Migraine: More Than a Headache

The excruciating pain of a migraine can drive us mad. But what exactly is a migraine anyway? And what symptoms indicate this form of headache?

These symptoms indicate a migraine

Two out of three adult Germans suffer from headaches on a regular basis. About 18 million people suffer from a particularly severe form of headache: migraines. The symptoms vary from person to person – even one and the same person can have different migraine attacks. However, they are characterized by a periodically recurring, sudden, pulsating and often hemiplegic headache. What are the possible signs of migraine? An overview of the most common symptoms, accompanying symptoms and triggers.

• Mood swings
• Hammering in the head
• Restless sleep
• Aura
• Stuffy nose and watery eyes
• Neck Pain
• Desires to eat
• Numbness or tingling
• Eye Pain
• Nausea or vomiting
• Strong urge to urinate
• Light, sounds or smells
• Excessive yawning
• Painful movement
• Speech disorders
• Dizziness or visual disturbances
• Symptoms of paralysis
• Hangover Headache

Why does it affect women?

“She has her migraines again!” That sentence is more reproach than statement. In fact, not so long ago, migraine was not considered a disease even by medical experts, but rather the imagination of female hysteria. Or as an excuse when a woman didn’t want to know anything about men.

Although the pulsating headache mainly affects women, it also affects 22 percent of male Germans. In childhood, slightly more boys than girls suffer from migraine headaches, and it is not until puberty that many women become affected. The female sex hormones, the oestrogens, are responsible.

But the sudden drop in oestrogen levels before menstruation is usually only one of several possible triggers. Only about one in ten actually have seizures exclusively before or during their period. There is usually a second trigger. But if there is a direct link to menstruation, you can try an oestrogen gel (available only on prescription) to see if it helps: you apply it just before and during your period to reduce oestrogen deprivation during menstruation. A birth control pill taken without a pill break can also help to balance hormone levels and reduce the number of migraine attacks.

Unfortunately, the disease does not stop with menopause either. It is usually only temporarily bearable for affected women: during pregnancy. “This is the best prevention of migraine, so to speak,” says Professor Hartmut Göbel, head of the Kiel Pain Clinic. Because expectant mothers have a constantly high hormone level and often live healthier lives.

Is there a migraine character?

Migraines are considered special at best, and strenuous at worst – supposedly always want to think everything through and ahead, to do everything perfectly. However, the reality check leaves little of this: the typical migraine character does not exist. There are numerous perfectionists and anxious brooders who keep a pain-free head for life.

But even if the illness is not a question of personality, many people favour the attacks through their behaviour: They are overactive, never take a break and don’t realize when they are overtaxing themselves. Only the migraine attacks force them to rest. This is another reason why the symptoms are often a family matter: mother and father not only pass on certain migraine risk genes, but often also their way or their inability to cope with stress. For many, the headaches, their frequency and severity change when they change their behaviour, for example through regular relaxation exercises or stress management training.

What is actually going on in your head?

Evil spirits, divine visions or an excess of bad digestive juices: our ancestors were inventive in their search for explanations for the pain attacks. Today, research has a fairly accurate picture of what goes wrong in the brain of a person with migraines. In certain situations it floods itself with nerve messengers.

To get rid of them, the brain starts an inflammatory reaction. The inflamed veins become more and more sensitive to pain until even the pulse beat seems to thunder like a hammer against the vessel walls. This creates the typical pulsating pain character.

About 15 percent of those affected experience a so-called aura even before the pain sets in. Mostly they see flickering spots or flashes of light, more rarely they experience paralysis, speech disorders or hallucinations. The reason for these misperceptions is an excitation wave that travels over the nerves of the brain surface at the beginning of the attack.

And where is the switch please?

Most migraine sufferers have a long list of what made their head spin: chocolate, red wine, the smell of savoy cabbage stew, sudden rain from the northeast or the Saturday after a busy week… And sometimes it is not so easy to identify a clear culprit.

Chocolate, for example, is usually wrongly suspected. Because migraines begin with a one or two-day pain-free phase, during which many sufferers are irritable and tired – or hungry for sweets. Anyone who eats chocolate will be in pain afterwards, but the real cause lies elsewhere. In most cases, a combination of several factors leads to a seizure: for example, when the weather and the monthly hormone changes coincide.

Unfortunately, headache attacks do not necessarily disappear, even if all the factors responsible are found and meticulously avoided. Neither is there any medication that can switch off the seizures once and for all. Migraine cannot be cured. There is a specific, unchangeable property of the nervous system behind it: it is extremely active, especially in migraine patients.

“The brain can do three things at once and think around five corners,” says researcher Hartmut Göbel. But at the same time it is bad at simply fading out recurring stimuli. On the contrary: it reacts more sensitively from time to time and thus virtually keeps rocking itself up.

But then nothing helps, does it?

About half of all those affected treat their seizures on their own without ever having seen a doctor for them. Many think that medicine or neurology cannot help them anyway. However, a lot has happened in headache research in recent years. There are now special migraine medications, so-called triptans, which combat not the pain but its cause, the inflammation in the blood vessels. Since then, severe migraine attacks can also be treated.

And they can also be effectively prevented: for example, with drugs such as beta blockers or therapies like biofeedback. Even those who have been experiencing pain for years can be treated successfully. However, it is important to keep a headache diary – this helps the doctor to make a diagnosis and subsequent treatment.

Nevertheless, it is dangerous to wait and see. Many sufferers fall into a fatal spiral: they become more and more cautious, avoid more and more actual or suspected triggers, until even the fear of the migraine triggers the next attack.

Migraines are a good thing, too – really?

Many people with migraines have a very powerful brain. For example, the tension that red lights mean for every car driver decreases from time to time in people without migraines. In migraineurs, on the other hand, the brain does not become dull in this way. And: Women and men with migraines simply shift gears faster – and not only when driving. And there is another advantage, even if it is only statistically valid: women who suffer from migraines have an approximately 30 percent lower risk of developing breast cancer.

Can the pain be ironed out?

Maybe the one or the other celebrity was among the rather random test persons: They had Botox injections to remove forehead wrinkles and felt that the rejuvenation treatment also improved their migraines. Just a psychological effect? Beautiful, young, happy and pain-free? No, studies have now established beyond doubt. The reason for the pleasant side effect is probably the muscle paralysing effect of the substance. Botulinum toxin type A also relieves migraine – but it only brings good results in people with chronic pain.

Relatively strict rules apply to the use of this therapy (no drug overuse, no tension headaches, migraine for more than four hours on at least 15 days a month). And it is only paid for by the health insurance company after examining each individual case. Nevertheless, it is a glimmer of hope for some patients, because: “Those who suffer every second or third day often have the feeling that they no longer have their own life under control,” says Dr. Astrid Gendolla. In such cases, targeted Botox injections every three months in the head and neck area can actually help. And if one or two wrinkles on the forehead disappear at the same time, it doesn’t really hurt any further – does it?

“It feels like going blind”

The world’s first migraine simulator enables relatives to understand what sufferers go through with friends and family.

The test subjects experience everyday situations such as a train journey, a visit to a café or a stay in light-flooded rooms from the perspective of a migraine patient. The simulator worn by them acts as a kind of spectacles. The intensity of the symptoms is controlled by the team.

After the experiment, a young woman describes that she felt as if she would go blind. All participants reacted in shock at the end and openly admitted that they had clearly underestimated the suffering so far. This simulation only addressed the visual perception disorders – physical pain was not included.

The fact that even the accompanying symptoms of a migraine attack are enough to throw people off track confirms once again what those affected have known for a long time: Migraine is much more than just “a little headache”, and if you reduce it to that, you are not really listening to those affected!

Reading tip: Here you can find out all about migraine home remedies and tension headaches.