Symptoms, warning signs and what helps against the suffering

One in ten Germans suffers from regular headaches. Our columnists explain what causes them and what helps against them.

Migraine is one of the most common headache disorders in Germany, affecting around 10 to 15 percent of the population. Women are affected three times more often than men, but children are also affected.

Migraines most often occur for the first time between the ages of 20 and 30, and the symptoms are most severe between the ages of 40 and 50. In old age, headache attacks are often milder and occur less frequently; in some patients, they even stop altogether.

The disease usually progresses episodically with repeated attacks that may occur several times a month, but usually not several times a week. The duration of a migraine attack can vary from a few hours to three days. In extreme cases, the symptoms may last longer than 72 hours.

One in five people suffers from migraines with “aura”

In about 20 percent of migraine patients, the attacks are accompanied by nausea, vomiting, impaired consciousness and visual disturbances, the so-called “aura”. It is characterized by neurological symptoms, especially visual disturbances with flickering vision, visual field defects, sensory disturbances on one side of the body or a speech disorder. This phase usually begins less than an hour before the headache and lasts between five and 60 minutes.

What is migraine?

It is a disease of the brain in which pain-processing centers are activated and pain-mediating messenger substances, such as calcitonin gene-related peptide (CGRP for short), are released.

These messenger substances lead to an inflammatory reaction in the blood vessels of the meninges. The pulsations (rhythmic pressure waves) in the blood vessels cause the inflamed vessel wall to stretch, which also explains the typical pulsating pain.

Genetics plays a role

Migraine is a genetic disease, and about two-thirds of patients have other affected relatives. Sometimes migraine runs like a thread through the entire family tree.

How can you prevent the attacks?

The brain of the affected patient often reacts to certain triggering factors or overloads with an attack. Therefore, those affected can protect themselves from this – at least in part.

Studies have shown that regular endurance exercise and muscle relaxation techniques have a positive effect on migraines. It is also helpful to limit digital media, get plenty of exercise in the fresh air, drink enough and eat regularly.

Some sufferers also react negatively to certain foods, but everyone has to find out for themselves what exactly is harmful. It is worth trying to avoid foods that are high in histamine (such as tomatoes, citrus fruits and chocolate), as well as convenience foods and foods that contain the flavor enhancer glutamate or preservatives such as curing salt, tartrazine and benzoic acid. Avoiding alcohol is generally recommended.

Dr. Gerd Wirtz (Source: Wirtz)

To person

Gerd Wirtz is a neurophysiologist, medical moderator and expert in digital health. His specialty is future medicine.

Together with Thomas Kurscheid and Volker Limmroth he answers in the podcast “Healthy & Healthy” Your questions about a better and longer life.

Prof. Dr. Volker Limmroth is an expert on all topics related to a longer and healthier life.
Prof. Dr. Volker Limmroth (Source: V. Limmroth)

To person

Volker Limmroth is chief physician, neurologist, neuroscientist, longevity expert. Chief physician of the Clinic for Neurology and Palliative Medicine in Cologne-Merheim since 2006. Specialist in multiple sclerosis, chronic pain and Parkinson’s. He was chairman of the Drug Commission of the Cologne City Hospitals for more than ten years.

Which painkillers help?

During an attack, common painkillers such as acetylsalicylic acid (ASA) or ibuprofen are usually used in combination with medication to combat the accompanying nausea. There are also migraine-specific substances, so-called triptans.

Most of them are prescription drugs, meaning that those affected can only take them if prescribed by a doctor. But even with triptans, which are available without a prescription, it is strongly recommended that you speak to your doctor beforehand. Certain groups of patients, such as those with heart disease, should not take these medications.

You should also avoid taking them if the aura phase has already begun. The general rule is that all medication should be taken as early as possible. Anyone who suffers from a particularly severe form of migraine, i.e. has more than two or three severe attacks per month, should consider taking preventive medication (prophylaxis) in order to reduce the frequency and intensity of the attacks in the long term.

Which means are suitable for prophylaxis

These are medications that are otherwise used to treat high blood pressure or epilepsy. Nutritional supplements and magnesium also have a good effect on some patients.

However, a little patience is required, as the effectiveness of a prophylactic treatment can only be assessed after four to six weeks at the earliest. For the past five years, there have also been highly specific preparations that are injected into the arm or thigh once a month. The three active ingredients approved in this country are Erenumab, Galcanezumab and Fremanezumab.

They act on the messenger substances that cause the vessels to become inflamed, swell and cause pain. The contents of the syringe either neutralize these CGRP molecules directly or block the receptors so that the messenger substance can no longer dock.

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