Migraine – definition, symptoms and treatment

Migraine is a widespread neurological disorder that can have a significant impact on the daily lives of those affected. It is characterised by intense headaches that are often accompanied by nausea and sensitivity to light and noise. Accurate diagnosis and effective treatment are crucial to improving the quality of life of those affected. In this article, we look at the causes, symptoms and treatment options for migraines and provide tips on how to prevent and alleviate the symptoms.

What is a migraine?

Definition and differentiation from other headaches:

Migraine is a neurological disorder characterised by recurring, pulsating headaches that often occur on one side. These headaches are often accompanied by symptoms such as nausea, vomiting and sensitivity to light and noise. Migraines differ from other types of headache such as tension headaches, which are characterised by a constant, pressing pain, and cluster headaches, which occur as extremely painful episodes around one eye.

Frequency and sufferers: who is particularly at risk?

Migraines affect around 10-15% of the world’s population and are more common in women than men, often due to hormonal influences. People with a family history are particularly at risk, as genetic factors play a significant role. Migraines can start at any age, but often occur for the first time in adolescence or early adulthood.

Migraine attacks can have a significant impact on daily life and often lead to absence from work and a reduced quality of life. Early diagnosis and a personalised treatment plan are crucial in order to control the symptoms and improve the quality of life of those affected.

Causes of migraine

Migraine is a complex disorder whose exact causes are not yet fully understood. It is thought that a combination of genetic, environmental and physiological factors play a role. Here are the main causes in detail:

Genetic factors:

• Heredity: migraines often run in families. If one parent has migraines, there is a higher probability that the children will also be affected. Studies show that around 70% of migraine patients have a family history.
• Genetic predisposition: Certain genetic changes can increase the risk of developing migraines. These genes influence the function of ion channels and the transmission of signals in the brain.

Environmental factors:

• Lifestyle: an irregular lifestyle, including irregular sleep patterns, unbalanced diet and inadequate hydration, can trigger migraine attacks.
• Environmental stimuli: Bright lights, loud noises and strong odours are common environmental factors that can trigger migraines.

Triggers and precipitants:

• Stress: mental and physical stress are common triggers of migraine attacks. Stress can affect hormone production and cause neurochemical changes in the brain.
• Diet: Certain foods and drinks, such as alcohol (especially red wine), caffeinated drinks, chocolate, aged cheese and foods high in sodium, can trigger migraines.
• Weather changes: Changes in barometric pressure, extreme heat or cold, and high humidity can trigger migraines in some people.

Link between hormones and migraines:

• Gender differences: women are more often affected by migraines than men, which is attributed to hormonal fluctuations. Around 60% of female migraine sufferers report a connection between their migraine attacks and their menstrual cycle.
• Oestrogen fluctuations: Changes in estrogen levels, such as those that occur during menstruation, pregnancy or menopause, can affect migraine attacks. Many women experience migraine attacks just before or during their period, which is known as menstrual migraine.

Migraine is a multifaceted disorder that is influenced by a variety of factors. Understanding these factors can help to identify individual triggers and take targeted measures for prevention and treatment.

Symptoms of migraine

Phases of a migraine attack:

Migraines often progress in four characteristic phases, which can vary in severity for each sufferer:

1. Prodromal phase:
   • Symptoms: mood swings, ravenous appetite, neck stiffness, increased yawning, irritability.
   • Duration: Hours to days before the actual migraine attack.
2. Aura:
   • Symptoms: visual disturbances (e.g. flickering, zigzag lines), sensory symptoms (numbness, tingling), speech disturbances.
   • Duration: 20 to 60 minutes.
   • Special feature: Only about 20-30% of migraine patients experience aura symptoms.
3. Headache phase:
   • Symptoms: one-sided, pulsating headache, nausea, vomiting, sensitivity to light and noise.
   • Duration: 4 to 72 hours.
   • Pain intensity: Moderate to severe, often aggravated by physical activity.
4. Postdromal phase:
   • Symptoms: fatigue, weakness, concentration problems, mood swings.
   • Duration: Hours to days after the headache has subsided.

Typical symptoms:

• Unilateral headache: often a pulsating pain on one side of the head.
• Nausea and vomiting: Many migraine patients suffer from gastrointestinal symptoms.
• Sensitivity to light and noise: Also known as photophobia and phonophobia, even normal levels of light and noise can be unbearable.

Differences between migraine and tension headaches:

• Migraine: typically unilateral, pulsating, accompanied by nausea and sensory sensitivities. Intensity is moderate to severe, often aggravated by movement.
• Tension headache: Bilateral, pressing pain that is felt like a band around the head. No nausea, rare sensitivity to light and noise. Pain intensity is mild to moderate.

Migraine is a complex disorder with different symptoms and phases. Understanding these aspects can help to better manage the condition and develop appropriate treatment strategies.

Migraine medication

Acute medication:

• Triptans: These medications (e.g. sumatriptan, rizatriptan) are specific to migraine and work by constricting blood vessels in the brain and inhibiting pain signals. They are particularly effective when taken at the beginning of a migraine attack.
• Painkillers: Over-the-counter painkillers such as ibuprofen, paracetamol or aspirin can help with mild to moderate migraines. They should be taken early on during the migraine attack in order to achieve the best possible effect.

Prophylactic medication:

• Beta blockers: drugs such as propranolol or metoprolol are used to prevent migraine attacks by dilating the blood vessels and lowering blood pressure.
• Antidepressants: Certain antidepressants, such as amitriptyline, can help to reduce the frequency and severity of migraine attacks. They influence the serotonin and noradrenaline levels in the brain.
• Antiepileptic drugs: Medications such as topiramate or valproic acid are also used prophylactically to prevent migraine attacks.

Side effects and interactions:

• Triptans: Can cause side effects such as dizziness, fatigue, dry mouth, nausea and rarely cardiovascular problems. They should not be used in patients with certain cardiovascular diseases.
• Painkillers: If taken in excess, painkillers can lead to stomach problems, liver or kidney damage and medication overuse headaches.
• Beta blockers: Possible side effects include tiredness, dizziness, sensitivity to cold and sleep disorders.
• Antidepressants: Side effects may include drowsiness, weight gain, dry mouth and high blood pressure.
• Antiepileptic drugs: Can cause drowsiness, difficulty concentrating, weight changes and, in rare cases, skin rashes or liver problems.

It is important that medication is always taken under medical supervision to minimise side effects and interactions and to ensure the best possible treatment.

What helps against migraines?

Home remedies and natural remedies:

• Ginger: Ginger has anti-inflammatory properties and can relieve nausea. A tea made from fresh ginger or ginger supplements can be helpful.
• Magnesium: Many migraine sufferers have low magnesium levels. Supplementation can reduce migraine attacks. Around 400-600 mg daily is recommended.
• Peppermint oil: A gentle massage of the temples with peppermint oil can reduce the intensity of the pain.

Dietary supplements for migraine prevention

Magnesium:

• Effect: Magnesium can reduce migraine attacks by supporting the function of nerve cells and relieving muscle tension.
• Dosage: Around 400-600 mg daily is recommended. Make sure you choose magnesium citrate or magnesium glycinate, as these forms are better absorbed by the body.

Vitamin B2 (riboflavin):

• Effect: Riboflavin improves energy production in the cells and can reduce the frequency and intensity of migraine attacks.
• Dosage: A daily intake of 400 mg is often recommended.

Coenzyme Q10:

• Effect: Coenzyme Q10 supports mitochondrial function and can prevent migraine attacks.
• Dosage: Typically 100-300 mg is taken daily.

Omega-3 fatty acids:

• Effect: Omega-3 fatty acids have anti-inflammatory properties and can reduce migraine attacks.
• Sources: Fish oil capsules or algae oil are good sources of omega-3.

Feverfew (feverfew):

• Effect: Feverfew can reduce the frequency of migraine attacks and alleviate symptoms.
• Dosage: 100-300 mg of dried feverfew leaf or equivalent preparations are recommended.

Melatonin:

• Effect: Melatonin can reduce sleep disorders and migraine attacks.
• Dosage: 3 mg before bedtime is a common recommendation.

Dietary supplements can be a valuable addition to migraine prevention. However, it is important to use them under a doctor’s supervision to ensure the correct dosage and to avoid possible interactions with other medications.

Relaxation techniques:

• Yoga: Yoga helps to reduce stress and improve posture, which can reduce migraine attacks.
• Meditation: Regular meditation exercises can reduce the frequency and intensity of migraine attacks.
• Progressive muscle relaxation: This technique relaxes the muscles and reduces stress, which can prevent migraine attacks.

Dietary changes and hydration:

• Eating a balanced diet: a diet rich in fruit, vegetables, wholemeal products and lean protein can help. It is important to identify and avoid triggers such as caffeine, alcohol and certain foods (e.g. chocolate, cheese).
• Regular meals: Irregular eating can trigger migraine attacks. Small, frequent meals help to keep blood sugar levels stable.
• Adequate hydration: Dehydration is a common migraine trigger. Drink at least 2 litres of water a day.

Behavioural therapy and biofeedback:

• Cognitive behavioural therapy (CBT): CBT can help manage stress and anxiety that trigger migraines. Targeted changes in thinking and behaviour can often alleviate migraine symptoms.
• Biofeedback: This technique makes it possible to control physical processes such as muscle tension and skin temperature. It helps to recognise the signs of a migraine at an early stage and take countermeasures.

The combination of these measures can help to reduce migraine attacks and improve quality of life. It is advisable to try different approaches and customise them to achieve the best results.

Prevention of migraine

Identify and avoid triggers:

• Keep a diary: A migraine diary can help identify triggers. Note when the migraine occurs, what you have eaten and done, as well as your emotional state.
• Diet: Avoid known migraine triggers such as alcohol, caffeine, chocolate, aged cheese and foods high in sodium. Make sure you eat a balanced diet with regular meals.
• Environment: Reduce environmental stimuli such as bright lights, loud noises and strong odours.

Regular physical activity:

• Moderate exercise: regular exercise such as walking, swimming, cycling or yoga can help reduce migraine attacks. It is important to increase the intensity slowly and avoid overexertion.
• Strength training: Supplement your training with moderate strength training to strengthen your muscles and relieve tension.

Healthy sleeping habits:

• Regular sleep rhythm: Keep to fixed bedtimes, even at weekends. Too little or too much sleep can trigger migraines.
• Sleep hygiene: Create a relaxing sleeping environment without electronic devices. Dark and cool rooms promote better sleep.

Stress management and relaxation:

• Relaxation techniques: regularly practise techniques such as progressive muscle relaxation, autogenic training, yoga or meditation to reduce stress.
• Time management: Plan your day and set priorities to avoid being overwhelmed. Regular breaks and leisure activities are important.
• Therapeutic support: When stress levels are high, psychotherapy or coaching can help you develop better coping strategies.

These preventative measures can help to reduce the frequency and intensity of migraine attacks and improve quality of life. It is important to recognise individual triggers and develop a plan tailored to personal needs.

Conclusion

Migraine is a complex and distressing condition caused by a variety of factors including genetic predisposition, environmental stimuli and hormonal fluctuations. Symptoms range from intense, one-sided headaches to nausea and sensitivity to light and sound. Various medications are available for treatment, from acute medication such as triptans and painkillers to prophylactic agents such as beta blockers and antidepressants. In addition to medication, home remedies, natural remedies and relaxation techniques can also be effective. A balanced diet, nutritional supplements and a healthy lifestyle also play an important role in the prevention of migraine attacks. To ensure optimal treatment, it is advisable to identify individual triggers and consider regular consultations with specialists.