Migraine is seen by many as a common minor ailment that can be treated with a little painkillers. Little do they know, it is not uncommon for gastrointestinal injuries and drug addiction to occur due to taking medication indiscriminately. Some patients even fall into a vicious cycle of 'the more they eat, the more painful it becomes'. Interview with Professor Gong Li, Deputy Director of the Neurology Department and Head of the Headache Center at Shanghai Jiao Tong University School of Medicine Affiliated Tongren Hospital, asking him to discuss common treatment misconceptions for migraines and provide a practical "self-help guide". Migraine is not just a "headache". Many people simply attribute migraine to "not getting enough rest", ignoring its attribute as a disabling neurological disease. In 2020, the World Health Organization listed migraine as the leading cause of disability among people aged 15 to 49 worldwide. Professor Gong Li told reporters that migraine does not mean "one side of the head hurts", it is actually a complex neurovascular event that can be divided into the following stages. Before a headache strikes, patients may experience a prodromal phase, characterized by frequent yawning, emotional fluctuations, neck stiffness, or cravings for specific foods. Some patients may also experience visual distortions during the premonitory phase, such as seeing flashes, blind spots, or feeling numbness in the face and fingers. When headache strikes, moderate to severe pulsatile pain often intensifies due to daily activities, accompanied by nausea, vomiting, and extreme sensitivity to light, sound, and odor. Some patients can only curl up in dark, quiet rooms. Even if the pain is relieved, the "hangover feeling" during the recovery period - extreme fatigue, slow thinking, and low mood - may still last for one or two days, and in severe cases, it is difficult to immediately return to normal life. Painkillers trigger a vicious cycle. Ms. Lin has a 15 year history of migraine. At first, a painkiller could help her recover as usual. But as work pressure increased, the frequency of her headaches gradually increased from 2 days per month to 10 days. In order to maintain her state, she began taking preventive medication every day and even carried caffeine containing painkillers with her. Not long ago, she was diagnosed with chronic migraine combined with medication overuse migraine. The head MRI suggests that she is at risk of cerebral ischemia. Ms. Lin's situation is not an exception. A meta-analysis in the European Journal of Neurology in 2023 pointed out that long-term and frequent use of nonsteroidal anti-inflammatory drugs and triptans may not only increase the risk of gastrointestinal bleeding and cardiovascular events, but also "transform" paroxysmal migraine into chronic migraine, forming a vicious cycle of "eating more and more painful, eating more and more painful". Professor Gong Li reminds migraine patients to be alert to compound painkillers containing caffeine, phenobarbital, and opioids, such as acaphenolics powder (commonly known as "headache powder" or "headache powder"). Some patients have been urgently sent to the hospital due to long-term abuse of "headache powder" causing multiple ulcers in the stomach. Compound aspirin, phenol coffee tablets, brain clearing tablets, etc. also belong to this type of compound preparation. A certain overseas Taobao "internet celebrity" painkillers contain ibuprofen, anhydrous caffeine, and valproide, which may cause serious side effects such as thrombocytopenia and purpura. It has been phased out by many countries and has not been approved for use in China. Although caffeine can enhance the analgesic effect in the short term, it can form tolerance and dependence. A study has shown that compound painkillers containing caffeine are nearly twice as likely to cause medication overuse headaches as single component drugs. Migraine patients must use medication under the guidance of a doctor to avoid falling into the trap of drug dependence. Many patients do not realize that internet famous quick acting painkillers are the biggest cause until they develop daily headaches, gastrointestinal injuries, or drug addiction. ”Professor Gong Li said. In recent years, with the launch of multiple monoclonal antibodies targeting CGRP (commonly known as injection therapy) and small molecule antagonists (such as zepam drugs), migraine treatment has entered the era of precision targeting. However, any treatment method needs to be based on standardized diagnosis. "Many patients have taken painkillers for more than ten years, but have never received carotid ultrasound and cerebrovascular imaging examinations." Professor Gong Li called, "Migraine should be diagnosed before treatment; prevention should be emphasized, and acute should be controlled. Although it can not be cured, it can be completely controlled." A guide to self-help for migraine patients Fast rhythm, high pressure, irregular sleep and other modern lifestyles are becoming an important driver of migraine incidence rate rising year by year. Medication cannot solve all problems, migraine sufferers need to learn "self rescue" in their daily lives. 1、 Find food triggers and avoid fasting. The key to dietary adjustment is to find and avoid foods that trigger migraines, while maintaining stable blood sugar levels. Common food triggers include alcohol (especially red wine), caffeine (which can be triggered by excessive or withdrawal), chocolate, cheese containing casein, processed meats containing nitrite (such as sausages and cured meats), and monosodium glutamate. 2、 A regular lifestyle is the best 'preventive vaccine'. Migraine sufferers' brains prefer a regular and stable environment, and any drastic fluctuations may trigger discomfort. Irregular sleep patterns are one of the core causes. Try to set a fixed time for falling asleep and waking up, even on weekends. Weekend revenge sleep or staying up late can easily trigger "weekend migraine". 3、 Learn to communicate with the body. In the early stages of migraine attacks, hot compress can be applied to the stiff back of the neck to relax the muscles. When pulsating throbbing pain occurs, applying cold compress to the forehead can help constrict blood vessels and reduce pain. Among female patients, menstrual migraines associated with fluctuations in estrogen levels are very common. Hormone levels can be stabilized through medication under the guidance of a doctor. 4、 Remember the 'Headache Diary'. It can record the date of each episode, prodromal symptoms, possible triggers, duration, and medication use. This not only helps with self-management, but also provides important basis for doctors to adjust treatment plans. Professor Gong Li pointed out that the management of migraine is essentially a long-term coexistence with neurological problems. The above non pharmacological methods cannot replace standardized medical care, but can form a combination of targeted drugs and acute phase treatment. (New Society)