Neurology-Online

How do I recognize a migraine?

introduction

Migraine is probably one of the most famous diseases. It belongs to the large group of headache disorders, which also includes tension headaches, cluster headaches and many other forms. The migraine itself, in turn, can present itself in many different ways, and even experienced doctors cannot always diagnose it with certainty. The aim of this article is to help you determine whether you may have a migraine and what further steps should be taken if you do.

What is a headache anyway?

“Headache” does not refer to a specific disease, but rather to a group of different diseases and symptoms. There are basically two types of headache:
Primary headaches are independent diseases that have the headache as the main symptom. In addition to tension headaches and cluster headaches, they also include migraines.
Secondary headaches, on the other hand, are just a symptom of another underlying disease and can accompany almost any disease. The causes of secondary headaches range from simple flu-like infections to serious illnesses such as strokes and brain tumors, so they are very unspecific. In the case of secondary headaches, the primary goal is to identify and treat the cause.

Interestingly enough, to this day one is not at all sure how headaches arise in the first place. What is certain is that it is not the brain that feels pain itself, but only the meninges, as only these have pain receptors.

Here is an overview of more Headache species

What is a migraine?

After tension headache, migraine is the most common primary form of headache. Therefore, one of the most important diagnostic steps is to differentiate between these two forms.
The migraine is attack-like, that is, it comes more or less suddenly and disappears after a relatively short time, but comes back at irregular intervals.

The causes of migraines are the subject of current research and are controversial. Various theories assume, for example, dilated blood vessels, over-excitability of nerve cells, inflammation or genetic causes. However, a detailed explanation is beyond the scope of this article.

The following article is all about recognizing the triggers and symptoms of migraines. For general information, please also read our Main article migraines

Causes and Triggers

In order to recognize whether you suffer from a migraine, you should first look at what causes it. An important factor is the family history. If there are many other people in your family who have migraines, they are more likely to cause headaches for you too.

In addition, we now know some so-called trigger factors that can trigger a pre-existing migraine. These are often very individual and not always available. These include in particular:

climatic influences such as strong / sudden weather changes
Luxury foods, especially Alcohol (red wine!), Nicotine, chocolate and dairy products
Changes in sleep patterns or irregular sleep
high mental or psychological stress over a longer period of time (so-called "holiday migraines")

In women, the hormonal cycle also plays a major role. For example, many women with migraines always have migraine attacks when they menstruate. Hormonal interventions such as the “birth control pill” can also trigger a migraine.

Symptoms of a migraine

Migraine headaches usually have a very clear character, which is why the symptoms and accompanying symptoms are also used to differentiate them from other types of headache. The prodromi (harbingers) and the aura are again separated from the actual migraine attack.

Prodromi

Prodromi, i.e. harbingers, also exist in many other diseases. They occur in about a third of migraine patients and announce an approaching migraine attack. If you know “your migraines” and the individual prodromes, it makes sense to start treatment at this point, as the principle of “hit hard and early” applies in migraine therapy. Prodromi can be very different and individually different, sometimes you notice them two days before the actual attack. Typical prodromes are:

Mood changes
Cravings
Increased yawning
Increased urination or severe thirst
Difficulty concentrating

As you can see, the prodromes are very unspecific and can also occur with many other diseases or without any disease at all. It is therefore advisable for those suffering from migraines to keep a headache diary for at least a while in order to identify the individual prodromes.

Migraine aura

A basic distinction is made between migraines with and without aura. In neurology, an aura is understood to mean neurological failures that do not last longer than 60 minutes and are stereotypical, i.e. always the same or very similar. Often the aura occurs shortly before the migraine, but it can also exist during an attack.

The best known and most common aura symptoms are ciliated scotoma. There is a circumscribed defect in the visual field (scotoma), which migrates from the side of the visual field to the center.

Other aura phenomena are flashes of light (photopsia), tingling, speech disorders, paralysis, dizziness and many more. It is important to rule out a stroke, especially if you have a first-time aura. This differentiation is particularly difficult because there are also auras without headaches, which only result in neurological failures. The migraine is therefore one of the so-called stroke mimics. If you have such symptoms, especially if you have never had them before, it is better to see a doctor. If there is an acute suspicion of a stroke, the emergency services must be called immediately.

Migraine headache

The headache itself is very characteristic and differs in particular from tension headache, the most important differential diagnosis of migraine. Typical of migraine headaches (compared to tension headaches) are:

a duration of 4-72 hours (tension headaches very variable from up to 2 weeks)
Unilateral localization, usually on the forehead or eye (often pulling forward from the back of the head for tension headaches)
Pain character pulsating (with tension headaches rather pressing)
often accompanying symptoms, see below (not present for tension headaches)
Aggravated by physical activity (does not affect tension headaches)

In addition to the headache, migraines typically have accompanying symptoms, including:

Nausea and vomiting
Photophobia
not bearing loudness (phonophobia)

What to do if migraines are suspected

If you suffer from recurring headaches and suspect a migraine, it is advisable to consult a neurologist. This will first find out through a conversation and examination how likely a migraine is. Often an MRI is done to rule out serious causes for the headache. If the diagnostic criteria apply, the doctor will work with you to find the right therapy for you. In contrast to “normal” tension headaches, drugs such as aspirin or ibuprofen often only help to a limited extent in the case of migraines. An important group of drugs here is that of the triptans. The accompanying symptoms, especially nausea, can usually be managed well with appropriate medication. The beta blocker propanolol and some other drugs are also approved for migraine prophylaxis in the case of frequent severe attacks.

A relatively new approach are antibodies against the calcitonin gene-related peptide (CGRP), a so-called neuropeptide that seems to play a central role in the development of migraines. In studies, for example, the administration of CGRP in migraine patients could trigger migraine attacks. Erenumab was the first CGRP antibody to be approved in 2018, followed by fremanezumab and galcanezumab. These antibodies are injected every 4 weeks via a syringe and are therefore also known as the "migraine vaccine". Like propanolol, they are suitable for severe chronic migraines.

Unfortunately, a cure for migraines is still not possible.

Further information