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MIGRAINE More than "just" a headache


The excruciating pain of a migraine can drive us insane. But what exactly is migraine anyway? And what are the symptoms of this type of headache?

These symptoms suggest a migraine headache

Two out of three adult Germans regularly suffer from headaches. Around 18 million of these people have a particularly severe form of headache: migraines. Symptoms vary from person to person - even the same person can experience different migraine attacks. However, it is characterized by a periodically recurring, sudden, pulsating, and often unilateral headache. What signs can indicate a migraine? An overview of the most common symptoms, side effects, and triggers.

Why does it hit women in particular?

"She has her migraines again!" The sentence is more of reproach than a statement. In fact, it wasn't long ago that even medical professionals did not regard migraines as a disease, but as the imagination of female hysteria. Or as an excuse when a woman didn't want to know anything from a man.

The pulsating headache affects mostly women, but at least 22 percent of male Germans. In childhood, there are even slightly more boys than girls with migraines, and it is only through puberty that many women are affected. The female sex hormones, the estrogens, are responsible.

But the sudden drop in estrogen levels before the menstrual period is usually just one of several possible triggers. Only about one in ten actually has seizures just before or during their period. Usually, there is a second trigger. However, if there is a direct connection to your period, you can try whether a (prescription) estrogen gel helps: Apply it just before and during your period to alleviate the estrogen deprivation during menstruation. Taking birth control pills without taking a pill break can also help to balance the hormonal balance and reduce the number of migraine attacks.

Unfortunately, the disease doesn't stop with menopause either. It is usually only temporarily more bearable for affected women: during pregnancy. "This is the best way to prevent migraines, so to speak," says Professor Hartmut Göbel, head of the Kiel Pain Clinic. Because expectant mothers have consistently high hormone levels and often live healthier lives.

Is there a migraine character?

Migraineurs are at best as special, at worst as exhausting - they supposedly always want to think everything through and ahead, to do everything perfectly. The reality check, however, leaves little of it: the typical migraine character does not exist. There are numerous perfectionists and fearful brooders who keep a painless head for life.

But even if the illness is not a question of personality, many favor the seizures through their behavior: They are overactive, do not allow themselves a break, and do not notice when they overwhelm themselves. Only the migraine attacks force them to rest. This is another reason why the complaints are often a family affair: mother and father not only pass on certain migraine risk genes but often also their way of dealing with stress or their inability to deal with it. For many, headaches, their frequency, and severity change when they change their behavior, for example through regular relaxation exercises or stress management training.

What is actually going on in your head?

Evil spirits, divine visions, or an excess of bad digestive juices: our ancestors were ingenious in finding explanations for the attacks of pain. Today research has a pretty accurate picture of what is going wrong in the brain of someone with migraines. In certain situations, it floods itself with neurotransmitters.

To get rid of them, the brain starts an inflammatory response. The inflamed veins become more and more sensitive to pain until even the pulse seems to thunder like a hammer against the vessel walls. This creates the typical pulsating pain character.

About 15 percent of those affected experience what is known as an aura before the pain starts. Mostly they see flickering spots or flashes of light, more rarely paralysis, speech disorders, or hallucinations occur. The reason for these misperceptions is an excitation wave that travels over the nerves of the brain surface at the beginning of the attack.

And where is the switch please?

Most migraineurs have a long list of what hits the hammer in their head and when: chocolate, red wine, the smell of savoy cabbage stew, sudden rain from the northeast, or the Saturday after a busy week ... Sometimes it is not that easy, to identify a clear culprit.

Chocolate, for example, is usually wrongly suspected. Because migraines begin with a one to two-day pain-free phase in which many sufferers are irritable and tired - or hungry for sweets. Anyone who then eats chocolate may have pain afterward, but the real cause lies elsewhere. Usually, a combination of several factors leads to the attack: for example, when the weather and monthly hormone changes come together.

Unfortunately, the headache attacks do not necessarily go away, even if you find all the responsible factors and avoid them meticulously. Nor is there any drug that will turn off seizures once and for all. There is no cure for migraines. Because behind this is a certain, unchangeable property of the nervous system: It is extremely active, especially in migraine patients.

"The brain can do three things at once and think around five corners," says researcher Hartmut Göbel. But at the same time, it is bad at simply blocking out recurring stimuli. On the contrary: it reacts more sensitively from time to time and so basically rocks itself over and over again.

But then nothing helps, right?

Around half of all those affected treat their seizures on their own without ever having seen a doctor. Many think that medicine or neurology cannot help them anyway. A lot has happened in headache research in recent years. There are now special migraine drugs, so-called triptans, which do not fight the pain but its cause, the inflammation in the blood vessels. Since then, severe migraine attacks can also be treated.

And preventive measures can also be effective: for example with drugs such as beta-blockers or therapies such as the biofeedback process. Even those who have dealt with the pain with themselves for years can be treated successfully. However, it is important to keep a headache diary - this will help the doctor with the diagnosis and subsequent treatment.

Still, it's dangerous to wait. Many sufferers get caught in a fatal spiral: They become more and more cautious, avoid more and more actual or suspected triggers until even the fear of the migraine triggers the next attack.

There is also something good about migraines - really now?

Many people with migraines have very powerful brains. An example: The tension that red lights mean for every motorist decreases from time to time in people without migraines. In migraineurs, however, the brain does not dull in this way. And: women and men with migraines simply switch faster - and not just when driving. And there is another advantage, even if it is of course only statistically valid: women who suffer from migraines have a 30 percent lower risk of developing breast cancer.

Can the pain be ironed out?

Perhaps there was one or the other celebrity among the more random test subjects: They had Botox sprayed away forehead wrinkles and had the feeling that the rejuvenation cure also improved their migraines. Just a psychological effect? Beautiful, young, happy equal to pain relief? No, studies have now unequivocally determined. The reason for the pleasant side effect is probably the muscle-paralyzing effect of the substance. Botulinum toxin type A also relieves migraines - but it is only successful in people with chronic pain.

Relatively strict rules apply to the use of this therapy (no drug overuse, no tension headache, migraines for at least 15 days a month for more than four hours). And it is only paid for by the health insurance company after checking the individual case. Nevertheless, it is a glimmer of hope for some patients because: "Those who suffer every second or third day often have the feeling that they are no longer in control of their own lives," says Dr. Astrid Gendolla. In such cases, targeted Botox injections every three months in the head and neck area can actually help. And if one or the other forehead wrinkle should disappear at the same time, it doesn't really hurt anymore - does it?

"It feels like going blind"

The world's first migraine simulator enables relatives to understand what those affected go through with friends and family.

The test subjects experience everyday situations such as a train journey, a visit to a café, or a stay in light-flooded rooms from the perspective of a migraine patient. The simulator they wear acts as a kind of glasses. The intensity of the symptoms is controlled by the team.

After the experiment, a young woman describes that she felt like she was going blind. In the end, all participants reacted in shock and openly admitted that they had clearly underestimated the suffering so far. This simulation only dealt with the optical perception disorders - the physical pain was not included.


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