migraine

Migraine: Short overview

• Description: recurring, severe, mostly one-sided headache attacks
• To shape: Migraine with and without aura, chronic migraine, Migraine sans migraine, vestibular migraine, hemiplegic migraine, basilar migraine, eye migraine, menstrual migraine
• symptoms: attack-like, usually one-sided headache, perceptual disturbances as harbingers (aura), nausea, vomiting, sensitivity to light and noise
• Causes: genetic predisposition, exact mechanism so far not clarified, hypotheses: disturbed messenger metabolism in the brain and reduced blood flow
• Trigger (Trigger): Stress, certain, food, lack of sleep, weather changes, hormone fluctuations
• Diagnosis: on the basis of typical symptoms, exclusion of other diseases by means of imaging techniques (CT, MRI, angiography), EEG, laboratory values, etc.
• Treatment: both preventive and acute medications, avoiding triggers, stress reduction, neurofeedback, behavioral therapy
• Forecast: incurable, intensity and frequency of seizures are reducible, often improves with advancing age, sometimes disappears after menopause.

Migraine: description

People who suffer from migraines have recurring headaches at irregular intervals. They are often accompanied by various other symptoms such as nausea, vomiting or blurred vision. Mostly the pain affects only one side of the head. He is described by those affected as pulsating, hammering or drilling. With physical exertion he strengthens.

A strong migraine can severely limit those affected in their everyday lives. The duration of a single attack is between 4 and 72 hours. The seizures occur at different time intervals. Duration and intensity may differ from time to time.

The most severe manifestation of the disease is the so-called status migränosus. This is what doctors say when a seizure lasts more than 72 hours. This is extremely stressful for those affected and must be treated with medical attention.

Migraine forms

Overall, experts differentiate a variety of migraine forms. This includes:

• Migraine without aura
• Migraine with aura (Migraine accompagnée)
• Migraine sans migraine (aura without headache)
• Vestibular migraine
• Hemiplegic migraine
• Basil’s migraine
• Migraines of the eyes
• Menstrual migraine
• Chronic migraine
• Abdominal migraine

Migraine without aura

Migraine without aura is the most common form of migraine. Typical are attack-like, one-sided headaches of moderate to severe intensity. The pulsating pain is intensified by physical activity and accompanied by nausea but also sensitivity to light and noise. The headache attacks last up to 72 hours.

Migraine with aura (Migraine accompagnée)

In about 30 percent of migraine patients, certain neurological symptoms occur before the headache phase. These symptoms refer to medical practitioners as aura. This form of migraine is also called migraine accompagnée (by franz accompagner = accompany).

Typical aura symptoms are

• Vision problems (flashes of light, flickering, seeing jagged lines),
• Language difficulties,
• Sensations of the skin
• dizziness
• malaise

These symptoms usually last for about half an hour to one hour and then disappear completely again. The cause is probably a temporary lack of circulation in certain areas of the brain caused by a vascular spasm.

Aura or stroke?

For medical laymen, the symptoms that occur in the auraphase are barely distinguishable from those of a stroke. An important feature of the aura, however, is that the symptoms begin rather creeping and slowly increase in intensity. In contrast, a stroke usually occurs very suddenly.

In the hospital, however, computerized tomography (CT) or magnetic resonance imaging (MRI) can accurately determine if it is a stroke or migraine symptoms.

Migraine infarction

A complication of migraine with aura is the so-called migraine infarction. The aura symptoms persist for more than 60 minutes. It can lead to a very pronounced under-circulation of certain parts of the brain that leave lasting damage (ischemic infarction). The reduced blood flow can be visualized using imaging techniques such as CT or MRI.

Migralepsie

Another complication of migraine with aura is so-called migralepsia. This is an epileptic seizure that occurs during or within an hour of the migraine aura.

Aura without headache (Migraine sans migraine)

Mostly, the aura symptoms precede headaches and do not last longer than about 40 minutes. However, an aura can also occur on its own without following a headache phase. This is often referred to as “eye migraine” or simply “migraine without headache” (French: “Migraine sans migraine”).

Of those who suffer from a “classic” migraine with aura, about ten percent occasionally develop auras without subsequent headaches. This migraine form is difficult to treat. In principle, it should be clarified particularly thoroughly, since the same symptoms can also be harbingers of a stroke.

Vestibular migraine

In vestibular migraine, especially the equilibrium system (vestibular system) is affected by migraine. Patients suffer from dizziness and balance disorders. Although headaches are usually noticeable, the focus is on the attack-like disorders of the balance system.

The vestibular migraine is widespread in the opinion of experts. It causes similar symptoms as the inner ear disease Meniere’s disease, with which it is sometimes confused.

Hemiplegic migraine

A hemiplegic migraine (also called “complicated migraine”) is a subtype of migraine with aura. It is very rare and occurs mainly in the family heaped up.

In addition to the symptoms of the Migraine accompagnée, patients with hemiplegic migraine also have movement restrictions. For example, they may be difficult, non-targeted or even impossible to move certain limbs. These symptoms disappear after about an hour. The hemiplegic migraine is mainly associated with genetic defects on the 1st, 2nd and 19th chromosome.

Basil’s migraine

The basilar migraine (basiliarismigraine or migraine of the basiliar type) is also considered a sub-form of migraine with aura. It mainly occurs in young adults. The headache is typically located at the occiput (occipital).

The basilar migraine is named after the basilar artery, which supplies the brainstem and cerebellum with blood. Doctors assume that this artery is temporarily cramping in a basilar migraine. Then not enough blood gets into the brain area that supplies it. Depending on the affected region, typical failure symptoms occur. These include, for example:

• Speech disorder (dysarthria)
• Disorder of movement coordination (ataxia)
• Hearing loss, tinnitus or dizziness
• Visual disturbances such as double vision or visual field defects (black spots in the visual field)
• Disturbance of consciousness
• bilateral sensory sensations (paresthesia)

Locked-in syndrome (LiS)

In very rare cases, a temporary lock-in syndrome (LiS) may occur in a basilar migraine. Although humans are fully conscious, they can no longer move or communicate with their environment. Locked-in syndrome due to basilar migraine may last between two minutes and half an hour.

Migraines of the eyes

There are two types of eye migraine: retinal and ophthalmoplegic migraine.

Retinal Migraine: Retinal migraine is a very rare form of migraine that affects mainly children and adolescents. About one hour before the headache, the retinal migraine begins with visual disturbances such as flicker in front of the eyes, visual field defects (scotoma) or even temporary blindness. All symptoms are only one-sided and disappear at the beginning of the headache phase.

Opthalmoplegic migraine: This also extremely rare form of the disease affects both eyes. Also in ophthalmological migraine, visual disturbances are the most important symptom.

In both forms experts discuss whether they are actually forms of migraine. Some researchers believe that they are more like an expression of other diseases.

Menstrual migraine

In menstrual migraine, medical professionals understand a migraine that only occurs in connection with the menstrual period: It occurs in the period of about two days before to two days after menstruation.

A menstrual migraine shows the same symptoms as a “normal” migraine. However, the symptoms are often more intense and last longer. Menstrual migraine may also occur with or without aura or motor difficulties. About seven percent of all women who suffer from migraines have menstrual migraine. Cause is probably the sharp drop in estrogen levels just before menstruation.

Hormonal migraine

In some women, the migraine attacks are often associated with menstruation, but also in other phases of the cycle. Then one speaks of a menstruation-associated migraine or hormonal migraine.

Chronic migraine

Usually, a migraine only occurs for a few hours or days, with symptom-free time intervals in between. In chronic migraine, patients suffer from migraine attacks for more than three months for more than 15 days a month. In addition, patients also have complaints between attacks.

A migraine without aura becomes more common than a migraine with aura. It should not be confused with analgesic-induced headache. In the latter, over-use pain medications cause headaches.

Abdominal migraine

A special form of migraine is abdominal migraine. It mainly affects children. Abdominal migraine causes a dull ache around the navel. Headaches are usually missing. This can be accompanied by loss of appetite, paleness, nausea and vomiting. An attack of abdominal migraine can last from one hour to several days.

The causes of abdominal migraine are not yet fully understood. However, the classic migraine with headache and the abdominal migraine may have similar causes. Above all, it is important for affected children to be able to rest and relax. Medically, abdominal migraine is rarely treated. Children with abdominal migraine are at an increased risk of developing a classic migraine headache during adulthood.

Migraine in children

In children, migraine headaches often occur bilaterally and mainly affect the forehead and temples. Often, the disease is long overlooked. In many young patients, the symptoms are atypical, as the headache is less pronounced or absent altogether. In addition, dizziness, disturbance of balance and sensitivity to odor are much more common in children than accompanying symptoms in migraine.

Instead, children with migraine are more likely to suffer from symptoms such as lethargy, tiredness, paleness, dizziness, abdominal pain, nausea, or vomiting. In addition, small children can not adequately express their symptoms.

Main trigger stress

Triggering migraine is very often stressful in children. This can be physical, for example because of fatigue, exhaustion, too little drinking or eating but also overstimulation. Likewise, mental stress such as stress at school, conflicts at home or quarrels with classmates in children trigger migraine attacks.

Little medication

The treatment of migraine is slightly different in them than in adults. The focus here is on non-drug therapy. It often works very well with children. These include the most regular daily routine, learning a relaxation procedure or biofeedback.

When supportive medications are needed, children are often prescribed drugs other than adult patients.

Detailed information on this topic can be found in the article Migraine in children.

symptoms

The most important migraine symptom is severe, mostly one-sided headache. In addition, other complaints such as photophobia or hypersensitivity to noise occur. In addition, various neurological deficits (also known as aura) can announce a migraine.

Migraine symptoms in four phases

A migraine can be divided into up to four different stages with different symptoms. They can express themselves differently in each phase. Not every person affected goes through every stage. The four stages are:

• Preliminary phase (prodromal stage)
• Aura phase
• Headache phase
• Regression phase

Symptoms in the migraine pre-phase (prodromal phase)

In about one third of migraine patients, migraine symptoms are manifested by several symptoms hours to days before the actual seizure. This includes

• irritability
• euphoria
• strong mood swings
• digestive problems
• Food cravings or loss of appetite
• Difficulty reading and writing
• remarkably frequent yawning

Migraine symptoms in the aura phase

The symptoms in the aura phase signal that a migraine attack is approaching. This includes

vision problems: The most common aura symptom is blurred vision. Usually single light flashes or zigzag lines appear in the field of vision, so-called fortifications. It is believed that such visual disturbances are said to have influenced, among other things, the style of Vincent van Gogh, who probably suffered from migraine with aura.

Visual field loss (negative scotoma): In addition, visual field defects can occur, so-called negative scotomas. This manifests itself as a black or gray spot in the middle of the field of vision. Here “missing” part of the picture. In rare cases, those affected even temporarily go blind in one eye.

Optical hallucinations (positive scotoma): For a positive scotoma, on the other hand, structures are seen that are not actually there. This type of visual disorder occurs especially in children with migraine. You will see, for example, colorful colors or fantastic figures. Physicians also refer to this phenomenon as “Alice in Wonderland syndrome”.

Tingling and paralysis: In addition to the visual disturbances may also occur tingling in the arms and legs and paralysis in the aura phase. Patients often think of a stroke. In fact, without further investigation, it is difficult even for a physician to distinguish these aura symptoms from those of a stroke. Also suspected to be potentially seizure-related are complaints such as balance disorders and speech disorders. Digestion then brings a brain scan (MRI).

Migraine symptoms in the headache phase

The duration of the migraine headache varies from a few hours to up to three days. The period can change from attack to attack again and again.

Strong, unilateral headache: The main symptom of migraine is the recurring, often severe headache. In two-thirds of those affected he appears only on one side. It manifests itself individually in different head regions, but usually behind the forehead, at the temples or behind the eyes. Those affected often describe it as pulsating, boring or hammering. The intensity of headache typically increases slowly over the course of hours. In contrast, a stroke or a cerebral hemorrhage would suddenly trigger the pain.

Nausea and vomiting: Common concomitants are nausea and vomiting in migraines. Scientists suspect the reason for this in the disturbed serotonin household in many sufferers. Serotonin is a messenger (transmitter) in the body that works both in the brain and in the gastrointestinal tract and in many other areas of the body.

Light and sound sensitivity: During an acute migraine attack many sufferers are extremely sensitive to loud noises or bright lights. How it comes to this phenomenon is not clear so far. In any case, sufferers should avoid appropriate stimuli during an acute attack. It often relieves migraine symptoms as patients retire to a quiet, darkened room.

Strengthened by effort: Migraine symptoms can be exacerbated by physical exertion, which is not the case with tension-type headaches. Even with moderate exercise, such as climbing stairs or carrying shopping bags, headaches and discomfort increase in migraine headaches.

Migraine symptoms in the recovery phase

In the recovery phase, the migraine symptoms gradually fade away. Those affected feel tired, exhausted and irritable. Concentration disorders, weakness and loss of appetite can persist for hours after the migraine attack. In rare cases, patients experience a kind of euphoria after a migraine attack. Another 12 to 24 hours may pass before complete recovery.

Stroke or aura?

Characteristic of the migraine symptoms of the aura is that the deficits are usually dynamic. This means, for example, that the scotoma moves through the field of view (the black spot repeatedly wanders to other places). The tingling in the arm can also move from the shoulder down to the fingertips, for example.

In addition, such symptoms gradually increase gradually in migraine. In the case of a stroke, they usually start suddenly. Migraine symptoms of the aura are also transient and, unlike a stroke, leave no lasting damage.

Take migraine symptoms seriously

Basically, if you have more migraine symptoms, you should have a check-up with the doctor. He can recommend effective measures for the treatment and prevention of migraine. In some cases, supposed migraine symptoms also turn out to be complaints of other diseases such as vascular malformation (aneurysm) or a tumor disease. These must necessarily be treated early!

Migraine: causes

There is no clear answer to the question “How does migraine develop?”. As a cause, various factors are discussed. However, it is probably not just a single factor that is crucial, but several things work together.

Doctors suspect a malfunction in the messenger substance budget in the brain, associated with circulatory disorders. Genetic factors also play a role. Certain trigger factors such as red wine, stress or lack of sleep can trigger a seizure.

Migraine causes: disturbances in the serotonin household

The messenger serotonin seems to play a central role in migraine. This neurotransmitter mediates information from nerve cell to nerve cell or to organs. The effect of serotonin in a migraine attack is complex and not yet fully understood.

One theory assumes that serotonin has at least two different sites of action in the body. There is the central serotonin level in the brain. In addition, it also works outside the brain (peripheral serotonin level).

Too much serotonin in the brain, too little in the body

In migraine, the balance between serotonin levels in the body (peripheral serotonin) and that in the brain (central serotonin) shifts. The combination of a low level of serotonin in the brain and a high level of serotonin in the brain can trigger a migraine attack, some researchers say. An excessive level of serotonin in the brain, for example, could cause the cerebral vessels to contract.

This coincides with observations made by scientists using a special imaging technique, the SPECT examination. This makes the blood flow in the brain vessels visible.

Circulatory disorder in the brain

During an aura, some brain areas are proven to be less well supplied with blood – the cerebral vessels in these areas are narrowed. Gradually, even more and more blood vessels can constrict and lead to a local circulatory disorder in the brain. The conclusion is that possibly the high serotonin level is the reason for the local vasoconstriction.

“Blood wealth” is no cause

It used to be thought that in response to the narrow vessels in the aura phase, certain areas of hearing were suddenly over-supplied with blood. This is supposed to trigger the headache. This can indeed happen, but it is not a migraine cause. Because in most migraine patients, the reduced blood flow from brain areas not only during the aura phase, but also in the headache phase.

Other messenger substances as possible migraine causes

In addition to serotonin, other messengers could play an important role, such as neurokinin A (NKA), substance P (SP) or calcitonin gene-related peptides (CGRP). The role of these messengers in migraine, however, is not yet clear.

Migraine Causes: Genes

Studies have shown that migraine occurs more frequently in certain families. In the meantime, numerous genetic variants have been found that increase the risk of migraine. Some are involved in the regulation of neurological circuits in the brain, others are associated with the development of oxidative stress. Which biological mechanisms they act exactly is not yet clear.

Special form hemiplegic migraine (FMH)

In a rare special form of migraine, familial hemiplegic migraine (FMH), a gene change has been detected on chromosome 19. Children of those affected have a 50 percent risk of also carrying the genetic change in their genetic material.

In FHM recurring migraine attacks with aura occur around the age of 20 years. Typical is the temporary hemiplegia (hemiplegia) associated with seizures.

Migraine triggers (triggers)

The exact causes of migraine are still not explained in detail. There are now known various migraine triggers. Such trigger factors can trigger an attack in people who may be genetically predisposed to migraine.

Which in the individual case, is individually different. Typical triggers for a migraine attack include:

• stress
• Changes in the sleep-wake cycle
• Sensory overload
• weather changes
• certain food and beverage
• hormone fluctuations

Migraine trigger: stress

A common migraine trigger is stress in the home or work environment. For example, changing jobs, conflicts with colleagues or in the family and high time pressure can trigger a migraine attack. For students, overworking at school and conflicts with other students are common migraine triggers.

Migraine trigger: Disturbed sleep-wake cycle

A shift in the sleep-wake cycle also causes a stress reaction in the body and can become a migraine trigger. For example, people with shift work or long-distance travelers are affected, whose “inner clock” gets out of balance due to the time changeover.

Even after a very restless night, the risk of a migraine attack is increased. But it is individually different, what a person feels as stress. One should therefore try to identify one’s individual “stressors” in order to avoid them as much as possible.

Migraine trigger: overstimulation

A migraine attack can also occur with overstimulation. For example, if sufferers work at home, taking care of their child and watching TV at the same time, the brain often can not clearly separate those many impressions. This ultimately triggers a stress reaction in the body. The brain is overwhelmed and reacts with migraine.

Migraine trigger: weather

Even with a change of weather, many patients experience more migraine attacks. Even a temperature change of six degrees Celsius up or down can become a “migraine weather”, thus increasing the frequency of migraine attacks. Also, an increase in humidity is considered a migraine trigger.

However, people react differently to weather changes. So there is no consistent “migraine weather” that causes headaches in all migraine sufferers. Many sufferers complain of humid warm thunderstorm or in a strong storm or hair dryer about migraine complaints. Even very bright light on a cloudless day can trigger a migraine attack.

Migraine attacks are less common in winter than in summer. The reason is probably that the weather conditions in our latitudes in winter are usually rather stable, in summer, however, often changeable.

Some people also get migraines when traveling to a country with a tropical climate. The climate change as well as the efforts of the journey can set off a migraine attack. Usually, however, you get used to the changed climate within a few days, and the symptoms disappear as quickly as they came.

Migraine trigger: food and beverage

Certain foods and stimulants can also trigger migraines. This applies among others for

• citrus fruits
• alcohol
• nicotine
• tyramine-containing foods (bananas, chocolate, red wine)

Tyramine and also histamine are degradation products of protein building blocks (amino acids) and are called biogenic amines. Tyramine stimulates, among other things, the release of the messenger noradrenaline. This has a strong vasoconstrictor – also locally in the brain. This could be the reason for a migraine attack after consuming tyramine-containing foods.

Frequently, migraine attacks also occur when you have eaten too little (“low blood sugar”).

Migraine trigger: Hormone fluctuations

It has been known for some time that sex hormones have a strong influence on migraine attacks. For example, girls and boys are almost equally affected by migraine during childhood. With puberty, however, the relationship shifts. Women are three times as likely to suffer as men.

Strikingly often migraine attacks fall into the period of time. By taking hormones, the symptoms improve often. Such a menstrual migraine loses significantly with the menopause intensity and seizure frequency.

According to researchers, a falling blood level of the female sex hormone estrogen (also known as estradiol) is likely to be responsible for this. How exactly the declining estrogen level ultimately triggers a migraine attack, however, has not yet been clarified.

However, a migraine attack during menstruation could also be the result of a body’s stress response resulting from the pain and mental tension.

Migraine through the pill?

For most hormonal contraceptives, women take a pill for 21 days and then take a seven-day pill break. During this break, the levels of female sex hormones in the blood drop rapidly. It uses a hormone menstrual bleeding. This can trigger a migraine attack. Continuous use of the pill can then reduce the frequency of such attacks.

Migraine Diary exposes trigger factors

To find out your personal trigger factors, you should keep a migraine diary. Sometimes a pattern can be found in these entries, for example, that the migraine prefers to appear after a long day at work or after eating certain foods. You can then specifically try to avoid these migraine triggers. The following things should be documented in your migraine diary:

• Time of day, duration and strength of headache
• Did the headache have an aura ahead or did you suspect the onset of the headache in another way?
• Did you experience nausea, photophobia or blurred vision at the same time?
• Did you have any other side effects?
• What did you eat before?
• Did you physically struggle or did you feel stressed?
• Did you have your menstruation or are you taking hormones?
• Which medication did you take in which dose? Did it help?
• What events preceded the attack?
• Do the attacks occur more frequently in connection with your period?

Pre-made headache calendars for one month each can be downloaded from NetDoktor.de and from the German Migraine and Headache Society on the Internet at www.dmkg.de.

Migraine: examinations and diagnosis

If you suspect that you are suffering from migraines, the family doctor is the right person to contact first. He may refer you to a neurologist or a headache specialist.

Survey of the medical history (medical history)

The doctor will first ask you about your current complaints and possible pre-existing conditions. It is important that you describe your symptoms and their course exactly. For example, the doctor may ask you questions like:

• Where exactly do you feel the pain?
• How does the pain feel?
• Does the headache get worse as a result of physical exertion?
• Treten die Schmerzen nach bestimmten Ereignissen (Schlafmangel, Alkoholgenuss, während der Menstruation etc.) auf?
• Litten oder leiden in Ihrer Familie auch andere Mitglieder regelmäßig an Kopfschmerzen?
• Nehmen Sie Medikamente ein, beispielsweise gegen die Kopfschmerzen oder aus anderen Gründen? If yes, which?

Wenn Sie vor dem Arztbesuch eine Zeit lang ein Migräne-Tagebuch oder einen Migränekalender führen, können Sie seine Fragen besonders gut beantworten.

Medikamenteninduzierter Kopfschmerz

Besonders die Frage zur Medikamenteneinnahme sollten Sie präzise beantworten. Manchmal sind Kopfschmerzen nämlich die Folge einer zu häufigen oder langen Medikamenteneinnahme. Mediziner sprechen von einem medikamenteninduzierter Kopfschmerz. Er kann durch ein zu viel an Schmerzmitteln (Analgetika), aber auch durch die dauerhafte Einnahme anderer Medikamente wie nitrathaltiger Arzneimittel oder Kalziumantagonisten entstehen.

Körperliche und neurologische Untersuchung

Auf das Anamnesegespräch folgt die körperliche Untersuchung. Dabei wird der Arzt die Funktion Ihres Nervensystems äußerlich überprüfen. Beispielsweise testet er die Sensibilität der Haut oder die Muskelkraft. Außerdem überprüft er, ob der Gleichgewichtssinn normal ist und ob es Auffälligkeiten an den Augen gibt. Anzeichen dafür sind beispielsweise eine veränderte Pupillenreaktion oder eine Bewegungsstörung der Augenmuskeln.

Normalerweise ist diese neurologische Untersuchung außerhalb eines akuten Anfalls vollkommen unauffällig. Findet der Arzt hingegen neurologische Auffälligkeiten, spricht dies eher gegen eine Migräne und möglicherweise für eine andere Ursache der Kopfschmerzen.

Weiterführende Untersuchungen

Besonders wichtig ist es, die Migräne gegen andere Kopfschmerztypen und andere Erkrankungen abzugrenzen, da diese anders behandelt werden müssen. Ähnliche Symptome wie die Migräne treten zum Beispiel bei Spannungskopfschmerzen und Clusterkopfschmerz auf. Ebenso muss der Arzt Erkrankungen wie Tumore, Entzündungen oder Verletzungen im Kopfbereich ausschließen. Dazu sind in der Regel bildgebende Verfahren wie eine Computertomografie (CT) oder eine Magnetresonanztomografie (MRT) des Kopfes notwendig. Eine MRT ist beispielsweise sinnvoll, wenn:

• die neurologische Untersuchung bislang unauffällig war
• die Migräne erstmals nach dem 40. Lebensjahr auftritt
• die Häufigkeit und/oder Intensität der Anfälle kontinuierlich zunimmt
• in kurzen Abständen viele Auren (vor allem mit psychischen Auffälligkeiten) auftreten
• die Begleitsymptome der Migräne sich plötzlich ändern

Elektroenzephalografie (EEG), Dopplersonografie

Auch eine Elektroenzephalografie (EEG) – also eine Messung der elektrischen Hirnaktivität – und eine spezielle Ultraschalluntersuchung der hirnversorgenden Blutgefäße (Dopplersonografie) werden häufig durchgeführt, um andere Erkrankungen auszuschließen.

laboratory tests

Vor der Behandlung mit Medikamenten sollte außerdem anhand von Blutwerten geprüft werden, ob Niere und Leber gesund sind. Gegebenenfalls muss man die Medikamentendosis anpassen, falls die Organfunktion eingeschränkt ist.

Migräne: Behandlung

Auch wenn sich eine Migräne nicht heilen lässt, lassen sich Häufigkeit und Intensität der Schmerzattacken deutlich reduzieren.

Vorbeugende Maßnahmen

Eine Kombination verschiedener Vorbeugungsmaßnahmen kann, konsequent angewendet, die Häufigkeit der Anfälle mehr als halbieren. Auch ihre Intensität kann deutlich reduziert werden. Möglichkeiten dazu sind

• Vermeidung von Triggerfaktoren
• Verhaltenstherapie (Ablegen belastender Denkmuster wie negative Gedanken und Leistungsdenken, die Stress erzeugen)
• Neurofeedback, bei dem die Patienten lernen, bestimmte Entspannungszustände im Kopf aktiv zu erzeugen. Das funktioniert, indem über Elektroden Hirnströme an ein Computerprogramm übermittelt werden, das dies in Bilder umsetzt.
• stress reduction
• Ausdauersport
• Erlernen einer Entspannungstechnik, z.B. progressive Muskelrelaxation nach Jacobson
• In schwereren Fällen werden vorbeugende Medikamente verschrieben, vor allem Betablocker, Flunarizin, Valproat und Topiramat

Maßnahmen im Akutfall

Bei einem akuten Migräneanfall helfen vor allem Medikamente.

• gegen die Schmerzen: Schmerzmittel aus der Klasse der nicht-steroidalen Antirheumatika (NSAR) wie Acetylsalicylsäure (ASS), Paracetamol, Ibuprofen, Diclofenac, Metamizol und Naproxen
• bei schwerer Migräne: Triptane
• gegen Übelkeit: Antiemetika
• Außerdem hilft oft Ruhe in einem abgedunkelten Raum.

Wie Sie Migräne vorbeugen und behandeln können, erfahren Sie im Text: Was hilft gegen Migräne.

Migräne: Krankheitsverlauf und Prognose

Migräne ist nach dem Spannungskopfschmerz die häufigste Form von Kopfschmerzen. Forscher schätzen, dass 12 bis 14 Prozent aller Frauen und etwa 8 Prozent aller Männer an Migräne leiden. Auch Kinder können die Krankheit bekommen. Bei 5 von 100 Kindern tritt sie vor der Pubertät auf. Meist kommt diese Kopfschmerzform aber in der Altersstufe der 35- bis 45-Jährigen vor. Die Migräne ist eine chronische Erkrankung. Ihre Ursachen sind noch nicht genau bekannt. Daher kann man nur die Symptome behandeln.

Erhebliche Belastung

Starke Migräne-Attacken können Betroffene extrem belasten und in ihrem Alltag erheblich einschränken. Manche sind sogar für einige Tage vollkommen außer Gefecht gesetzt. Allerdings lassen sich Intensität und Häufigkeit der Attacken durch eine adäquate Behandlung und die richtige Lebensweise günstig beeinflussen.

In wenigen Fällen nehmen die Attacken trotz der vorbeugenden Einnahme von Medikamenten zu. Dies ist meist eine Folge einer zu häufigen Einnahme von Schmerzmitteln, auch von Migräne-Mitteln wie Triptanen.

Abschwächung mit zunehmendem Alter

Bei einigen Menschen reduziert sich die Häufigkeit der Anfälle nach dem 40. Lebensjahr ohne erkennbare Ursache. Während aber die Stärke der Kopfschmerzen abnimmt, erhöht sich oft die Intensität der Aura-Symptome.

Bei Frauen, die unter menstrueller oder hormonell bedingter Migräne leiden, hören die Anfälle nach den Wechseljahren weitestgehend auf. Im Allgemeinen sollten Sie sich aber darauf einstellen, dass die Migräne immer wieder auftreten kann.

Additional information

Books:

• Kopfschmerzen und Migräne. Das Übungsbuch: Vorbeugen, entspannen, Schmerzen lindern, Benjamin Schäfer, TRIAS, 2017
• Erfolgreich gegen Kopfschmerzen und Migräne: Ursachen beseitigen, gezielt vorbeugen, Strategien zur Selbsthilfe, Hartmut Göbel, Springer, 2016

guidelines:

• Leitlinie “Therapie der Migräneattacke und Prophylaxe der Migräne” der Deutschen Gesellschaft für Neurologie (2018)

Selbsthilfegruppe:

• Deutsche Migräne- und Kopfschmerzgesellschaft e.V. (DMKG)