What helps against migraines?

Migraine: what to do?

Migraine treatment is not just to relieve an acute migraine attack. Just as important is the preventive migraine treatment (migraine prophylaxis). In both cases, drug and non-drug treatments help with migraine. Most importantly, sufferers can significantly influence the severity and frequency of attacks through their own behavior.

Avoid migraine trigger

In order to reduce the frequency of attacks, those affected should avoid triggering factors. These can be, for example, certain foods.

In many cases, an attack is also triggered by missed meals or too little fluid. The answer to the question “Migraines – what to do?” Is: regular eating and adequate hydration.

Above all, stress is a central migraine trigger. For sufferers, therefore, rest and relaxation are important factors for prevention. Try to slow down your daily routine and find out about suitable stress management measures. Above all, make sure you have regular breaks in hectic everyday life, preferably in an undisturbed place. Even with just a few minutes of targeted break and relaxation, you can preventively do something with migraine. It is also very helpful to practice relaxation exercises regularly.

Already react at the first signs!

During an acute attack, the person is best retreating to a darkened room, switching off noise sources such as television or radio and lying down. A suitable analgesic should be taken as early as possible, ie already at the first harbinger of a migraine attack. This sometimes stops the seizure because the analgesic is more effective if taken early. On the other hand, it is important that the painkillers are not taken too often because otherwise they themselves can trigger headaches (drug-induced headache). So you can preventively do something with migraine.

Migraine therapy: medication

Migraine therapy: medications in a migraine attack

At the first signs of a migraine attack, the person concerned takes an “antiemetic” such as metoclopramide or domperidone. It not only counteracts nausea, but also enhances the effect of the subsequently taken analgesics. For pain therapy of an acute migraine attack are suitable depending on the severity of the symptoms:

• mild to moderate migraine: non-steroidal anti-inflammatory drugs (NSAIDs) such as paracetamol, aspirin and ibuprofen, with the latter being best demonstrated.
• severe migraine: triptans and ergot alkaloids (ergotamine)

Non-steroidal anti-inflammatory drugs (NSAIDs)

High-dose analgesics from the group of NSAIDs (NSAR = non-steroidal anti-inflammatory drugs) are suitable for mild to moderate migraine attacks. These drugs include acetylsalicylic acid (ASA) and ibuprofen. Also, the painkiller acetaminophen can be used. Often, combined preparations of ASA, paracetamol and caffeine, ibuprofen or naproxen are given. The triple combination of ASA, paracetamol and caffeine proved to be more effective in studies than the single substances and the combination without caffeine. It is therefore recommended by the German Migraine and Headache Society as a first-choice drug. The threshold for the emergence of a headache, which results from the overuse of analgesics, lies with these combination preparations when ingested for more than ten days per month. By comparison, it is 15 days a month for single preparations.

triptans

Triptans are used in severe migraines, such as sumatriptan, zolmitriptan, almotriptan and naratriptan. As so-called serotonin receptor agonists, they bind to the same receptors in the brain as the neurotransmitter serotonin. So it can not dock, which reduces the headache and its accompanying symptoms (such as nausea). At the same time, the blood vessels in the brain narrow, which can relieve the pain of a migraine.

Triptans are available in tablet form, as a suppository, nasal spray or as an injection under the skin. They work best when used as early as possible in the headache phase of an acute attack.

The two triptans Almotriptan and Naratriptan are now also available without a prescription. Nevertheless, in any case a medical consultation before taking triptans is necessary. Because the active ingredients should not be used for example in a migraine accompagnée in the aura phase or in Migraine sans migraine.

In addition, triptans must not be used in certain diseases. These include, for example, coronary heart disease (CHD), untreated high blood pressure, Raynaud’s syndrome, severe kidney and liver dysfunction and strokes. For children under 12 years triptans are also not suitable.

Ergot alkaloids

Another group of medicines that can help with migraines are the ergot alkaloids (Ergotamine). However, they have strong side effects and should therefore only be used if individual migraine attacks are particularly long or other medications have no effect. Ergotamine derivatives are not suitable for people at high risk for cardiovascular disease (such as heart attack and stroke). Even children under the age of twelve should not take ergotamine. Other recommendations for the treatment of migraine apply to this age group.

Herbal migraine medicines

Herbal medicines (phytotherapeutics) are becoming increasingly popular. For use in migraine are mainly preparations from butterbur and feverfew. In fact, butterbur has been shown to reduce migraine symptoms. The medicinal plant was therefore included in the current guidelines for migraine treatment. Likewise, feverfew can fight migraine symptoms. It has a calming effect, but can also relieve nausea and vomiting.

Follow the instructions of the doctor when using phytotherapeutics. It is a widespread misconception that medicinal plants and preparations made from them are basically harmless. As with chemical preparations but must also be considered in herbal instructions and possible contraindications. Before the migraine treatment should be clarified, for example, with a blood sample, if the kidney and liver function are normal. The intake of the preparations is therefore recommended only after express medical advice.

Migraine therapy: medication for prevention

Medicines for migraine prevention (migraine prophylaxis) are only used when non-pharmacological prophylactic measures do not help sufficiently. Basically, a medical migraine prophylaxis should be considered in the following situations:

• There are more than three migraine attacks per month.
• The frequency of attacks increases noticeably.
• The attacks take more than 72 hours.
• The person has to take painkiller or migraine more than ten times a month.
• The attacks do not improve enough despite medication intake, or the drugs are not well tolerated.
• The attacks are associated with pronounced neurological deficits.
• The quality of life, professional tasks or school attendance are significantly affected by the migraine seizures.
• From the previous history, a migraine infarction is already known.

For the preventive treatment of migraine first and second choice drugs are available. First, a prophylaxis with drugs of first choice is tried. If these reduce the seizures neither in their strength nor in their frequency, it is switched to second-line drugs.

Migraine prophylactic drugs of first choice are:

• Antiepileptic drugs (anticonvulsants) such as topiramate or valproic acid (may only be given with safe contraceptive methods due to its teratogenic effects in women of childbearing potential)
• Beta-blockers such as metoprolol or propranolol
• Calcium antagonists such as flunarizine
• Tricyclic antidepressants such as amitriptyline

Second-line migraine prophylactics are:

• Antidepressants from the group SNRI such as venlafaxine
• other antiepileptic drugs such as gabapentin (studies have contradictory results)
• Acetylsalicylic acid (has poor scientific evidence)
• Butterbur extract (Petasites hybridus)
• Magnesium and vitamin B2 (riboflavin), combined with coenzyme Q10, omega-3 fatty acids, berry extracts and vitamins reduces the severity of migraine attacks, but not the frequency

Botox for migraine

Since the fall of 2011, the neurotoxin onabotulinum toxin A has been approved for chronic migraine for the prevention of attacks. Adults who have been suffering from migraine headaches for at least 15 days a month and who have had no previous medication may be treated. The Botox is administered as a syringe. The treatment should be performed in specialized headache centers.

Non-drug migraine therapy

In addition to medicines, there are a number of ways to treat a migraine additionally or alternatively. Behavioral therapy has proved to be particularly effective for the prevention of migraine attacks. Some procedures can also help with acute pain attacks.

consultation

A first important, non-drug measure is the detailed consultation and education about the disease by the attending physician. It alone can significantly reduce the frequency of seizures. This is especially true for children with migraine.

Cognitive behavioral therapy

A central component of non-drug migraine therapy is cognitive behavioral therapy (CBT). The overarching goal is to become an expert in their own right, who can use different coping strategies depending on the situation.

For this purpose, the patient analyzed and improved, among other things, his handling of stress as part of a single or group therapy. Also, certain negative thought patterns are processed that can cause stress. Overall, patients develop a stronger sense of self-efficacy and control. This means that they no longer feel powerless from the attacks, but dare to be able to influence their illness.

In an acute migraine attack pain relief procedures help. Patients learn to distance themselves from pain, for example in the form of attention control and imagination exercises.

Above all, cognitive behavioral therapy helps patients who are very ambitious and have high expectations of themselves, patients in whom stress is the main trigger and those who suffer from pronounced depressive symptoms. Even patients, in which the migraine attacks occur very frequently, benefit particularly. But also other migraineurs a combination of cognitive behavioral therapy and drug therapy often helps better than just taking medication.

relaxation techniques

Learning a relaxation procedure such as Autogenic Training or Progressive Muscle Relaxation (PMR) according to Jacobson is also useful for migraine sufferers. With their help, the migraine patient can reduce the frequency and severity of his attacks and often comes with fewer painkillers. After a briefing by a therapist, patients should complete the exercises daily. It is easier to learn and to integrate better into everyday life, the progressive muscle relaxation. Autogenic training is more complicated to learn and requires more practice, but also offers opportunities for positive self-conditioning.

biofeedback

Also help with migraine can offer the so-called biofeedback. Using sensors and acoustic or visual signals based on an EEG or computer tomograph, patients learned to control autonomic nervous system functions that are usually unconscious. By willpower, for example, you will then be able to narrow your right or left temporal artery even in an acute attack. Too much blood circulation in this area is considered as a possible cause of a migraine attack.

Sports

Regular preventive sports activities (endurance sports, exercise therapy) can especially reduce the intensity of pain during a seizure. However, this does not significantly affect the number of attacks. Especially moderate endurance sports are recommended, for example three times a week for 40 minutes.

Alternative cures for migraine

Many patients ask themselves: What helps against migraine beyond conventional medical treatment? An answer to this is provided by naturopathically trained physicians and alternative practitioners. They recommend herbal medications, acupuncture or even home remedies for migraines.

Acupuncture for migraine

Acupuncture is used for a wide range of ailments and ailments. Meanwhile, she finds her application also in migraine. The placement of the needles should alleviate both the frequency and intensity of migraine attacks – but only preventively. An acupuncture session usually lasts about half an hour. The setting of the needles is noticeable, but does not usually hurt.

Experts recommend two sessions a week at the start of acupuncture migraine treatment. After only 15 sessions, the complaints were significantly reduced. Thereafter, only regular refresher sessions of acupuncture follow.

A comparison of acupuncture with sumatriptan injected under the skin showed approximately equally good results at the beginning of a migraine attack. In an already pronounced pain symptoms acupuncture was clearly inferior.

Acupuncture does not cure migraine, but in the long term it can increase the quality of life of many people affected by the reduced pain.

Acupressure in migraine

An alternative method according to the same principle as acupuncture is acupressure. Migraine complaints are relieved by gentle pressure on specific parts of the body. Overall, acupressure shows less success than acupuncture.

Homeopathy for migraine

Many patients swear by homeopathy. In the opinion of many naturopathic oriented doctors and alternative practitioners, migraine should actually be particularly effective here. In scientific studies, however, a clear effect has not yet been proven. Homeopaths, however, often have more time for their patients and thus can often reveal the individual triggers of migraine in a detailed conversation.

The answer of a homeopath to the question “What helps with migraines?” Depends on the type and severity of the symptoms. Recommended are for example:

• Iris versicolor: especially in migraine with pronounced aura and nausea
• Belladonna: especially with throbbing headache with severe nausea and vomiting
• Bryona: if even the slightest touch leads to severe headaches
• Gelsemium sempervirens: when the pain draws from the back of the head to the eyes
• Sanguinaria: especially with very severe pain
• Nux vomica: in migraine, which is triggered by anger, rush and sheep shortage

Virtually all homeopathic remedies are available in the form of tablets, liquid extract or globules. Migraine attacks are usually treated with C30 potency.

Migraine: Schüssler salts

Many people report positive experiences with the use of Schüssler salts. Migraines can be treated with various Schüssler salts. Pharmacists and non-medical practitioners especially recommend the following:

• No. 7: Magnesium phosphoricum
• No. 8: sodium chloratum
• No. 14: Potassium bromate
• No. 21: Zincum chloratum
• No. 22: Calcarea carbonica

You can use several Schuessler salts for migraine, but never more than three salts at the same time. For adults with migraine, the recommendation is to take one to three tablets three to six times a day. Children can take one to two tablets one to three times a day, depending on their height and weight.

Especially in migraine, which is triggered by stress, nervous or mental overload, taking magnesium can prevent migraine attacks. Therefore, there are appropriate mineral supplements in the pharmacy or drugstore. But also in the form of Schüssler salts magnesium should help with migraine.

Migraine therapy according to Kern

Core Migraine Therapy is a special concept that will help you to control your migraine headache as much as possible yourself. It contains the following components:

• manual migraine treatment
• Bewegungsschulung
• Mental training

The basis of migraine therapy according to Kern is to be able to localize the migraine symptoms. Depending on the location, another treatment may be considered. In addition, it teaches how to classify the symptoms according to their strength into different stages and assign the pain to different anatomical structures. With special handles (manual migraine treatment), the doctor can release tension and movement blocks, for example in the neck or shoulder area. This positive experience is intended to erase the pain memory and cause the person affected

Diet in migraine

In almost all migraineurs, an acute attack is triggered by individual trigger factors. Thus, some foods can trigger or increase a migraine attack. Why this is so, is largely unclear. In many cases certain ingredients in foods, called biogenic amines such as tyramine and histamine, appear to be responsible. Because many people report migraine attacks after eating red wine, aged cheese, chocolate, sauerkraut or bananas – all food with biogenic amines.

The flavor enhancer Sodium Glutamate is generally considered a potential trigger of headache. Caffeine can also induce headaches. In some cases, however, the opposite also leads to migraines: Many people who regularly drink coffee during the work week react to caffeine-free weekends with a “weekend migraine”. Similarly, cold ice cream can provoke a migraine attack. However, this is not done by certain ingredients in the ice, but by the cold, which irritates certain structures in the brain.

Migraine Diary

There is no universal migraine diet! Because not every person reacts to histamine, caffeine & Co. with a migraine attack. It therefore does not make sense to forego certain foods from the outset. Instead, you can keep a migraine diary for a while: write down everything there about eating and drinking and the onset of migraine attacks.

It may be possible to identify a specific trigger from the records over time: If you notice an accumulation of migraine seizures after eating a particular food, you should try to avoid it in the future to see if the migraine seizures in the result will be less. Keep in mind, however, that there are usually a few hours, sometimes even a whole day, between taking a food and an attack. In addition, you may not be able to tolerate a particular food unless other interfering factors are added.

Home remedies for migraine

Home remedies for migraine have the advantage that they usually do not burden the organism by pronounced side effects. On the other hand, the effect of migraine home remedies is usually not scientifically confirmed. Physicians and psychologists suspect that in many cases, the belief in a particular home remedy alone can lead to an actual improvement.

peppermint oil

There are a variety of different home remedies: Migraines and other headaches should be relieved, for example, with peppermint oil. Recommended is a tummy massage with the essential oil.

Arm and foot baths

If the migraine starts with a feeling of warmth in the head and cold feet and / or hands, a rising arm or foot bath can help, ie a partial bath with a slow increase in temperature. Alternatively, you can take a rising bath. If you want, you can add rosemary, arnica or spruce needles as a bath additive. These stimulate the circulation and at the same time ensure that the muscles relax.

Instead of warmth, other migraine patients benefit from cold: Through a cold arm or foot dip, the blood vessels in the arm / foot and reflexively narrow the arteries in the head, which are painfully stretched. In bladder, kidney and abdominal inflammations cold baths are not allowed! In addition, some cool compresses on the forehead.

Even with warm-cold alternating showers, you can do something for migraine. Drinking vanilla extract dissolved in water, fresh vegetable, grape or fruit juices with fresh ginger extract should also help.

Migraine therapy: pregnancy and lactation

A special case is pregnant women and breastfeeding mothers with migraine. What do you think about migraine medicines? Basically, all medicines – even over-the-counter medicines – should only be used after consultation with a doctor during this time. He knows best which active ingredients are most harmless for mother and child.

Paracetamol may be used for example for migraine treatment, acetylsalicylic acid (ASA) only in exceptional cases. For prophylaxis, metoprolol, propranolol and amitriptyline can be used during pregnancy. Triptans should not be used during pregnancy. As they pass into breast milk, a breastfeeding period of at least 12 hours after the last dose of triptan must be observed during breastfeeding. Ergotamines must not be taken during pregnancy or while breastfeeding.

However, in most cases, pregnancy is a positive influence on a migraine. According to the German Migraine and Headache Society, the frequency and intensity of migraine attacks are reduced in approximately 70 percent of migraine patients during pregnancy and lactation. Responsible for this should be the female sex hormones. After pregnancy, however, migraine recurs in many cases.