Migraine and Headaches

What is migraine?

Migraine is a neurological condition that manifests as recurrent, usually one-sided, throbbing headache attacks. It is one of the most common neurological conditions and affects about 10–15% of the population, women more often than men.

Besides migraine, there are other forms of headache that should be evaluated neurologically, including tension headaches, cluster headaches, and medication-induced headaches.

Symptoms

Migraine

  • One-sided, throbbing or pounding headache
  • Moderate to severe pain intensity
  • Nausea and/or vomiting
  • Sensitivity to light and noise (photophobia, phonophobia)
  • Worsening with physical activity
  • Attack duration: 4 to 72 hours

Migraine with aura

In about one third of those affected, neurological symptoms occur before the headache phase (aura):

  • Visual disturbances (scintillating scotomas, zigzag lines, visual field loss)
  • Sensory disturbances (tingling, numbness in the hands or face)
  • Speech disturbances
  • The aura typically lasts 5 to 60 minutes

Tension headache

  • Bilateral, pressing or pulling headache
  • Mild to moderate intensity
  • No nausea, no worsening with movement

Cluster headache

  • Extremely severe, one-sided pain attacks around the eye and temple
  • Accompanied by watering eyes, runny nose, eyelid swelling on the affected side
  • Attack duration: 15 minutes to 3 hours, often occurring at night

Causes

The exact causes of migraine are not fully understood. According to current research, the following factors play a role:

  • Genetic predisposition (familial clustering)
  • Changes in pain processing in the brainstem
  • Release of inflammatory messengers (CGRP) at the blood vessels of the meninges
  • Trigger stimuli: stress, lack of sleep, hormonal fluctuations, certain foods, weather changes

Diagnostics

The diagnosis is made primarily on clinical grounds, that is, through a detailed conversation (medical history) and a neurological examination. Additional diagnostics may include:

  • EEG (electroencephalography) – to rule out epileptic causes in migraine with aura
  • Neurosonography – ultrasound of the blood vessels supplying the brain to rule out vascular causes
  • Laboratory tests – to rule out secondary causes of headache
  • Headache diary – to document frequency, duration and triggers

Treatment

Acute therapy

  • Painkillers (Ibuprofen, ASA, Paracetamol) for mild to moderate attacks
  • Triptans (e.g. Sumatriptan, Rizatriptan) for moderate to severe migraine attacks
  • Antiemetics (e.g. Metoclopramide) for accompanying nausea

Prophylaxis (prevention)

For frequent attacks (more than 3 per month), drug-based prophylaxis may be useful:

  • Beta blockers (e.g. Metoprolol, Propranolol)
  • Anticonvulsants (e.g. Topiramate)
  • Antidepressants (e.g. Amitriptyline)
  • CGRP antibodies (e.g. Erenumab, Fremanezumab, Galcanezumab) for chronic migraine
  • Botulinum toxin for chronic migraine

Non-drug measures

  • Regular endurance exercise
  • Relaxation techniques (progressive muscle relaxation according to Jacobson)
  • Stress management
  • Regular sleep-wake rhythm
  • Avoidance of individual trigger factors

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Last updated: 2026-07-04