Migraine Headache

Symptoms

Migraine occurs in attacks. It may announce itself up to three days before an attack with various precursors (prodromes). These include, for example:

  • Mood changes
  • Fatigue
  • Hunger
  • Frequent yawning
  • Irritability

Aura may occur before the headache phase in up to about one-third of patients:

  • Visual disturbances such as flickering lights, dots or lines, facial loss.
  • Stinging, tingling sensory disturbances or numbness (paresthesias).
  • Speech disorders

Typical complaints of the headache phase include:

  • Unilateral pulsating throbbing headache of moderate to severe intensity localized around the eye.
  • Nausea, vomiting
  • Sensitivity to light, noise, smells and touch.

After a migraine, other symptoms may occur, such as cognitive impairment, fatigue and mood changes (postdrome). Finally, the patients recover. The individual phases (prodrome, aura, headache, postdrome) may overlap. Attacks may occur on more than 15 days per month in chronic migraine, and headaches may last for up to three days. Migraine interferes with personal and professional activities and results in inability to work during an attack.

Causes

Migraine is a neurological disorder that is partially inherited. Several triggers are associated with it. Examples are shown below. However, some of these may also be associated with the symptoms of the prodromal phase:

  • Stress or relaxation after stress
  • Certain stimuli, e.g. psychological, smells, light.
  • Altered sleep-wake rhythm, changes in the daily routine such as a skipped meal.
  • Hormonal fluctuations, menstruation
  • Weather changes
  • Food and stimulants such as alcohol, red wine, cheese, see also under histamine-rich foods.

Diagnosis

The diagnosis is made in medical treatment based on the patient’s history and symptoms. It must be noted that serious diseases such as meningitis can cause similar symptoms. These must be ruled out during diagnosis.

Drug treatment

Drug treatment is used to interrupt a seizure and relieve acute symptoms. Aggravating factors such as light and noise should be avoided, for example, in a darkened room. Antiemetics and prokinetics are effective against nausea and vomiting and are also administered before analgesics to promote their absorption:

  • Domperidone
  • Metoclopramide

Painkillers are administered in a sufficiently high dose. They are also sometimes combined with caffeine:

Triptans are specific migraine medications:

Ditane:

  • Lasmiditan

CGRP receptor antagonists:

  • Ubrogepant

Calcium channel blocker – for selective aura treatment:

  • Cinnarizine

Herbal migraine remedies:

  • Willow bark
  • Motherwort
  • Essential oils: put peppermint oil on the temples.

Ergot alkaloids such as dihydroergotamine and barbiturates are rarely used today because of the adverse effects. Comments on drug treatment:

Non-drug prevention

Drug prevention

The goal of drug prevention is to increase quality of life by decreasing seizure frequency, severity, and length. At the same time, pain medication use should be reduced. Not all of the following agents are approved by regulatory agencies for this indication (selection): beta blockers:

Calcium channel blockers:

  • Flunarizine, verapamil

Antiepileptic drugs:

Tricyclic antidepressants:

  • Amitriptyline

Monoclonal antibodies:

Minerals, trace elements, and vitamins:

Phytopharmaceuticals:

  • Motherwort
  • Butterbur