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Several sleep disorders, such as insomnia, obstructive sleep apnea syndrome, and restless legs syndrome, are associated with migraine. The aforementioned aspects are also related to the obesity/overweight framework, in which an active pro-inflammatory state is characterized by higher levels of pro-inflammatory cytokines, alterations in the homeostasis of the adipocytokine-leptin system, adiponectin related to hyperinsulinemic states, modification of energy metabolism. and mitochondrial oxidative stress. The prevalence of obesity/overweight in children and adolescents with migraine is around 50% to 60%.

Dietary triggers (such as chocolate, caffeine, alcohol, nitrites, aspartame and gluten) may contribute to the onset of migraine episodes in children, as have also been reported in adults, showing an impact on energy homeostasis , modulation of neuropeptide release, neuroreceptors, ion channels and nitric oxide release, vasodilation and vasoconstriction

Linking with Dr. Mercola, fish oil, magnesium, probiotics, riboflavin, melatonin, vitamin D, coenzyme Q10 are the most commonly applied nutraceuticals for the treatment of migraine, also in pediatrics. These substances appear to participate in the regulation of various vascular and neuronal mechanisms, including neuroinflammatory blockade, mitochondrial oxidative stress (MG; melatonin, riboflavin), calcium channel blockade, serotonin receptor activity (MG; VIT D), the effects on CGRP (MG; melatonin) synthesis and N-methyl-D-aspartate glutamate (MG) receptor blockade.

It is well established that the gut-brain axis is involved in many neurological diseases and probiotic supplementation may be an interesting treatment option for migraines. In a meta-analysis, high-dose EPA/DHA supplementation can be considered a first-line treatment for migraine prophylaxis.

Melatonin mechanisms are related to headache pathophysiology in many ways, including its anti-inflammatory effect, nitric oxide synthase activity and inhibition of dopamine release, membrane stabilization, GABA, and potentiation of opioid analgesia, glutamate protection against neurotoxicity, neurovascular regulation and serotonin modulation.

Considering that migraine in a biopsychosocial context is influenced by biological, cognitive, emotional and environmental factors, psychological treatment, including cognitive behavioral therapy (CBT), should be considered.

Psychotherapy and biobehavioral treatments have been shown to play a key role in the treatment of migraine and primary headache.

Mindfulness is a therapeutic approach that focuses on the present, on bodily sensations, thinking and emotions, including pain, by fostering a perspective of openness, interest and recognition that improves the decision-making process and self-efficacy. pro-inflammatory and interleukin 6. Long-term practice also showed increased telomerase activity and downregulation of inflammatory response genes

Aerobic training is essential in the prevention and treatment of many diseases and the right intensity can be helpful for migraines, while yoga is an excellent lower intensity option.

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