0001). Динамика выраженности болевого синдрома представлена на рис. 2. Из рис. 2. видно, что на фоне приема Вазобрала приступы мигрени протекают значительно легче: доля пациентов с интенсивностью ГБ от легкой до умеренной достоверно (р<0,0001) возрастает по сравнению с фоном. Приступы мигрени на фоне терапии Вазобралом протекают легче также за счет меньшей выраженности сопутствующих симптомов - тошноты, рвоты, свето- и звукобоязни. Доля пациентов с сопутствующими симптомами достоверно (p<0,0001) ниже через 1 мес приема, статистически значимое (p<0,0001) снижение также отмечается через 2 мес приема Вазобрала. Более легкое течение приступов и отсутствие сопутствующих симптомов положительно влияют на общее состояние и работоспособность пациентов, даже если приступ мигрени возник. Так, если в фоне 15,2% пациентов требовался постельный режим во время приступа, у 56,6% общее состояние и работоспособность были значительно нарушены, у 25,4% - нарушены незначительно, у 2,9% не было нарушений общего состояния и работоспособности, то через 1 мес приема Вазобрала лишь 1,8% пациентов во время приступа требовался постельный режим, у 25,1% общее состояние и работоспособность были значительно нарушены, у 54,4% отмечались незначительные нарушения общего состояния и работоспособности, у 18,7% не было нарушений общего состояния и работоспособности (p<0,0001). Через 2 мес приема Вазобрала состояние пациентов во время приступа улучшилось еще в большей степени: никому из пациентов не требовался постельный режим, у 8,9% общее состояние и работоспособность были значительно нарушены, у 51,4% - нарушены незначительно, у 39,7% не было нарушений общего состояния и работоспособности.
Rice. 2. Dynamics of the severity of pain syndrome in the background, after 1 and 2 months of therapy with Vasobral. 
Rice. 3. The proportion of patients with concomitant symptoms in the background, after 1 and 2 months of therapy with Vasobral. 
Patients rated the effectiveness of the drug as high: after 1 month of therapy, 19.1% of patients were very satisfied with the therapy, 48% were quite satisfied, 29.8% were satisfied to some extent, 3.1% were not satisfied at all. After 2 months of therapy with Vasobral, 27.6% of patients were very satisfied with the therapy, 57.5% were quite satisfied, 12.5% were satisfied to some extent, 2.4% were not satisfied at all.
It is important to note that the high efficacy of the drug correlates with younger age of patients (p=0.07), shorter duration of the disease (p=0.09), shorter duration of migraine attacks (p=0.07) and better general condition of the patient during seizure (p=0.07). Vasobral is equally effective in patients with migraine with aura and migraine without aura. The ineffectiveness of the preventive treatment of migraine, carried out earlier, is not a predictor of the low effectiveness of Vasobral. Therefore, Vasobral can be indicated in a wide range of patients with migraine, especially in young patients with a shorter duration of the disease and milder attacks.
Attention should be paid to the safety of Vasobral. Of the 5475 patients taking the drug, adverse events occurred in 189 (3.5%) people. All adverse events were mild, self-limiting, and did not require the appointment of additional medications or discontinuation of the drug. Most often, patients reported adverse effects from the gastrointestinal tract - nausea and other dyspeptic phenomena, abdominalgia.
Thus, an open prospective study that included 4886 patients with migraine from 27 cities of the Russian Federation showed that Vazobral is an effective and safe agent for migraine prevention. In this study, there was a high percentage of patients who were completely satisfied with the results of treatment. The preventive effect of Vasobral was carried out both by reducing the frequency of migraine attacks and by reducing the objective parameters of the duration of attacks, pain intensity (reducing the percentage of patients with intense pain) and associated symptoms. Also, this effect was expressed in an improvement in the condition of patients as a whole: a significant decrease in the level of maladjustment (a decrease in the proportion of patients who were forced to stay in bed during an attack), and an improvement in working capacity. Vasobral can be indicated in a wide range of patients with migraine, especially in young patients with a shorter duration of the disease and more mild attacks.
