One in three people with chronic headaches have migraines. Migraine is a disease of the brain in which nerve cells are impaired in their function. This results in changes to the blood vessels in the brain, which are controlled by the nerve cells. Patients often experience migraines in the form of migraine attacks. These are moderate to severe, throbbing headaches that can last for minutes or hours. The pain is often only felt on one side of the head. Those affected sometimes also experience changes in perception (so-called aura) before or during a migraine attack.

Other regular headaches are sometimes wrongly referred to as migraines.

The exact causes of migraine are still unknown. Very often there is a familial connection. The so-called hereditary migraine has been known in Chinese medicine for a very long time. Conventional medicine has long questioned a hereditary factor. However, scientists have discovered that a special hormonal imprint in the womb is responsible for migraines occasionally being passed on from mother to daughter.

Hormonal and genetic factors play an equal role. Hormones are also responsible for the fact that women are more frequently affected by migraines and suffer more migraine attacks during menstruation.

The influence of so-called triggers (triggers for a migraine attack) is the subject of controversial scientific debate. For example, certain foods are considered to be frequent triggers. Alcohol, coffee or highly processed foods can promote an attack.

Stress and hormonal imbalance are a proven factor.

Migraine has many faces

The pain is often accompanied by nausea, vomiting and sensitivity to light and sound. Some people also experience neurological symptoms such as visual disturbances or tingling before a migraine attack, known as an aura.

There are various forms of migraine, which differ in their symptoms and frequency. The most common are

Migraine without aura: This form occurs in around 80 percent of migraine patients and is characterized by pulsating, usually half-sided headaches that worsen with movement. The attacks last between four and 72 hours and occur on average about once a month. There are also subtypes such as purely menstrual migraine without aura, which only occurs around the time of menstruation.
Migraine with aura: This form occurs in around 15 to 20 percent of migraine patients and is characterized by neurological symptoms that precede or accompany the headache. The aura usually lasts between five and 60 minutes and can manifest itself as visual disturbances (e.g. flickering or loss of visual fields), tingling or numbness (e.g. in the hands or face), speech disorders (e.g. difficulty finding words or understanding) or dizziness. There are also subtypes such as migraine with brain stem aura, which also causes symptoms such as swallowing disorders or impaired consciousness, or hemiplegic migraine, which causes temporary paralysis of one side of the body.
Chronic migraine occurs in around two percent of migraine patients and is characterized by very frequent headaches that occur more than 15 days a month. The pain can occur with or without an aura and is often difficult to treat.
Migraine complication: This form occurs in less than one percent of migraine patients and is characterized by serious consequences of a migraine attack. These include, for example, migraine infarction, which leads to a stroke, or persistent aura without infarction, in which the aura symptoms last longer than a week.
Status migränosus is a migraine that lasts longer than 3 days without interruption. Simultaneous aura phases are possible. Overuse of medication is assumed to be the cause. Status migraine can also occur in connection with menstruation. This form of migraine is considered difficult to treat with medication.

How is migraine diagnosed?

Migraines are primarily diagnosed by taking the patient’s medical history. A doctor then decides whether other possible causes of the headache can be ruled out. In some cases, a magnetic resonance imaging (MRI) or computer tomography (CT) scan is ordered. There is no special laboratory test (e.g. blood test) to diagnose migraine. In rare cases, a vitamin B12 deficiency can occur in connection with a migraine.

The difficult diagnosis is sometimes a problem if other rare causes of headaches are not taken into account. Post-Covid, for example, can cause very similar symptoms.

Treatment of migraine

The treatment of migraines with medication aims to reduce the frequency and severity of attacks and relieve the symptoms. There are various medications that can be used to prevent or treat migraines, depending on the type of migraine.

Preventive medication includes beta blockers (blood pressure medication), antidepressants, antiepileptic drugs (for epilepsy) and CGRP antibodies (affects the immune system).

Women who suffer from migraines due to hormonal fluctuations occasionally treat their symptoms with the contraceptive pill. Cannabis and some so-called poppers (an aphrodisiac) have also been on the unofficial list of possible symptomatic medications for some time. Treatment with these preparations is very dangerous.

Medications that can be used acutely include painkillers, triptans (vasoconstrictors), ergotamines (ergot poison, has a relaxing effect) and antiemetics (against nausea).

However, many patients want holistic treatment with no or very little medication. The desire for fewer side effects and less dependence on painkillers is paramount.

In osteopathic practice, but also for acupuncture, many empirical values are available. A special acupuncture point has also been described for so-called hereditary migraines (Bahr et al.) Women who suffer from migraines, particularly during menstruation, may be supported by hormonal regulation with acupuncture.

In addition, measures can also help to prevent or manage migraines. These include a healthy diet, sufficient sleep, stress management, regular exercise and avoiding alcohol, caffeine or certain foods.

Conclusion

Although there is a relatively high proportion of people with migraines, sound medical diagnosis and treatment options are still not very well developed. This makes it all the more important to take a lot of time to talk to patients and listen carefully.

Treatment with medication is always aimed at alleviating the symptoms. This is the medical standard and has been very well researched. Alternative forms of treatment such as osteopathy and acupuncture try to find a holistic approach and combat the causes of migraines. However, this approach has not yet been very well researched scientifically. However, the experience with acupuncture is so good that the World Health Organization (WHO) included migraine in a list of indications for acupuncture in 2002.

Ask a naturopath, osteopath or naturopathic doctor for advice on individual treatment options. You are also welcome to book a consultation with me.