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And no more headaches



Do you know that you can get rid of wrinkles and migraines at the same time? Swiss doctors have discovered a method of curing unbearable headaches that torment a certain segment of humanity and are difficult to eliminate with the help of therapy. Dr. Reto Agosti was the first to suggest a unique formula for victory over migraines, in which Botox is used, and this method has been successfully applied at the Headache Center of Hirslanden (Zurich).

– Dr. Agosti, you are known as one of Switzerland’s foremost headache specialists. Using Botox for migraine control is one of the treatment methods applied in your center. How did you come to use this method?

– The fact that botulinum toxin can treat migraines was discovered accidentally. Clients of Dr. William D. Binder from Los Angeles were surprised to find that, after cosmetic sessions aimed at the removal of wrinkles, their headaches and migraines had stopped. The effect was confirmed by scientists. Our experience in this field is based on the results of two pieces of researche that have been conducted in European scientific centers. One of them was even extended from seven to eleven months, since its participants, feeling relieved, asked for its continuation.



– How widespread is migraine now and what are its manifestations?

– In Switzerland, it affects more than one million people. There are two forms of this disease: with the aura and without it. The aura refers to visual
phenomena (an example of how they may look is given in the illustration): for example, with light denticular forms that sparkle in the field of vision of a migraine sufferer for 15-60 minutes before a migraine attack, increase, and move around the field of vision. At the same time, sensitivity and speech disorders may occur. 15-20 percent of the total number of patients are afflicted by migraines with the aura.

Unbearable – in anyone’s opinion – pain lasts from 4 to 72 hours, and in children up to 15 years, from 2 to 48 hours. But despite the fact that the diagnosis is quite simple, doctors often make mistakes and prescribe the wrong treatment.

One of the most common causes of migraine is stress. Others include alcohol, irregular sleep patterns and increased sensitivity of a person to changes in the weather. All these factors must be taken into account. It is preferable for the patient to keep his own calendar of headaches.

Approximately 60 percent of patients have a so-called prodromal period preceding an attack. It is associated with symptoms such as a wolfish appetite, very intensive yawning or mood swings that can last from a few minutes to several hours. At this stage, the disease can be stopped by simple medication and complementary treatment.

– Is it true that women are more prone to migraines?

– We must understand that we are not talking about an unambiguous disease, but about headaches of a certain type. These include, in particular, a very severe headache with such typical concomitant phenomena as increased sensitivity to light and noise, as well as nausea and vomiting. The reasons can be very different. Also, these include fluctuations in female sex hormones.

In the case of men, there is no such correlation.

– How do female sex hormones affect this?

– Before puberty, the incidence of migraines in boys and girls is approximately the same. Only afterwards do the girls begin to get ill often.

Since migraine is a complex disease, it is not possible to reach an unambiguous conclusion about its causes. Most women have attacks simultaneously with their hormonal fluctuations, especially before menstruation. But sometimes, on the contrary, the pain stops during this period. A similar pattern can be observed when patients are taking contraceptives: some have migraines while others, on the contrary, do not. The same applies to pregnancy: 70 percent of expectant mothers suffer from migraines until about the third month. For some of them, it occurs only during pregnancy, as it is often a ‘forbidden time’. For others, the headaches disappear without a trace.

– Do you have specific medical recommendations for the fairer sex?

– First of all, as mentioned above, you should carefully maintain a personal calendar of headaches. This will allow us to determine of the cycles of migraine attacks and, possibly, of the cause. If the sequence is obvious, hormonal or other treatments will be prescribed. The best result is achieved when a headache specialist works together with a gynecologist. In addition, it is recommended that a sufferer start treatment immediately if the attacks are observed at the beginning of the menstrual cycle; otherwise the disease may worsen.

– What are the modern methods of migraine treatment?

– It is necessary to distinguish between treatment during migraine attacks and treatment to prevent these attacks. For many patients, it is enough to simply
stop the pain. The most effective means  is drug treatment. We recommend this treatment if the attacks last for more than three days monthly. The optimal choice requires extensive professional experience and close long-term interaction of a headache specialist with a patient. Non-pharmacological methods, such as lifestyle changes and regular physical activity in the fresh air, are of great importance.

– Triptan is often used against migraine. Beta-inhibitors are also used as a basic therapy to reduce the incidence of attacks. What if these measures are ineffective?

– If the pulse and blood pressure are not lowered, your doctor may increase the dose of beta-inhibitors. As a preventive medication, I would advise drugs containing magnesium, or the anticonvulsive active substance topiramate at a dosage of 50 to 200 mg per day. They can replace the triptan. There are other medications in this class of substances: the first active ingredient, which has been developed for these purposes, is called Sumatriptan, followed by Zolmitriptan, Naratriptan, Eletriptan, Secutrity, Almotriptan and Frovatriptan. They differ from each other in the duration and nature of their effects.

Different forms are provided: tablets, but also capsules, injections and nasal sprays, which give faster effects than tablets. In addition, solutions with the active substance diclofenac can be used – they are recommended for mild migraine attacks with and without the aura.

– People who suffer from migraine often complain of sleep disorder and depression. Could you recommend basic therapy for such patients?

Yes, sure. In the case of sleep disorders, tricyclic antidepressants have been well established for many years. The elimination of the depressed state will be helped by a newly developed antidepressant with the active substance venlafaxine, which is characterized by a stimulating effect. This is the so-called SSRI-selective serotonin renewal inhibitor. You can also take coenzyme Q10, which is a component of antiangiogenic cosmetics. Q10 and coenzymes are found in the human body and are involved in important metabolic processes, which produce more than 95% of all physical energy.

Recently, to improve sleep cannabidiol is increasingly used – one of the cannabinoids contained in hemp – which has a powerful calming effect.

– For migra ine treatment you also use the new medication imovig, developed by Novartis. What can you tell us about it?

– In my opinion, for patients with frequent and severe migraine attacks the active ingredient of this drug, erenumab, is a breakthrough. It is very effective and practically causes no adverse effects.



The headache center conducted two cycles of research, on the basis of which I was able to trace the effectiveness of the medication. One of our patients received the active substance erenumab, and the second a placebo. A striking fact: between 5 to 10 percent of the research participants, after a 36-month course of taking the medication, generally got rid of migraine attacks, despite the fact that this substance does not cure migraine but only affects the process of attack occurrence and blocks it. To ensure the therapeutic effect, imovig should be injected once every 30 days.



Reto Agosti

Doctor of medicine, a specialist in neurology, and the founder and chief physician of the research clinic ‘Hirslanden Headache Center’. In 1988-1991 he worked in the neuropathology and neurology departments of the University hospital of Zurich. From 1991 to 1999 he worked in the United States, in particular at the Hospital of Boston University (Department of neuropsychology and neurorehabilitation) and Massachusetts General Hospital (Department of migraines). In 1999-2002 he was the chief physician and Head of the Department of Headaches at the University Hospital of Zurich. In 2002 he was appointed chief physician of the Headache Center at Hirslanden Clinic.

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