Health

Migraines: causes, symptoms and therapy

Migraines
How do I recognize migraines? What helps against migraines? Here you will find all the facts about headaches, such as symptoms, phases, complications, triggers, causes, and treatment options.

There are over 200 types of headaches. A distinction is made between primary and secondary headaches. A primary headache is a disease in its own right, which also includes migraine, cluster headache, or tension headache.

Secondary headaches show up as symptoms of other diseases, e.g. B. head injuries, infectious diseases, or vascular diseases as well as overuse of medicines and similar substances.

This article is about migraines. Here you will find all information on symptoms, the frequency of migraines, their various forms, their triggers, causes, diagnostics, therapy options, and the answer to the question of whether migraines can be cured.

frequency of migraines

Around 10 percent of the world’s population suffers from migraines, that’s around 758 million people. 1.7 to 4% of them have a migraine attack more than 15 days a month. In Germany, around 10 to 30% of the population is affected by recurring headaches. About 15% of them suffer from the special form of migraine with aura. Women are about three times more likely to get migraines than men.

How do I know if I have migraines? – symptoms

Migraine is characterized by episodes of paroxysmal, pulsating, and unilateral headaches which, unlike tension headaches, are often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light or noise.

»So migraine is not just  pain  alone, as is often assumed, but a complex, neurological disease such as epilepsy.«

If you suffer from migraine with aura, the attack is preceded by an accompanying symptom, the so-called aura, which can manifest itself in visual disturbances, numbness, or other neurological disorders of perception.

How do I know if I have migraines? – Diagnosis

Many people suffer from different types of headaches at the same time. The general practitioner or neurologist can use a headache diary to find out whether the diagnostic criteria for migraine are met in the patient concerned. The first thing to do when suffering from a headache is to see a doctor who will rule out that the headache is secondary and not primary.

Primary and secondary headaches

Secondary headaches are symptoms of other illnesses, eg headaches caused by the flu; a hangover can also be accompanied by a secondary headache. One speaks of primary headaches when they are independent headache disorders – such as migraine, cluster, or tension headaches.

Once doctors have made the diagnosis of migraines, you can also use our migraine app to monitor how things are progressing and discuss them regularly with the doctor.

Why do I have migraines? – Causes of a neurological disease

According to the current state of migraine research, the cause of migraine is still unclear. However, research into the causes is particularly crucial when it comes to developing an individual and adapted therapy for those affected. There are the following theories about the causes of migraines:

stimulus processing disorder

A congenital stimulus processing disorder is discussed by researchers as a possible cause of migraine. The brain is constantly under high tension and reacts particularly sensitively to certain stimuli.

Hereditary predisposition

Another possible cause could be hereditary predisposition. A gene defect on the 19th pair of chromosomes was found in certain forms of migraine, such as hemiplegic migraine (a variant of migraine with hemiplegia as an aura) or CADASIL disease (a disorder of the blood vessels in the brain).

circulatory disorder

A spontaneous circulatory disorder in the brain is also considered a possible theory in the development of migraine with aura. This theory assumes that external factors lead to a short-term constriction of the blood vessels in the brain and meninges. The subsequent vasodilatation and increased blood flow are perceived as migraine headaches.

Neurogenic inflammation and increased nerve activity

Another possible cause is neurogenic inflammation in the brain. The overactivity of nerve cells in the cerebral cortex leads to a release of noxae (pollutants) that can get into the pain-sensitive meninges. This creates a painful inflammation.

What types of migraines are there?

Episodic migraines vs. chronic migraines

One speaks of a  chronic migraine when headaches occur on 15 or more days for at least three consecutive months. Migraine-like headaches must be present for more than seven days. When diagnosing the clinical picture of chronic migraine, it is important to rule out drug overuse and other headache-triggering diseases. Episodic migraines, on the other hand, occur at longer intervals.

Special forms of migraine

However, there are also special forms of migraine. These include aura without headache, migraine with prolonged aura, retinal migraine, ophthalmoplegic migraine, basilar-type migraine, and familial and sporadic hemiplegic migraine.

In the case of a  migraine aura without a headache, sufferers have symptoms of a typical aura that are not followed by a migraine headache. When aura symptoms last longer than a week, it is called a  prolonged aura migraine. Retinal migraine

describes a form of migraine in which unilateral visual disturbances can occur, for example in the form of unilateral visual spots, flickering, or even brief blindness in the affected eye. Ophthalmoplegic migraine is characterized by sudden double vision or drooping of an eyelid in the early stages.

In addition to the migraine headache felt on both sides, the basilar migraine is accompanied by severe dizziness, ringing in the ears, or speech and consciousness disorders. Another special form is the familial and sporadic hemiplegic migraine, which shows up as a migraine with aura and motor weakness and must also appear in a relative of the first or second degree.

Phases and duration of a migraine attack

An average migraine attack usually lasts 4 to 72 hours and can be divided into different phases. The classic migraine with aura is characterized by four phases, the simple migraine without aura goes through three phases.

harbinger phase

In the harbinger phase,  also known as the prodromal phase, the coming attack is announced a few days beforehand by so-called “harbingers”. This is the case for about 30% of those affected. Such harbingers can include mood swings, neck discomfort, and sensitivity to light.

In addition,  food cravings, a pronounced feeling of cold, inner restlessness, sensitivity to noise, and problems focusing the eyes are also possible symptoms that indicate that a migraine attack is imminent. Intense yawning is the most common symptom of the harbinger phase and is considered a very reliable predictor.

The tipping point theory describes the transition from the pain-free period to the headache phase and emphasizes the difference between precursors and triggers. Heralds are seen as internal disturbances (such as the sensitivity to light mentioned above) and triggered external disturbances (such as glaring sunlight). Shortly before the brain “tips” into the pain phase of a migraine, the body goes through a process that is characterized by physiological, hormonal, and emotional changes.

aura

Fortunately, those who suffer from migraines without aura are not familiar with this phase. Affected people with migraine with aura have a so-called aura in this phase. These are additional sensory disturbances and other neurological deficits that occur before the actual headache begins.

These can be visual disturbances and light phenomena such as zigzag lines, flashes of light, or flickering, but also dizziness, speech disorders, difficulty concentrating, numbness or paraesthesia, and misperceptions such as Alice in Wonderland syndrome. These slowly spreading and usually escalating symptoms typically subside after 20 to 30 minutes.

After the aura appears, the headache usually sets in. This can overlap or be delayed. In the case of a special form of migraine, the migraine aura without a headache, the pain after the aura can also be completely absent.

pain phase

The pain phase is characterized by moderate or severe one-sided headaches. These often have a pulsating, throbbing, or stabbing character and are often localized in the temporal region, but can also occur anywhere else on the head.

In addition, there are often other symptoms such as loss of appetite, nausea, vomiting, the partial standstill of metabolic processes, but also sensitivity to light, noise, or smells. Physical activity typically increases the pain, which is why many migraine sufferers retreat to a dark, quiet room.

The pain does not always appear on the same side, it can change the side of the head from attack to attack. In one in four migraine sufferers, the pain occurs in the early morning hours.

Sensitivity to light, noise, or smells often goes hand in hand with a one-sided headache. Physical activity typically increases the pain, which is why many migraine sufferers retreat to a dark, quiet room.

recovery phase

In the recovery phase, exhaustion is often followed by a sleep phase, during which the attack subsides and the pain subsides. Sometimes the opposite symptoms of the harbinger phase also appear. Some feel particularly euphoric, alive, and free, but for others, the need for rest and sleep prevails. Loss of appetite and sensitivity to pain is also not uncommon for a few hours or even days afterward.

What can trigger a migraine attack?

There are some internal and external factors that can favor an attack but are not the cause of it. The following  triggers (also called “triggers”)  can “initiate” a migraine attack:

  • stress or relaxation
  • Environmental stimuli, such as  weather changes and climate change
  • hormonal fluctuations ( menstrual or menstrual-associated migraine )
  • Diet (e.g. irregular meals, a low-carbohydrate diet, and resulting fluctuations in blood sugar)
  • alcohol
  • nicotine
  • fluctuating caffeine consumption
  • dehydration
  • certain smells, spices, bright lights
  • altered sleep-wake cycle

The possible triggers are very individual or different for everyone. In order to find out the personal triggers, you should keep a  headache diary  – with pen and paper or digitally.

What can you do about migraines? – Treatment and forms of therapy

In the therapy of migraine, a distinction is made between the preventive treatment of migraine attacks by means of trigger management,  prophylactic medication  (such as beta-blockers or antidepressants), and alternative measures such as regular endurance sports and relaxation exercises, as well as treatment of acute attacks with acute medication and alternative home remedies, such as cold, withdrawal, darkness, etc.

prevention/prophylaxis

A regular daily routine is particularly important in the prevention of migraines, because sudden changes in the daily rhythm in terms of meals, sleep, as well as tension, and relaxation can promote an attack.

“Therefore, relaxation methods and techniques for  reducing stress  such as progressive muscle relaxation, autogenic training, meditation or  breathing exercises are particularly helpful .”

However, such alternative treatment methods can only be successful if the exercises are carried out regularly. In addition, you should strengthen your stamina in seizure-free times and find a suitable sport that you enjoy doing.

There are also a number of prophylactic medications that can reduce the frequency, duration, and intensity of attacks. Drug-based preventive treatment is recommended if the patient has to take painkillers or migraine medication more than 10 days a month, or if these have little or no effect.

Prophylaxis can also make sense if the quality of life of the person affected is so severely restricted by the migraine that they are often on sick leave due to the attacks or can no longer pursue their other activities.

Treatment of an acute attack

In an acute attack, non-drug measures such as lying down, resting, and darkening the room as well as cooling measures or relaxation or imagination exercises, such as those offered under acute help in the Active therapy module, can help. However, if the migraine attack is too severe, various acute medications can help.

»In addition to medication for nausea and pain medication, this also includes specific migraine medication such as triptans.«

These block the release of neurotransmitters, which can lead to local neurogenic inflammation in the blood vessels in the brain. Also, triptans normalize increased nervous activity in various brain centers and narrow dilated vessels.

Triptans have the advantage over other painkillers that they have a targeted and selective effect on the switching points in the brain that are involved in a migraine attack and thus also combat accompanying symptoms such as nausea, dizziness, and sensitivity to noise and light.

However, since overuse of medication can lead to medication overuse headaches, it is important to follow the so-called 10/20 rule. This rule states that headache medication may be taken on fewer than 10 days per month and must be completely free of acute pain medication or specific migraine medication for at least 20 days per month.

Keeping a headache diary also helps to keep track of things. In the M-Sense migraine app, for example, you can enter when you took which medication. If you have another migraine attack, you can then carry out a Medi-Check and the app will tell you whether you should still be taking pain medication this month or not. Extremely practical!

Complications of migraines

status migrainous

When the migraine turns from an attack to a permanent condition, it is called status migrainous. This is the case when a migraine attack lasts longer than 72 hours, or a new one begins before the previous one has completely subsided. This status may also have been preceded by misuse of migraine medication and painkillers.

Persistent aura without cerebral infarction

A persistent aura is when aura symptoms persist for more than a week without radiographic evidence of cerebral infarction. This migraine complication lasts for months to years but is generally rare.

Are migraines curable?

Migraine is suspected to be incurable, but as a migraine sufferer, you can remain optimistic.

First, there are various ways to minimize seizure frequency and intensity. Of course, this includes medication in the first place. In addition to special painkillers for migraines, the triptans, there are a number of prophylactic drugs such as beta-blockers or Botox that are used for migraines. For a long time, there were hardly any new developments in drug-based migraine therapy, but fortunately, there are currently new developments and new drugs such as the CGRP antibodies and Diane and Gepants, which will come onto the market in the next few years.

It doesn’t always have to be medication – various home remedies, and alternative and non-drug treatments can also help to prevent migraines. This includes driving one headache diary, regular endurance sports,  relaxation exercises, or trigger management. All of these methods are integrated into our M-sense migraine health app, which also helps with reminders and motivation to stay on track with therapy.

Those affected report again and again that they have gotten their migraines under control through a good combination of different methods. It is important that you find the right therapy methods for you because not everything works the same for everyone, and that you get competent medical help. If in doubt, you have to change doctors to find the right one.

Conclusion

Migraine is a complex neurological headache disorder that affects approximately 10% of the world’s population. In addition to severe, unilateral, pulsating headaches, it can have a variety of other symptoms such as nausea, vomiting, blurred vision, or dizziness. There are different forms of migraine, such as chronic or episodic, but also migraine with aura or migraine without headache.

A migraine attack goes through different phases and can also lead to complications. There are many different triggers for migraines, such as hormone fluctuations, stress, weather changes, alcohol, or blood sugar fluctuations, so the everyday life of those affected by migraines is often very restricted.

The best way to diagnose a migraine is to describe the symptoms clearly, so it makes sense to keep a headache diary. The causes of migraines are still unclear: There are different theories and therefore different treatment options. A rough distinction is made between the treatment of an acute migraine attack and the preventive treatment of migraine attacks, such as taking prophylactic medication or regular relaxation or endurance sports exercises.

Although migraines are suspected of being incurable, various measures can be taken to reduce the frequency and intensity of attacks.

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