Patient needs, drug intake patterns, and adherence to therapy are significant challenges in the management of migraine patients.Objective: to identify drug treatment needs, drug use patterns and adherence factors in migraine patients.Patients and methods. An online survey was conducted among Internet users through social networks (Instagram, Facebook, Vkontakte) from 01/22/2020 to 02/22/2020. The selection of respondents was based on an anamnesis of headaches and passing the ID Migraine screener. One thousand five hundred ninety-eight individuals (93.8% women and 6.2% men) aged 18—39years participated in the survey.Results and discussion. Among 1598 participants, 1490 experienced any headache, 937 respondents noted migraine symptoms, and 542 (58.4%) had a migraine diagnosis. 899 (96%) of responders used medications to relieve headaches, and in 59% of them drugs were self-prescribed. 125 (13%) patients received prophylactic therapy for migraine, of which only 47 (37.6%) complied with the prescribed treatment. We found a significant (p=0.019) association between the degree of adherence to therapy and the number of days with migraine.Conclusion. The study revealed a low referral rate in patients with headaches. In addition, more than half self-prescribed the drug for headache relief, and only a third of patients complied with the prescribed prophylactic treatment.

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Migraine is the first most frequent cause of disability among women of reproductive age globally, and up to 60% of patients note the association of headache attacks with menstruation.Objective: to determine the features of menstrual cycle and gynecologic pathology in women with menstrual-related migraine (MRM).Patients and methods. A prospective comparative study included 69 women of reproductive age with a migraine diagnosis who did not receive hormonal contraception. Depending on the association of migraine attacks with menstruation (according to headache diaries), the patients were divided into two groups: the 1st group consisted of 44 patients with MRM; group 2 — 25 patients with non-menstrual migraine (without the association of attacks with menstruation).Results and discussion. Patients with MRM had heavier menstrual bleeding, longer menstruations (more than six days), abnormal menstrual cycle length and regularity, dysmenorrhea. In addition, the obtained data indicate a comorbid estrogen-associated gynecological pathology (endometriosis, adenomyosis, endometrial polyps, myoma) in MRM.Conclusion. Presumably, the hypothalamic-pituitary-ovarian axis dysfunction plays the leading role in the MRM. It presents with menstrual cycle abnormalities and increased presence of estrogen-associated gynecological pathology, which should be considered during patient evaluation and suggesting recommendations.

About 60% of women report menstrual-associated migraine attacks, characterized by a higher intensity and duration and more pronounced treatment resistance. Often, preventive treatment with drugs aimed to relieve menstrual attacks – non-steroidal anti-inflammatory drugs and triptans – is difficult in these patients due to a high risk of medication-overuse headache. In addition, due to a hormonal trigger – a perimenstrual decrease in estrogen – the effect of hormonal contraceptives on migraine attacks has been studied for a long time. This article discusses the results of studies indicating the successful administration of specific hormone therapy regimens, especially in patients with concomitant gynecological pathology or in patients using these drugs for contraception.

The main burden of headache in the world falls on primary cephalalgia (tension headache, migraine). However, there is often a need to rule out a secondary cause of the headache. This review presents the main options for the differential diagnosis of cephalgias, taking into account the patient’s age, headache characteristics, and anamnestic information. The role of non-steroidal anti-inflammatory drugs in headache treatment, the safety of its long-term use and prevention of medication overuse headache are discussed.