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Diagnosis and treatment of migraine: Russian experts' recommendations

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Migraine is one of the most common types of headache, which can lead to a significant decrease in quality of life. Researchers identify migraine with aura, migraine without aura, and chronic migraine that substantially reduces the ability of patients to work and is frequently concurrent with mental disorders and drug-induced headache. The complications of migraine include status migrainosus, persistent aura without infarction, migrainous infarction (stroke), and a migraine aura-induced seizure. The diagnosis of migraine is based on complaints, past medical history, objective examination data, and the diagnostic criteria as laid down in the International Classification of Headache Disorders, 3 rd edition. Add-on trials are recommended only in the presence of red flags, such as the symptoms warning about the secondary nature of headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks and the amount of analgesics taken. It includes three main approaches: behavioral therapy, seizure relief therapy, and preventive therapy. Behavioral therapy focuses on lifestyle modification. Nonsteroidal anti-inflammatory drugs, simple and combined analgesics, triptans, and antiemetic drugs for severe nausea or vomiting are recommended for seizure relief. Preventive therapy which includes antidepressants, anticonvulsants, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide or its receptors, is indicated for frequent or severe migraine attacks and for chronic migraine. Pharmacotherapy is recommended to be combined with non-drug methods that involves cognitive behavioral therapy; progressive muscle relaxation; mindfulness; biofeedback; post-isometric relaxation; acupuncture; therapeutic exercises; greater occipital nerve block; non-invasive high-frequency repetitive transcranial magnetic stimulation; external stimulation of first trigeminal branch; and electrical stimulation of the occipital nerves (neurostimulation).

About the Authors

E. G. Filatova
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991

V. V. Osipova
Z.P. Solovyev Research and Practical Center of Psychoneurology, Moscow Healthcare Department; University Headache Clinic
Russian Federation

Vera Valentinovna Osipova

43, Donskaya St., Moscow 115419
2, Molodogvardeiskaya St., Build. 1, Moscow 121467 

G. R. Tabeeva
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991

V. A. Parfenov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991

E. V. Ekusheva
Academy of Postgraduate Education «Federal Research and Clinical Center for Specialized Medical Care Types and Medical Technologies, Federal Biomedical Agency of Russia»
Russian Federation
91, Volokolamskoe Shosse, Moscow 125371

Yu. E. Azimova
University Headache Clinic
Russian Federation
2, Molodogvardeiskaya St., Build. 1, Moscow 121467

N. V. Latysheva
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991

M. V. Naprienko
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991

K. V. Skorobogatykh
University Headache Clinic
Russian Federation
2, Molodogvardeiskaya St., Build. 1, Moscow 121467

A. V. Sergeev
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991

V. A. Golovacheva
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991

E. R. Lebedeva
Ural State Medical University, Ministry of Health of Russia
Russian Federation
3, Repin St., Yekaterinburg 620028

A. R. Artyomenko
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991

O. V. Kurushina
Volgograd State Medical University, Ministry of Health of Russia
Russian Federation
13, Angarskaya St., Build. 7, Volgograd 400049

M. I. Koreshkina
Scandinavia Clinic
Russian Federation
55A, Liteinyi Prosp., Saint Petersburg 191186

A. V. Amelin
Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation
6-8, Lev Tolstoy St., Saint Petersburg 197022

L. R. Akhmadeeva
Bashkir State Medical University, Ministry of Health of Russia
Russian Federation
3, Lenin St., Ufa 450008

A. R. Rachin
National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia
Russian Federation
32, Novyi Arbat St., Moscow 121099

E. D. Isagulyan
Academician N.N. Burdenko National Medical Research Center of Neurosurgery
Russian Federation
16, 4th Tverskaya-Yamskaya St., Build. 5, Moscow 125047

Al. B. Danilov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991

A. B. Gekht
Z.P. Solovyev Research and Practical Center of Psychoneurology, Moscow Healthcare Department
Russian Federation
43, Donskaya St., Moscow 115419


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For citations:

Filatova E.G., Osipova V.V., Tabeeva G.R., Parfenov V.A., Ekusheva E.V., Azimova Yu.E., Latysheva N.V., Naprienko M.V., Skorobogatykh K.V., Sergeev A.V., Golovacheva V.A., Lebedeva E.R., Artyomenko A.R., Kurushina O.V., Koreshkina M.I., Amelin A.V., Akhmadeeva L.R., Rachin A.R., Isagulyan E.D., Danilov A.B., Gekht A.B. Diagnosis and treatment of migraine: Russian experts' recommendations. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(4):4-14. (In Russ.)

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