What is Migraine?
Migraine is more than just a severe headache. It is a complex neurological inflammatory response characterized by recurrent, often unilateral headache attacks. These attacks can last between 4 and 72 hours in adults and are usually accompanied by other symptoms. The most common include nausea, vomiting, light sensitivity (photophobia), and sound sensitivity (phonophobia).
Migraine often runs in families, indicating a genetic component. However, the exact cause of migraine is not yet fully understood. It is believed that a combination of genetic predispositions and environmental factors plays a role. Various triggers such as stress, hormonal changes, certain foods, weather changes, or lack of sleep can provoke a migraine.
Migraine without Aura: Recognizing Symptoms and Differences
Migraine without aura is the most common form of migraine and affects about two-thirds of patients. The main symptoms are intense, pulsating headaches that often affect only one side of the head. These headaches can range from moderate to severe intensity and may worsen with physical activity. Other accompanying symptoms include nausea, vomiting, and increased sensitivity to light and/or sounds.
In contrast to migraine with aura, the preceding neurological symptoms are absent here. It is also important to rule out other possible causes of the headache. A thorough discussion with a doctor and a detailed medical history, including a neurological examination, are therefore essential.
Migraine with Aura – What Does It Mean for Affected Individuals?
A specific form of migraine is migraine with aura. About one-third of migraine patients experience this form, where neurological symptoms precede or accompany the headaches. These symptoms, referred to as aura, can be visual, sensory, or motor. The most common visual auras include flickering vision, zigzag lines, and visual field defects. Sensory auras may include tingling or numbness, while motor auras can be associated with speech disturbances or weakness.
The aura typically develops over 5 to 20 minutes and lasts less than an hour. The subsequent headaches are often more severe and longer-lasting than those with migraine without aura. For those affected, the aura can be frightening, especially when it occurs for the first time. It is important to seek medical advice to confirm the diagnosis and discuss appropriate treatment options.
How Migraine Medications Effectively Relieve Pain
The treatment of migraine aims to reduce the intensity and duration of headaches as well as alleviate accompanying symptoms. There are various groups of medications that can be used for migraine:
1. Acute Medication
These medications are taken when a migraine attack begins to relieve symptoms. This includes:
- Analgesics: Pain relievers such as paracetamol, ibuprofen, or aspirin.
- Triptans: Specific migraine medications like sumatriptan, rizatriptan, or zolmitriptan that specifically target migraine pain.
- Gepants: New, specific migraine medication, e.g., rimegepant.
- Antiemetics: Medications for nausea and vomiting such as metoclopramide or domperidone.
2. Prophylactic Medication
These medications can reduce the frequency and severity of migraine attacks. This includes, for example:
- Magnesium and vitamin B2
- Beta-blockers: Such as propranolol or metoprolol.
- Calcium antagonist: Flunarizine.
- Anticonvulsants: Such as topiramate or valproic acid.
- Antidepressants: Such as amitriptyline or venlafaxine.
- Antibodies against CGRP or the CGRP receptor: e.g., eprinezumab, fremanezumab.
At Medgate, you can request the following migraine pain medications by prescription:
All medications are selective 5-HT1 receptor agonists and effectively relieve migraine symptoms by constricting dilated blood vessels in the brain. They also inhibit the release of pro-inflammatory substances, thus reducing pain and accompanying symptoms such as nausea and light sensitivity. This includes the following medications:
- Sumatriptan: available as tablets, nasal sprays, and subcutaneous injections
- Eletriptan: primarily in tablet form as Eletripta and Relpax
- Rizatriptan: available as tablets and meltable tablets, known as Maxalt
- Zolmitriptan: offered as tablets, meltable tablets, and nasal sprays
- Almotriptan: available as tablets under the name Almogran
- Naratriptan: in tablet form as Naramig and Menamig, with specific dosage instructions
Use and Administration of Migraine Medications
The correct use and administration of migraine medications are crucial for their effectiveness. Here are some general guidelines:
- Acute Medication: These medications should be taken as early as possible after the onset of a migraine attack. Triptans, for example, work best when taken right at the start of the headache. However, if there is an aura, one should wait a little longer before taking them until the aura has passed.
- Prophylactic Medication: These medications are taken monthly or every 3 months to be effective. It is important not to interrupt the intake, even if migraine attacks become less frequent.
- Dosage: Always adhere to the prescribed dosage and your doctor's instructions. An overdose can lead to serious side effects.
- Combination: Sometimes it may be necessary to combine different medications to achieve the best possible relief.
Side Effects and Interactions of Migraine Medications
The most common side effects when taking migraine medications are:
- Triptans: Fatigue, dizziness, hot flashes, and a feeling of pressure in the chest. They can rarely cause cardiovascular problems.
- Non-steroidal anti-inflammatory drugs (NSAIDs): Gastrointestinal issues, such as stomach pain, nausea, and in rare cases, ulcers or bleeding.
- Prophylactic Medications: Beta-blockers can cause fatigue and dizziness, anticonvulsants can lead to weight loss and concentration problems, and antidepressants can cause dry mouth, weight gain, and drowsiness.
Interactions with other medications are also possible. Some combinations can affect the efficacy of migraine medications or increase the risk of side effects. Always discuss the intake of migraine medications with a doctor beforehand to avoid interactions.
Who Should Not Take Migraine Pain Medications?
Not all patients are suitable for taking certain migraine medications. The following groups of people should be cautious or avoid taking them:
- Pregnant and breastfeeding women: Some migraine medications are contraindicated during pregnancy or breastfeeding. Discuss alternative treatments with a doctor.
- Individuals with cardiovascular diseases: In particular, triptans can increase the risk of heart problems and are often not suitable for patients with existing cardiovascular diseases.
- Patients with kidney or liver diseases: The dosage of many medications must be adjusted for patients with impaired kidney or liver function to avoid side effects.
- People with certain allergies: If you are allergic to any of the ingredients in a medication, you should not take that medication.
It is crucial to inform your doctor about all existing health issues before starting a new medication.
Prevention of Migraine: Effective Strategies
In the case of chronic migraine, defined as headaches on 15 or more days per month, prevention plays a central role. Here are some proven strategies for migraine prevention:
- Medication Prophylaxis: Regular intake of prophylactic medications, such as beta-blockers, anticonvulsants, or antidepressants, can reduce the frequency of attacks.
- Lifestyle Changes: Regular sleep, a balanced diet, and adequate hydration are essential. Avoid known triggers such as alcohol, caffeine, and certain foods.
- Stress Management: Techniques such as yoga, meditation, and progressive muscle relaxation can help reduce stress and prevent migraine attacks.
- Exercise: Regular moderate physical activity. However, be careful to avoid extreme physical exertion, which can trigger migraines in some people.
- Cognitive Behavioral Therapy: Cognitive behavioral therapy can help improve coping with migraine and reduce the frequency of attacks.
Natural and Alternative Treatments for Migraine
In addition to medication treatment, there are also natural and alternative approaches that can help with migraines
- Acupuncture: Some studies have shown that acupuncture can reduce the frequency and intensity of migraine attacks.
- Magnesium: A deficiency in magnesium has been linked to migraines. Taking magnesium supplements may be helpful for some patients.
- Riboflavin (Vitamin B2): High doses of vitamin B2 have shown in studies that they can prevent migraine attacks.
- Biofeedback: This technique helps patients control their physical reactions to stress, which can reduce migraine attacks.
Disclaimer
The articles are for informational purposes only and should not be used for diagnostic or therapeutic purposes. They do not replace personal medical advice and treatment. Medgate has carefully compiled the information but cannot guarantee the accuracy and completeness of the information. Medgate accepts no liability for any damages that may arise from the use of this information. Are you sick and need help? Our doctors are available 24/7 via the Medgate app.