When migraine patients have acute headache, if nonspecific drugs are used, the analgesic effect is not good, which may be because the headache is too severe during the attack. At this point, they can switch to specific drugs, that is, triptans. If taking one triptan drug is ineffective, you can switch to another triptan drug.
Migraine attacks frequently, and the damage to patients' health is mainly reflected in three aspects: first, it affects patients' normal life; Second, recurrent or long-term migraine attacks may lead to some mental diseases, such as anxiety, depression, sleep disorders (such as difficulty falling asleep and waking up early). Thirdly, some patients will have some premonitory symptoms before headache, such as flashing lights, bright lines, bright spots or unclear vision. Migraine with these aura symptoms is called aura migraine. If such patients often have headaches or long-term headaches, it is ischemic stroke, which is often said to be a risk factor for cerebral infarction.
Therefore, migraine patients must be actively treated, and the frequency of headache attacks must be controlled to reduce the secondary damage caused by frequent headaches.
Dong Zhao, Deputy Chief Physician, Department of Neurology, Beijing 30 1 Hospital.
How to use medicine for reflux esophagitis?
Because of gastrointestinal discomfort, I had a gastroscope and was diagnosed as chronic superficial gastritis and reflux esophagitis. How should I take medicine?
Mr. Liu from Henan
Mr. Liu:
When patients with spleen and stomach diseases go to the hospital, doctors are most concerned about two issues: one is the most uncomfortable symptom, and the other is the duration. You didn't mention either of them, so you can only talk in general terms.
For reflux esophagitis with definite diagnosis, rabeprazole and PPI (proton pump inhibitor) are internationally recognized treatments.
Reflux esophagitis can be divided into two types: one is esophagitis formed by strong acid reflux and gastric acid reflux to esophagus; One is acid-free or weakly acidic reflux. Generally, a 24-hour pH monitoring is done, that is, a small electrode is held in the esophagus for one day to monitor where and when the reflux acid is the most. This is the gold standard for detecting gastric acid reflux.
Clinically, drugs often improve and relapse, which will last for about two years. Now we use the decreasing therapy. As we all know, there are three kinds of western medicines for treating reflux esophagitis. The first is a covering agent for neutralizing gastric acid and mucosa; The second category is H2 receptor blockers, that is, Tibetans; The third is the strongest PPI inhibitor, such as rabeprazole and other drugs.
If you take the strongest rabeprazole, etc. It still doesn't help. We suggest lowering the steps to treat it. That is to say, rabeprazole can't be stopped immediately, and the dosage should be gradually reduced. At the same time, traditional Chinese medicine should be added and treated according to syndrome differentiation. For example, for the liver and stomach stagnation type with particularly severe acid regurgitation and heartburn, drugs such as Julian Liu Yi Pill and western medicine should be added to fundamentally and gradually reduce gastric acid. After taking it for a period of time, the patients were treated with H2 receptor blockers combined with various decoctions, and then the western medicine was gradually removed, and then treated with decoction for about a month, and some patients could get rid of western medicine. For acid-free and weakly acidic reflux, there is often no obvious heartburn and acid reflux, but belching and foreign body sensation in the pharynx are the main symptoms. At this time, the three kinds of western medicines have little effect, so we can consider traditional Chinese medicine, and treat it mainly with decoction such as Huagan Decoction for invigorating spleen, soothing liver and regulating qi.
Reflux esophagitis is one of the refractory diseases with high recurrence rate. In addition to taking medicine, we should also pay attention not to overeat and eat chocolate and strong tea in our daily diet.
Li Bo, deputy chief physician of Beijing Hospital of Traditional Chinese Medicine.
How to do long-term insomnia and nightmares?
I am 65 years old. Insomnia for more than 3 years, often plagued by nightmares. Sometimes I feel kicked when I fall asleep, and I seem to hear someone calling my name when I wake up. I am hypnotized by white wine now. I can sleep for about 4 hours after drinking 232 liquor. Sometimes I can sleep for a while when I wake up, and sometimes I wake up when I fall asleep. What should I do?
Hunan Mr. Liao
Mr. Liao:
According to the description of symptoms, you have insomnia, nightmares, auditory hallucinations and other clinical manifestations, which should be diagnosed as schizophrenia, depression and anxiety after mild stress. It is not appropriate to use hypnotics such as liquor for a long time. The experimental study of sleep shows that drinking alcohol before going to bed can shorten the time of falling asleep, but make sleep shallower, prolong the time of shallow sleep, increase the number of waking up in the middle and sleep intermittently. It can be seen that the role of alcohol is to make people sleepy first. On the surface, it seems to be beneficial to sleep, but it may actually interfere with sleep. In the middle of the night, after the effect of alcohol gradually disappears, it will cause insomnia and dreaminess and reduce the overall quality of sleep. Therefore, drinking before going to bed can not increase the total sleep time, but may make sleep shallower, which is not conducive to sleep. In addition, the decomposition of alcohol produces acetaldehyde, which is a harmful toxin. If you fall asleep immediately after drunkenness, acetaldehyde circulating in the body will lead to dehydration to a certain extent, dry mouth, leading to waking up, and then it is difficult to fall asleep.
According to your condition, you should have a correct understanding of mild mental symptoms, and it is recommended to go to the encephalopathy department or psychiatric department of a regular hospital for treatment. Diagnosis and treatment internal medicine.
Zhou Desheng, Department of Neurology, First Affiliated Hospital of Traditional Chinese Medicine, Hunan Province
How long does it take to get the medicine for depression?
A relative of mine has got depression and has been taking medicine. Now he can work and live normally. Can he reduce or stop taking medicine? In addition, can you take medicine casually to treat depression?
Beijing Ms. Wang
Ms. Wang:
The cause of depression is very complicated, which is related to heredity, neurotransmitter changes, personal personality, psychological factors, life events and other factors. All kinds of problems and difficulties in life will cause us great pressure, affect our sleep and mood, and over time there will be different degrees of depression and anxiety.
The treatment of depression can be divided into three stages: acute treatment, consolidation treatment and maintenance treatment. The acute phase is the period when the patient is ill, and the treatment time is about 6 ~ 8 weeks. The consolidation period is the period when patients' symptoms are obviously improved or disappeared, and they need to continue to take drugs for consolidation treatment for 4 ~ 9 months; The maintenance period is to consolidate the treatment. If the patient has no symptoms and can work and live normally, he can consider reducing the drug. Treatment usually lasts for 2 to 3 years. During the maintenance treatment, it is necessary to observe the patient's situation after reducing the dosage. Once it recurs, it is necessary to supplement the original dose in time to avoid further aggravation of the disease, and then find a doctor to determine the next treatment plan.
The symptoms of most patients with depression will be relieved or significantly relieved after drug treatment alone. However, about 20% of the patients' treatment effect is not ideal, which is related to their own psychological and family environment. It is generally recommended that these patients receive psychotherapy while taking medicine. Some patients with depression have not improved after taking medicine for a week or two. Generally speaking, it takes about 2 to 4 weeks for antidepressants to take effect from the beginning, so it is unlikely that they will have obvious effects after taking them for one or two weeks. Research shows that the treatment time is positively correlated with the treatment effect. The longer the treatment time, the better the effect, so patients need to continue taking medicine.
It is normal that the disease will recur after taking the medicine for a period of time, because the drug effect is still unstable, and patients need to continue taking the medicine according to the doctor's advice, and generally good therapeutic effect can be obtained after 2 ~ 4 weeks. If the patient consciously improves during the treatment, he will reduce the dosage or stop taking the medicine on his own, which will lead to repeated illness and need to continue taking the original medicine. In short, we must adhere to the medication, sufficient, sufficient course of treatment.
If the patient thinks that taking medicine has no effect, he will not take it, which is equivalent to giving up treatment and the condition will only develop further. Moreover, some patients will have different degrees of withdrawal reactions, such as flu-like symptoms, anxiety, insomnia, dizziness and so on.
Yu Jing, Chief Physician of Psychiatry Department of Beijing Anding Hospital
Can chronic nephritis develop into uremia?
Last year, I got chronic nephritis, and the doctor said that it could not be cured, saying that more than half of chronic nephritis would develop into uremia. Is that really the case?
Chongqing Zhangsheng
Mr. Zhang:
The cause of nephritis is very complicated. Most chronic nephritis needs long-term or even lifelong medication, and a few can be cured. However, as long as the disease is controlled stably, it will generally not develop into uremia. The treatment of chronic nephritis should be said that the combination of traditional Chinese and western medicine is the best scheme, because western medicine alone may have some side effects, which can be alleviated if combined with traditional Chinese medicine. In addition, if some western medicines are not effective, choosing traditional Chinese medicine for conditioning will often have unexpected effects. In short, we should use Chinese and western medicine flexibly to achieve the best results. In the process of treatment, we must be patient and not impatient, otherwise we will easily lose confidence and give up treatment, which will easily lead to the development of the disease and uremia. To prepare for a protracted war, it is very important to cooperate with doctors for regular examination. It's easy to make detours by constantly changing doctors.
Once nephritis is diagnosed, it is necessary to cooperate with the doctor to do kidney biopsy in time, so as to judge the condition and prognosis and avoid misdiagnosis and mistreatment, because some kidney diseases have completely different treatment methods. Such as lipoprotein nephropathy, obesity-related nephropathy and renal amyloidosis. Can't be treated with hormones and immunosuppressants. If the treatment plan cannot be determined without renal biopsy, it is not enough to rely on experience alone.