Migraine is a disease in which a severe headache is the main focus of suffering and symptomatology. Migraine is often accompanied by nausea, sensitivity to light and noise aversion.
What is migraine?
Infographic on the causes and symptoms of migraine and headache. Click image to enlarge. The definition of migraine can best be described as a mostly one-sided headache with recurrent attacks, often accompanied by vomiting and nausea as accompanying symptoms. Migraine is often perceived by sufferers as a kind of painful aura characterized by neurological symptoms. These include, in particular: blackness before the eyes, dizziness, paralytic sensations, speech disorders, visual disturbances and disturbed senses of smell and taste.
Causes
The causes of migraine are not yet fully understood. However, it is suspected that mainly familial or genetic reasons are behind this disease. Above all, nerve excitability probably plays a central role in this context. The theory that a lack of blood flow to the brain (ischemia) is responsible for migraine is considered outdated. However, it is possible that a pinched facial nerve, for example, can cause painful headaches. Nowadays, however, it is believed that the neurotransmitter serotonin plays a major role in the development of migraine. In this context, serotonin is a substance that functions to excite a nerve cell. Neurotransmitters thus have either an inhibitory or excitatory effect on human sensation or neural construct. In migraine, serotonin levels are probably out of balance, causing nerve or excitability dysfunction. In this case, the prominent headache is due to an excitation of the nerve fibers in the cerebral cortex. This can cause a painful, pulsating or stabbing wave of pain. Other causes may also include lack of sleep, stress, bright lights, overwork, smoking, alcohol and hormonal imbalances.
Symptoms, complaints and signs
Migraines are very severe and long-lasting headaches that often occur on one side only. Typical symptoms of a migraine are headache, photophobia or also hypersensitivity in relation to sounds. The well-known headache is the leading symptom, from which probably every affected person suffers. The affected side on which the headache occurs is the same in many patients. The stabbing pain builds up over two hours, so that in many cases even nausea attacks can occur. The pain often has a restless and agonizing character, so that the ability to concentrate also decreases. Very simple activities such as climbing stairs can only be performed with great difficulty and effort. As a result, the general performance of the affected person is also very severely limited. A dry mouth at night is also a common symptom that occurs in connection with a migraine. A migraine has very distinct symptoms, so affected individuals can often make an explicit diagnosis themselves. Those who want to achieve relief should definitely seek medical and drug treatment. Otherwise, there is a risk that the respective symptoms will intensify and worsen considerably.
Course of the disease
The course of a migraine is shaped in five phases:
- Preliminary phase: during the preliminary phase of a migraine occur either particularly hypersensitivity of the senses, ravenous appetite and hyperactivity or the complete opposite, i.e. fatigue, fatigue, nausea and sometimes constipation.
- Auraphase: as the name itself accurately describes, a kind of aura develops in the aura phase, which is characterized mainly by visual disturbances and other neuronal-visual abnormalities.
- Headache phase: here the typical, drilling, throbbing, pulsating or stabbing headache occurs. Nevertheless, the pain can occur in different places in sufferers. In most patients, the headache occurs particularly on the forehead. This phase is accompanied by sensitivity to light, noise, nausea and sometimes vomiting. Some patients suffer so severely that they can only rest or lie motionless in darkened, silent rooms. The duration of the headache phase is usually 4 to 70 hours.
- Regression phase: In this phase of migraine, the pain and symptoms decrease again. Those affected feel at the same time limp, tired and exhausted.
- Recovery phase: at the end of the migraine course then sets the recovery phase, which requires up to two days. Only then are the migraine attack and the headache completely gone.
Complications
Migraine can be accompanied by various complications. First and foremost among the dreaded long-term consequences is chronic migraine. Doctors speak of a chronic form when migraine symptoms appear on at least 15 days a month. The length of the pain is irrelevant. Frequent attacks occur mostly in migraine without aura. Another migraine complication is the so-called status migraenosus. In this form of migraine, the symptoms last longer than 72 hours despite medical treatment. In addition, frequent vomiting occurs, which in turn poses the risk of dehydration. Sometimes even the circulation of the affected person collapses, so that inpatient therapy in a hospital is necessary. Until a status migraenosus occurs, it often takes many years, during which migraine attacks occur again and again and numerous medications are administered. Another sequelae is the migrainous infarction, which is a cerebral infarction. It is accompanied by an aura that lasts for over an hour. One of the rare complications of migraine is persistent aura. In this case, the aura symptoms last longer than a week. However, a cerebral infarction cannot be detected in this case. In most cases, the aura symptoms occur on both sides. Permanent brain damage is not to be feared from persistent aura, in contrast to migrainous infarction.
When should you see a doctor?
With a recurrent migraine, for making a diagnosis, a doctor should be consulted. Therefore, any patient who has ever suffered from a migraine or suspects that migraine is behind recurrent headaches should see a doctor. First of all, the attending physician needs to diagnose the migraine with certainty and rule out any other diseases that could cause such symptoms. Then a form of treatment must be found that enables the patient to enjoy as much quality of life as possible despite the migraine. If the migraine is severe, or if the migraine attacks are so distressing that they make the patient unable to work, the patient should see the doctor again, because there are good treatment options nowadays. If the symptoms of a migraine change, become worse or significantly better, the doctor should clarify the cause. The accompanying symptoms of migraine also occur with other diseases. However, migraine patients would possibly overlook such symptoms or not take them seriously, since they already know them from the migraine and attribute them to it. Changed symptoms can also occur because the medication is no longer tolerated – in which case a change in dosage or active ingredient by the doctor may be necessary.
Treatment and therapy
The treatment or therapy of migraine usually drags on for years. Often, a complete cure is not possible or is not on the horizon. To date, migraine treatment has relied primarily on medications and other therapeutic measures. The main goal is to alleviate the headache and other symptoms or migraine. Independently one can achieve a reduction of the headache above all by cold compresses, Migränebrille, much sleep, little stress, retreat of noise and glaring light. Likewise, various foods should be avoided. Migraine-triggering foods can be alcohol, cheese, glutamate and chocolate. Furthermore, therapeutic measures for stress management should be learned and applied. Autogenic training and progressive muscle relaxation have proven promising in this regard. Painkillers should only be taken in consultation with the attending physician. These include antiemetics for nausea and analgesics (e.g. paracetamol, ibuprofen) for the pain. For mild headaches, strong coffee sometimes helps, as caffeine can be analgesic.
Outlook and prognosis
Migraines can take very different courses.Some people unfortunately suffer recurrent severe migraine attacks, others have irregular attacks that can be treated with medication. The prognosis depends on the intensity and cause of the migraine. In most cases, drug therapy using beta blockers, painkillers or anticonvulsants such as topiramate is sufficient. Severe migraine attacks represent an enormous burden in everyday life for those affected. Although the attacks decrease with age, the intensity can increase. The prognosis tends to be negative, especially if the patient leads an unhealthy lifestyle. Chronic migraine patients usually suffer from the symptoms throughout their lives. In children during puberty, the prognosis is better. The migraine usually subsides after a few months without any long-term consequences. In affected women, migraine often subsides during menopause, in men during andropause. However, migraine usually requires ongoing therapy, as symptoms may return after months or years. Life expectancy is not reduced by migraine, but quality of life is greatly reduced with forms of migraine such as cluster headaches.
Prevention
Migraines are difficult to prevent. Nevertheless, a life without stress, a lot of exercise or sports in nature or fresh air are among the most important preventive measures here. Likewise, attention should be paid to a healthy diet with sufficient minerals and trace elements. Smoking and alcohol are taboo for migraine patients. Autogenic training can be good for some sufferers against stress and thus also preventMigräne.
Aftercare
The recurring attacks of pain put an enormous strain on the psyche and body. Headaches lead to hypercirculation in various parts of the body and are usually accompanied by high blood pressure and other symptoms. Impaired vision can lead to accidents and falls if the sufferer suddenly suffers a migraine attack. In the long term, this can also lead to the development of anxiety disorders. Since emotional stress promotes the attacks, it is important for migraine patients to be particularly mindful of their mental balance. Excessive stress situations should be avoided; instead, balancing sports such as jogging and yoga or swimming can help to relax the mind and increase well-being. Plenty of fresh air and long walks should occur every now and then in the course of the day to prevent mood swings, irritability and depressive moods. Many migraine patients suffer from hair loss or pallor, for example, and these complaints are caused by the ongoing stress. Sometimes follow-up care should include psychological support.
What you can do yourself
Keeping a pain diary helps track down possible migraine triggers. If certain foods are responsible for the pain attacks, they must be consistently avoided. Migraine headaches caused by the female cycle can often be positively influenced by changing the contraceptive method: switching to a birth control pill without estrogen, for example, can bring improvement. Learning relaxation techniques such as yoga or Jacobson muscle relaxation can counteract stress-induced migraines, and regular sports activities also help to reduce stress. A regular daily routine with sufficient rest breaks should also be emphasized. In an early phase of a migraine attack, home remedies can ward off an attack or weaken its course. Medicinal herbal preparations with willow bark, butterbur or redbush have proven to be effective – this also ensures an increased fluid intake, which should not only be paid attention to during an acute attack. Alternating showers, treading water or cold arm baths can help as long as the pain has not yet fully set in. Grated ginger is an effective remedy for nausea and can prevent headaches in some cases if taken in time. If it is not possible to ward off the migraine in the early stages, an attack is best survived in a quiet, darkened room. Painkillers available from pharmacies can provide relief, but a doctor should be consulted in the event of repeated migraine attacks.
