Understanding Migraines: More Than Just a Headache

The most important facts in brief

Migraine is a common neurological disorder characterized by episodic, usually one-sided headaches. Accompanying symptoms such as nausea, sensitivity to light, and visual disturbances (aura) take a heavy toll on those affected. Personalized treatment with medications such as triptans, along with medical care, can improve quality of life.

Millions of people in Germany are familiar with this condition: a throbbing pain that brings daily life to a standstill. Migraine is far more than “just” a headache. It is a complex neurological dysfunction in the brain in which neurotransmitters and nerve pathways become out of sync.

What exactly is a migraine?

Migraine is a chronic, recurrent, episodic functional disorder of the brain. It typically manifests as severe, throbbing headaches that often occur on one side of the head and worsen with physical activity. Statistically speaking, women are affected more often than men. The exact causes have not yet been definitively determined, but genetic factors play a significant role.

The Stages of a Migraine Attack and Typical Migraine Symptoms

A migraine attack often progresses through several phases, not all of which every patient experiences. Recognizing these phases can help you take timely action to counteract the symptoms.

• Prodromal phase (early warning signs): Warning signs appear hours to days before the pain begins. These include food cravings, mood swings, fatigue, or a stiff neck (often mistakenly attributed to the cervical spine).
• Aura phase: In migraines with aura, sufferers experience neurological symptoms. Typical symptoms include visual disturbances (flickering, flashes of light, visual field defects), tingling in the limbs, or speech difficulties. This phase usually lasts 20 to 60 minutes.
• Headache phase: The actual pain sets in. It is usually throbbing, pulsating, or pounding. It is often accompanied by nausea, vomiting, and extreme sensitivity to noise and light.
• Postpartum recovery phase: The pain subsides, but exhaustion, difficulty concentrating, and fatigue often linger.

A Special Form: Migraine Without a Headache

There are cases in which only the aura symptoms occur, without the typical headache following. Doctors refer to this as a “migraine without a migraine” or a silent migraine. Since the symptoms can resemble those of a stroke, medical advice should always be sought promptly when they first occur.

Migraine Causes and Triggers

While the biological cause lies in the hyperexcitability of certain nerve cells, acute attacks are often triggered by so-called triggers. These vary greatly from person to person:

• Stress: Both acute stress and the relief of stress (weekend migraine).
• Hormonal fluctuations: Especially in women during menstruation.
• Sleep patterns: Too much or too little sleep.
• Diet: Alcohol (especially red wine), caffeine withdrawal, or irregular meals.
• Weather changes: Significant fluctuations in temperature or air pressure.
• Sensory stimuli: Flickering light, bright sunlight, or strong odors.

There is a persistent myth: Problems with the cervical spine are rarely the primary cause of a migraine, even though neck pain often serves as a warning sign. However, muscle tension can trigger tension headaches, which in turn can increase the likelihood of a migraine attack.

Treatment: What Helps with Migraines?

The treatment is based on two pillars: acute treatment and prevention (prophylaxis). The goal is to reduce the intensity of the pain and decrease the frequency of attacks.

Acute Treatment: Migraine Pills and Triptans

For mild attacks, traditional pain relievers (analgesics), such as acetylsalicylic acid or acetaminophen, often help—frequently in combination with anti-nausea medications. If these are not effective enough, specific migraine medications are used:

Triptans for migraines: This class of drugs specifically targets serotonin levels. They constrict the blood vessels in the brain that dilate during an attack and inhibit the release of inflammatory mediators. Triptans are available as tablets, nasal sprays, or injections.

Prevention of Chronic Migraines

If a person experiences headaches on more than 15 days a month, this is referred to as chronic migraine. In such cases, acute medications are not sufficient. Doctors use various strategies for prevention:

• Pharmacological prophylaxis: beta-blockers, antiepileptic drugs, or antidepressants.
• Botox for Migraines: Botulinum toxin is injected into specific points in the head and neck muscles to block pain signals. This is an approved treatment for chronic migraines.
• Migraine injections (CGRP antibodies): These newer medications specifically block the neurotransmitter CGRP, which plays a key role in migraines. They are typically administered once a month.

Alternative Approaches: Can Piercings Help with Migraines?

On social media, the so-called Daith piercing (in the cartilage of the outer ear) is often touted as a miracle cure. The theory is based on acupuncture points. However, there is no scientific evidence that a piercing is effective against migraines. Doctors tend to recommend validated relaxation techniques such as Jacobsen’s progressive muscle relaxation.

How TeleClinic Can Help with Migraines

For many patients, the trip to the doctor’s office during an acute migraine attack is a torment. The bright lights and noise in the waiting room are almost unbearable. This is where telemedicine offers a valuable complement to in-person care.

Through the TeleClinic platform, you can quickly and easily get in touch with qualified doctors:

• From the comfort of your own home: Medical consultations via video in a dimly lit room.
• Prescriptions: If medically necessary, prescriptions may be issued at the doctor’s discretion.
• Request a sick note: If you are unable to work, you can request a sick note*.

Conclusion: When Should You See a Doctor?

Occasional headaches can often be treated with home remedies. However, if you suspect you have a migraine, it’s important to get a professional diagnosis to prevent it from becoming chronic. See a doctor if:

• The headaches occur regularly and interfere with daily life.
• You need pain medication on more than 10 days a month.
• If the pain pattern suddenly changes or neurological symptoms (aura) occur.

Sources/evidence

• German Migraine and Headache Society (DMKG) – Information for Patients
• Robert Koch Institute (RKI) – Special Issue on Migraine
• AWMF Guideline – Treatment of Migraine Attacks and Migraine Prevention