Migraine

Introduction

A migraine is a headache that is often one-sided and pulsating. The headache is accompanied by other symptoms such as nausea or hypersensitivity to light, noise or odours. In some cases, the headache is preceded by neurological symptoms such as visual or speech disorders or even paralysis. These symptoms are known as an aura.

Specialists distinguish between different forms of migraine. The most important difference is between migraine without aura and migraine with aura, whereby migraine without aura occurs far more frequently (85 per cent without aura, 15 per cent with aura). The exact cause of migraine is still unclear - hereditary factors probably play a significant role, as several family members are often affected by the disease. For some sufferers, stress, hormonal influences, irregular sleep patterns or certain foods trigger the attacks. However, the triggering factors are very individual.

Migraine is a chronic disease and cannot yet be cured. In recent years, however, there have been promising research results that could enable better treatment options in the coming years. In Switzerland, around ten per cent of all adults suffer from migraines, and women are affected three to four times more often than men. Children can also suffer from migraines.

Symptoms

During a migraine attack, headaches often occur as attacks. These headaches usually recur periodically and generally only affect one side of the head, although the pain can also be on both sides. In many cases, the headaches are also accompanied by other symptoms such as nausea, vomiting, sensitivity to odours, light and noise. In 10 to 15 per cent of all cases of migraine, sufferers are plagued by a so-called aura. These are neurological symptoms such as impaired vision or speech and paralysis. These symptoms are known as an aura and can be very similar to a stroke.

Course

A migraine attack can progress in different phases; experts categorise it into four phases. Not all affected persons experience all four phases or experience them with the same intensity: some sufferers only experience two to three phases, while others go through all phases. The four phases of migraine are
Pre-phase (prodromal phase): In this phase, migraines can be heralded by factors such as increased irritability, mood swings, ravenous appetite, hyperactivity or hypersensitivity to sensory impressions. These are so-called "plus factors". These factors are offset by "minus factors" such as tiredness or constipation.

Aura: Ten to 15 per cent of all migraine patients complain of an aura. These are neurological symptoms such as impaired vision or speech and signs of paralysis. In most cases, a visual disturbance develops completely within five to 20 minutes - after 60 minutes at the latest, the flickering in the eyes has disappeared. As a rule, the headache only sets in after the aura.

Headache phase: The headache, which is typical of migraines, usually increases slowly over a period of hours. The pain often only occurs on one side. The stabbing, throbbing or pulsating headache can be accompanied by other symptoms. A migraine attack usually lasts between four and 72 hours.

Recovery phase: During this phase, the symptoms of a migraine subside and the person affected feels exhausted. In addition, complaints may occur that are contrary to the symptoms of the previous phase - for example, loss of appetite.

For any migraine attack that lasts longer than 72 hours, it is recommended that you seek medical clarification in the hospital. A very rare complication is a so-called migraine infarction. In this case, the aura symptoms do not disappear completely within seven days. This in turn can be a sign of a stroke. However, a migraine infarction is very rare.

Causes

The exact cause of migraines is still unclear. Hereditary factors probably play a significant role, as several family members are often affected by the disease. The immediate trigger of the aura is thought to be vasoconstriction with a slight reduction in blood flow in the cerebral vessels, which explains the aura symptoms. During the headache phase, on the other hand, the blood vessels tend to be too wide, which is why those affected experience pulsating and pressing pain.

In addition, certain foods, activities or living conditions can trigger a migraine attack. These triggers are called trigger factors. Examples of such trigger factors are hormonal changes such as menstruation, stress, a disturbed sleep-wake rhythm or certain foods (e.g. chocolate, cheese, alcohol or flavour enhancers such as glutamate).

In many cases, the interaction of various factors favours the occurrence of migraines. This also explains why not just one factor can be recognised as a trigger during an attack. However, the triggering factors are very individual. In addition, there are also courses of migraine that occur without any explainable external influences. Migraines very often occur after stressful periods of life, for example at weekends and during holidays.

Diagnosis

A migraine is diagnosed on the basis of the patient's medical history, the anamnesis, the description of the headaches and other possible complaints. Physical neurological examinations should rule out the possibility that cranial nerves, vision or the sensation of pain and touch are disturbed. The doctor also checks whether the affected person has problems with the cervical spine, teeth or jaw - these complaints can also trigger headaches. In most cases, a diagnosis of migraine can already be made. In some cases, the doctor may recommend additional tests: For example, an electroencephalogram (EEG) reveals increased irritability of the nerves in people with migraines. Imaging procedures such as computer tomography (CT) and magnetic resonance imaging (MRI), on the other hand, show no abnormalities in migraines.

Treatment

Migraines are treated using various methods. In acute migraine attacks, medication helps to relieve the headache and other symptoms. In addition, prophylactic measures such as sports, relaxation techniques or stress management training supplement the treatment. A complete cure is not possible: migraine therapy should alleviate symptoms and prevent further migraine attacks.
Over-the-counter pain medication can help with mild to moderate migraine headaches. Other symptoms, such as dizziness or nausea, are treated with medication prescribed by a doctor.

So-called triptans can be used for severe migraines. Triptans have the same effect as the body's own messenger substance serotonin and also help against the typical accompanying symptoms such as nausea and vomiting. They have a vasoconstrictive and anti-inflammatory effect. Due to their effect, triptans should only be taken after the aura has passed. Triptans are available as tablets, nasal sprays or suppositories.
Taking medication over a longer period of time should always be discussed with your doctor.

During an acute migraine attack, it helps many sufferers to stay in a darkened room, avoid external stimuli and rest. Cold compresses can be applied to the forehead or neck to relieve the pain. Taking the migraine medication early is crucial for correct migraine treatment: if you wait too long, the migraine attack can spread and last for hours or even days.

In the long term, patients can try to avoid their personal trigger factors: A so-called headache diary helps with this. In it, sufferers record the symptoms, possible trigger factors and treatment. The better the triggers are known, the easier it is to avoid them.

Prevention

Migraines can be partially prevented - for example with special medication ("migraine prophylactics"), which are taken during symptom-free phases. This is useful if migraine attacks occur more than three times a month or last longer than 72 hours. Migraines with a long-lasting aura can also be prevented with medication. In principle, the frequency, severity and duration of migraine attacks should be reduced by taking medication prophylactically.

Erenumab, the first antibody for migraine prophylaxis, has been available since 2018. This is injected under the skin once a month. However, it is currently only administered if certain conditions are met - for example, a very frequent migraine that cannot be treated with medication.

The following measures can also help to prevent migraine attacks: sufficient sleep, regular daily routines, avoidance of pressure and stress, recurring relaxation, a balanced diet, adequate drinking and sufficient exercise. Researchers recommend 45 minutes of endurance exercise two to three days a week for migraines. For some patients, a daily intake of magnesium also helps to prevent migraine attacks. However, the intake must be continuous and should be in the correct dosage (400 - 600 milligrams per day).