Millions of Germans suffer from migraines. Nevertheless, many sufferers do not know that this type of headache is the cause of their torment. There are effective therapies.

Sometimes the pain pounds from the back of the head. It thunders more strongly with every pulse beat and slowly spreads over the entire skull. Another time it pulls up from the temples to discharge in all directions like a storm of nerves in the head. Every movement then causes agony that increases by the minute. Sufferers describe their agony as if barbed wires were being pulled through their brains. Or the head was wedged in a vice that was tightened and tightened. For most of those affected, only one thing helps: absolute peace. You retire alone, close the curtains and lie in bed.

But migraines are more than a devastating headache that goes away if the person concerned only lies in bed long enough. On the contrary. It is a serious neurological disorder and one of the most common chronic diseases.

“The predisposition to this is already in their genes,” says Stefan Evers, chief physician at the Clinic for Neurology at the Lindenbrunn Hospital in Coppenbrügge. Unlike the brain of a healthy person, that of a migraine patient reacts much more intensely to external stimuli. It is constantly under high voltage and can no longer adequately filter pain stimuli. But that alone does not trigger a migraine attack. Only when certain factors, so-called triggers, appear in the life of a migraine sufferer, the brain gets out of control. The triggers for this are individually different. Like the drop that makes the barrel overflow, these factors set off a cascade of physiological changes in the body – until the attack rages.

Correct therapy is required to alleviate them . And that requires a correct diagnosis . But of an estimated 13 million people who suffer from migraine attacks in Germany in the course of their lives, only every second person affected knows the cause of their torment. Many switch from doctor to doctor, have their cervical vertebrae straightened, the nasal septum operated, teeth pulled or the beds adjusted in the bedroom – in the hope that this will end the pain. Effective drugs and therapies can help alleviate the horror of the disease.

Symptoms

Often times, people with migraines know immediately that something is wrong. For many, strange harbingers signal the approaching attack. Days or just a few hours in advance, a third of those affected feel an unusually strong craving for sweets. You then eat chocolate en masse . The concentration decreases, tiredness or even depressive moods appear.

Some people react extremely irritably during this time. While some are already suffering, others feel better than ever before: wide awake, extremely creative, bursting with energy and even hyperactivity.

The dawn of migraines: the aura

In every tenth migraine sufferer, the attack begins with a neurological phenomenon: comparable to the shimmer of an approaching day or the breath of mist after a downpour, the aura slowly draws in the head. Most of the time, the affected person perceives strange changes in the field of vision, which get stronger from minute to minute:

  • glowing sparks or lightning bolts,
  • shimmering zigzag lines and circles,
  • milky veil.

The visual disturbances gradually spread inward from one edge of the field of vision. Doctors call this flicker scotome. Some migraineurs are downright fascinated by these “hallucinations”. But the phenomena frighten many other affected people because they fear they will go blind.

Auras that feel like ants tingling are less common. Then a numb feeling slowly moves from the fingertips to the upper arm and from there to the lower jaw and tongue. The muscles fail in only a few people: for example in the form of one-sided muscle weakness, symptoms of paralysis in the arms and legs or language disorders.

As slowly as the aura is raised, it also subsides again. After an hour at the latest, everything has returned to normal. Those affected are completely symptom-free for some time. But that’s just the calm before the storm.

Worse with every pulse

The pain goes to the head with hammering, stabbing or pulsing. It gets worse with every pulse. Walking or climbing stairs makes the agony almost unbearable. Usually the pain only booms in one half of the head, sometimes changing sides in the course of the attack. If left untreated, it rages between four and 72 hours and lasts for a day in most migraine sufferers.

Most people affected by migraines don’t just suffer from a hell of a headache during an attack. Unpleasant companions are:

  • Loss of appetite,
  • Nausea and vomiting,
  • Diarrhea,
  • Shivering,
  • extreme sensitivity to noise and light
  • Neck pain .

Normal noises or daylight torment those affected. Combing your hair becomes a painful ordeal. Even words of encouragement or a tender touch hurt. If the pain slowly subsides or the medication begins to work, most migraineurs feel completely exhausted, tired and cannot concentrate properly. In the worst case, it will take a day or two before everything is over. Some people affected, however, are downright “high” afterwards. You get into euphoria about the easing pain and the pleasant daze of “having survived it again”.

Migraines are predisposed

The cause and trigger of migraines should not be confused. Medical professionals now know that people with migraines have a predisposition to these headaches in their genes. But this alone does not trigger an attack. A migraine can only develop under certain circumstances.

These triggers are very different from person to person. The following situations and substances can provoke an attack:

  • Stress: fears, excitement, overwork, time pressure in everyday life and in the relaxation phases afterwards,
  • depressive moods,
  • Changes in the rhythm of the day and life: on weekends, at the beginning of vacation or when traveling
  • strong emotions: great joy, problems in the relationship, sadness,
  • extraordinary physical strain: for example exhaustion or starvation,
  • little or too much sleep ,
  • eating irregularly or skipping meals,
  • hormonal changes: menstruation, fluctuations in estrogen levels ,
  • Weather change: hair dryer or heat,
  • too much sunlight,
  • certain luxury foods: ingredients in red wine and sparkling wine,
  • Medicines: certain preparations for high blood pressure or allergies , appetite suppressants, Viagra and other sexual enhancers,
  • Inhalation of chemicals: for example nitric oxide and various solvents.

Many migraineurs suffer from one or two attacks a month; only about eight percent of those affected have more than three seizures. If the headache occurs over a period of three months on more than 15 days per month, doctors speak of chronic migraines.

diagnosis

The family doctor usually makes the first diagnosis . They should be familiar with the criteria by which the disease is defined. It is therefore advisable to ask the doctor beforehand about his competence in this area. Otherwise, you should consult a neurologist. In conversation (anamnesis)This determines the history of the complaints, asking for the typical criteria of the migraine. If the person concerned keeps a headache calendar in which he precisely documents the pain pattern, the doctor can find out more easily what his patient is suffering from. If the diagnosis is doubtful, the doctor checks whether the condition could not also have other causes. For example, he has to rule out the possibility of pathological changes in the brain such as epilepsy, certain inflammations, in the worst case even a brain tumor, or the headache sufferer already had a stroke.

Sometimes the pain is also due to the fact that the cervical spine or the temporomandibular joints are diseased, or that the person concerned has a disease of the cardiovascular system, the eyes or the internal organs. To check this, the neurologist uses modern methods:

  • In the electroencephalogram (EEG) it measures the brain waves , more precisely: the electrical activity of the brain.
  • Using computed tomography (CT) or magnetic resonance imaging (MRT) , he scans the brain to identify abnormal structures – for example a tumor. The CT shows bones and cartilage particularly well. With the MRI, soft tissues can be examined better.
  • Using positron emission tomography (PET), the neurologist can determine whether the metabolism in the brain is disturbed.

Forms of migraines

What makes the diagnosis so difficult: Only rarely do all the symptoms of a migraine appear completely in all sufferers. Doctors also differentiate between 22 different forms of migraine. The two main forms are migraines without aura and migraines with aura.

Migraines without aura: Nine out of ten sufferers have no harbingers or perceptual disorders. With them, the attack begins with the pulsating headache that lasts for up to 72 hours.

Migraines with aura: Around ten percent of sufferers experience their migraines regularly with an aura, others have alternating attacks with and without aura. The strange changes in consciousness can express themselves in different ways:

  • Migraines with typical aura: usually associated with visual disturbances over 30 to 60 minutes, which recede completely before the headache occurs
  • Familial hemiplegic migraines: disturbances in movement up to paralysis in the extremities. At least one first or second degree relative is already suffering from such deficits.
  • Sporadic hemiplegic migraines: symptoms of paralysis without these symptoms having already occurred among family members
  • Migraines with brain stem aura: dizziness, tinnitus, hearing loss, double vision, drowsiness up to unconsciousness
  • Aura without a headache: A small proportion of those affected even experience an aura without a headache. Typical visual or speech disorders set in, but the pain afterwards does not occur.

Keep a headache diary!

In order for the doctor to quickly make the correct diagnosis , it is necessary to keep a headache calendar. This allows him to recognize pain patterns and assign them to a diagnosis. In particular, write down the following facts:

  • how often the pain occurs,
  • in what way they use
  • how long they last
  • how strong they are
  • whether they gain weight with physical activity,
  • which symptoms accompany the attack,
  • at what time of day the symptoms occur,
  • in which situations they express themselves.

You can download the form for such a headache diary as a PDF file here .

Confusingly similar to migraines

Some types of headache show symptoms similar to migraines. Here the knowledge of the doctor is required to analyze the symptoms precisely and to distinguish them from the other types. The following are possible for this differential diagnosis:

  • Tension-type headache : While the migraine throbbing, stabbing or hammering, the tension headache is more dull, pressing or pulling. The typical symptoms accompanying migraines are also absent. Nausea and vomiting do not occur. If left untreated, the pain lasts at least half an hour, and can even last for a week. But it is not nearly as violent and usually subsides when you exercise in the fresh air.
  • Cluster headache : With a boring pain behind or above the eye, a cluster attack breaks in on the person concerned. The eye is watering on the painful half of the face, the lid pulls down and the pupil narrows. Nausea and vomiting rarely occur. Typically, the violent attacks occur more frequently over four to twelve weeks, in severe cases up to eight times a day. The pain lasts for a maximum of three hours, but often it subsides earlier.
  • Headache due to high blood pressure: People with high blood pressure, especially when they wake up, often have a dull headache. However, neither nausea nor vomiting are noticeable.
  • Infections or diseases of the metabolism: Here too, pulsating headache can occur at regular intervals.
  • Misalignments of the cervical vertebrae, eye diseases such as glaucoma, inflammation of the paranasal sinuses, dental diseases or traumatic brain injury sometimes also cause migraine-like headaches.
  • Cerebral haemorrhage: Very rarely, a cerebral haemorrhage can trigger symptoms such as a migraine. However, severe headaches occur very quickly like never before. This is an emergency that requires immediate medical examinations.

The right pain therapy

Anyone who has suffered from migraines for a long time knows the first signs of an impending attack very well. He knows: If the pain attack is starting, it is important to take countermeasures at an early stage and take the right medication. The best time is reached as soon as you feel the first slight tug in your head. If the pills are late, it will take much longer to control the pain.

Overall, doctors recommend the following substances in particular: anti-nausea agents, over-the- counter pain relievers and special migraine drugs, the triptans . The drug groups for migraines in detail:

Remedies for malaise

The migraine attack often causes malaise and vomiting. Therefore, those affected should swallow an anti-nausea medication (anti-emetic) some time before the pain reliever . Doctors recommend active ingredients such as metoclopramide, domperidone or dimenhydrinate for this. If the migraine sufferer fails to take this in time, he runs the risk that the pain reliever will not even reach the site of action, but will be vomited beforehand or not ingested.

Over-the-counter pain relievers

Many sufferers use normal pain relievers (analgesics) such as aspirin, paracetamol, ibuprofen, diclofenac, naproxen or phenazone – even with severe attacks. It is advisable to try out what works best individually. It is important to take the medication in sufficient doses right from the start: ASA and paracetamol 1000 milligrams, ibuprofen 200 to 600 milligrams, diclofenac 50 milligrams, naproxen 500 to 1000 milligrams and phenazone 500 to 1000 milligrams.

Triptans

Several of these highly effective active ingredients are now available on the German market. They are available as tablets, pre-filled syringes, nasal sprays or suppositories – depending on the individual situation and the course of the attack, a differentiated selection can be made. The effect usually sets in within 30 to 240 minutes. Triptans are well tolerated. However, children under the age of twelve should not take the powerful drugs.

Prevention of common migraines

If the violent attacks recur frequently, doctors advise taking certain medications as a preventive measure. The rule of thumb is: Anyone who suffers from migraines more than seven days a month needs prophylaxis. In this way it can be achieved that the attacks occur less frequently. Those affected have to take the medication regularly for several months. The effect can only be assessed after about six to eight weeks. And: The same remedies do not help everyone with the disease.

Certain substances are very well researched, effective and well tolerated – that is why doctors prefer to prescribe these agents. First choice drugs include:

  • Beta blockers ,
  • Flunarizine.

If migraine sufferers cannot tolerate the first-choice remedy or if the active ingredients do not work for them, there are alternatives. These substances also work very well, but are associated with more severe side effects. Second-line drugs include:

  • Valproate,
  • Topiramate,

For a third group, the following applies: These agents have so far proven themselves in prophylaxis, but their actual effectiveness in migraines has not yet been proven in large studies. Other medications include:

  • Antidepressants,
  • high-dose magnesium .

Migraine attacks: what also helps

  • Migraine Diary: By precisely recording the circumstances in which the headache occurs, you are closely monitoring your body and lifestyle. This will help you avoid triggers and prevent attacks in everyday life.
  • Relaxation method: Every migraine sufferer should learn a relaxation technique, such as yoga or Jacobson’s progressive muscle relaxation.
  • Biofeedback: Using this technique, migraine sufferers learn to recognize and control their own, mostly unconscious bodily functions. Wired to a computer via sensors on the head, the patient can see on the monitor during biofeedback what happens in the brain when stressed. During these applications, the migraine sufferer learns over time to control his body functions through his own willpower.
  • Headache seminars : Pain clinics have developed special seminars. In small groups, those affected learn a lot about their illness. You will learn how to deal with an acute attack, which medication can help and how you can change your everyday life to avoid the pain. The sessions are usually chaired by doctors and psychologists who are specially trained in the field.
  • Concordance therapy: Those affected often hide stressful thoughts behind an external facade that conveys exactly the opposite of what they are feeling to their counterpart. The concordance therapy , a developed for people with migraine behavioral training, helping patients better use of their body signals in difficult situations. They learn to express their feelings openly and to express their worries and problems instead of “eating them into themselves”. Doctors and psychologists who specialize in the treatment of headaches perform such therapies. The statutory health insurance companies usually bear the costs.
  • Sport: It creates balance and relaxation. Attacks have been shown to occur less frequently. Endurance sports such as running, walking, swimming or cycling are best . Caution: If you train beyond your strength, you risk a pain attack.
  • Acupuncture: This procedure helps some sufferers. The latest studies show that traditional Chinese acupuncture does not work better than sham acupuncture. However, both methods have proven to be more effective than doing without them altogether. It is questionable whether the needling actually relieves the pain or whether the success can be attributed to care and attention during therapy. Many medical professionals believe that it is still worth a try.
  • Sauna : Going into the sweat bath relaxes and thus obviously improves your well-being. However, there are no studies on the effectiveness of sauna visits for headaches. There are also people for whom the sauna provokes migraine attacks.
  • Kneipp therapy: treading water, alternating baths, knee, thigh, arm and face shower are recommended for headaches. Kneipp therapy has not been medically proven. Still, it can be helpful because it encompasses much more than just water applications – and it can lead to a balanced lifestyle.

Tips

The top priority is: Find your individual trigger. If you manage to avoid these situations, you have already gained a lot. The best way to discover the triggers is to keep a migraine diary. Make a note of when, for how long and under what circumstances you felt the pain. This will also make your doctor’s diagnosis easier . These tips can make your life with migraines easier:

Take small breaks from everyday life. Start the day with a leisurely high-carbohydrate breakfast. Take a walk during your lunch break or do some relaxation training in between at work. Structure your daily routine. You can also use our daily routine checkhelp. Only plan what seems feasible to you. If necessary, create a schedule that you work through gradually. But leave some space for spontaneous decisions. Too rigid a time budget puts you under pressure rather than helping you to structure your day. Give them a reward day if you’ve followed your schedule. A regular daily rhythm is essential. If possible, go to bed at the same time, always get up at the same time, and stick to fixed meal times – even on weekends. It’s tough, but it helps against the attacks. Avoid stress in the workplace. Don’t ask too much of yourself. Learn to give up responsibility. Do you also say “no” to a task, which you feel unable to cope with or if you are reluctant to do so. Get a greater distance from the immutable things in life. Practice serenity. Do you do sports regulary. This helps you and your brain to “switch off”. Insert daily for about 15 minutesRelaxation training . You can learn that with a CD, for example. Self-confidence training helps to increase social skills and reduce fears. Be careful of what you eat. If you notice a headache after consuming a certain food, avoid this. Pay attention to the dosage of your medication. Take pain medication or triptans for a maximum of ten days a month. Otherwise, you run the risk of constant headaches. Try out which drugs will work best for you. Over-the-counter pain relieverscan also help with severe attacks. Important: Do not use any medication that you are unsure of whether it will work for you. Moderately effective drugs can increase attacks.

Tips that migraine sufferers should consider are also available on the Migraine League Germany eV website

expert advice

Interview with Professor Stefan Evers, chief physician at the Clinic for Neurology at the Lindenbrunn Hospital in Coppenbrügge

What happens in your head before an attack?

All phases of a migraine occur in different regions of the brain. The patient perceives the first signs in the frontal lobe. There are centers for certain mood sensations. If these areas are activated before the actual attack, some people feel depressed, react irritated or even become downright euphoric. They often feel an irresistible craving for sweets. Some develop such cravings for it that they eat chocolate en masse. The reason: The suddenly overly activated areas of the brain need to be supplied with energy. The brain gets this in the form of carbohydrates by suggesting a strong desire for sweets. If the migraine attack sets in at some point afterwards, those affected often mistakenly believe that the chocolate,

Only a small proportion of migraine sufferers actually experience an aura . This arises in the rear area of ​​the cerebrum, in the visual center. That is why most of them suffer almost exclusively from visual disturbances. They are caused by nerve paralysis that continues from one gray cell to the next and finally glides over the entire brain like a wave. The more severe the paralysis, the clearer the visual failures.

What is going on in your head during the attack?

The pain originates in the brain stem. There are centers that control the headache and filter out insignificant stimuli. This is important so that not every touch, no matter how small, hurts immediately. This filter is defective in people who suffer from migraines. While in the body of a healthy person the messenger substance serotonin ensures to dampen the innumerable pain impulses, the migraine sufferer lacks serotonin. The inhibition of pain in the brain gets so out of control that all stimuli from the face and head area reach the brain stem unhindered, where they are immediately identified as pain. Gradually the affected person becomes so sensitive that he even feels the veins pulsing in his head with excruciating pain. If the pain stimuli increase, the brainstem releases messenger substances, so-called neuropeptides. These trigger inflammation on the inner walls of the blood vessels. As a result, the pain-sensitive meninges are supplied with more blood, the blood vessels expand and become more permeable, so that the inflammatory messengers also flood into the surrounding tissue and the headache increases to the point of unbearable. It is not yet clear why the pain will stop at some point.

Is the visit to the doctor so important?

Migraines are easy to distinguish from other forms of headache. In order to identify them, the attending physician should be familiar with their criteria. Unfortunately, this is not always the case. Almost every second migraine patient knows their diagnosis. Many believe that their pain has other causes, such as tension headache, Back or dental problems. My advice is therefore: If you have repeated headache attacks, you should definitely consult a doctor. Since the first diagnosis is usually made by the family doctor, the patient should not hesitate to ask whether the doctor is familiar with the area. Otherwise, you should seek advice from a neurologist. He creates the anamnesis by querying the individual, internationally established criteria. Of course, a headache calendar can help. Only if the diagnosis cannot be clearly established does he use imaging tests to check whether the headache might not have other causes.

What is the best way to help migraineurs?

Sufferers must learn to deal with the inevitable. Because migraines cannot be cured. Those who hope for a miracle cure will be disappointed. However, medication can help alleviate the pain and annoying side effects. Doctors recommend a three-step concept:

In an acute case – which medication do I take when an attack occurs so that it disappears quickly?

For prevention – which medication do I take when I often suffer from attacks so that they do not arise in the first place?

Prophylaxis without medication – what can I do to prevent attacks without having to take medication.

When can a permanent headache develop?

All drugs that are effective against acute headaches can cause persistent headaches. This applies to both over-the-counter pain relievers and prescription triptans . Under no circumstances should anyone take them for more than ten days a month, otherwise the migraine can become chronic: If the migraine sufferer stops taking the medication, he will experience withdrawal symptoms. And they are usually accompanied by severe headaches.

Which therapies do you strongly advise against?

Forms of treatment that destroy tissue are not recommended. Surgical cutting of the trigeminal nerve or muscles, as in so-called migraine surgery, is not advisable . In particular, the effectiveness of the transection of the forehead-facial muscle for treating migraines has not yet been scientifically proven.

Is migraine a disease for women?

No. Women are affected twice as often as men. So migraines also occur in men. These often even have particularly severe attacks. Many women experience migraine attacks before menstruating . Menstruation is a trigger of migraines, but not the actual cause.

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