Migraine: more than just a headache

Everyone has headaches, but in most cases they’re not too bad. That’s one of the reasons why migraine sufferers face many prejudices – and sometimes even downplay their own suffering. According to the World Health Organisation (WHO), migraine is one of the diseases that has the greatest impact on quality of life.

“About one million people in Switzerland suffer from migraine,” estimates Andreas Gantenbein, a neurologist specialising in headaches and pain medicine. “Many people have frequent migraine attacks, but it’s not really noticed,” says Gantenbein, summing up the crux of the problem: migraine is invisible. For those affected, the lack of understanding among employers, friends and family is usually harder to bear than the disease itself.

Causes and triggers of a migraine attack

The exact causes of this neurological disorder are not yet fully understood. Put simply, migraine sufferers’ brains process stimuli earlier and faster than in normal cases, which leads to a sensory overload. The predisposition is probably genetic. “Between 60 and 80 per cent of sufferers have a hereditary predisposition,” estimates Gantenbein.

If the migraine attacks occur on fewer than 15 days per month, they’re known as episodic migraine. If they occur on 15 or more days per month, they’re classed as chronic migraine. Often, the attacks occur spontaneously or result from triggers. A migraine diary can therefore be helpful to document the overload and find your own specific triggers. Known triggers include:

• Stimulants in excess, especially coffee, alcohol and nicotine
• Changes in oestrogen levels, which is why women are more likely to be affected by migraine (often during ovulation and menstruation)
• Medicines, especially potency medicines and nitro preparations for the treatment of heart disease
• Environmental influences, especially changes in weather and altitude; external stimuli such as noise or smells are usually precursors rather than triggers
• Irregular food intake, hypoglycaemia and insufficient fluid intake
• Fluctuating sleeping patterns with too much or too little sleep
• Stress, both of a physical and mental nature

The symptoms of a migraine attack

A migraine usually announces itself 4 to 48 hours in advance. The warning signs include nervousness, euphoria, mood swings, loss of appetite, ravenous hunger, chills and sweating. The migraine itself lasts between a few hours and up to three days, and the pain can be excruciating: a pulsating, throbbing sensation, usually on one side.

In addition, there are typical symptoms such as hypersensitivity to light and noise, nausea and vomiting. Sensitivity to smell and touch are also common. Every movement makes the pain worse. “These are not the main problem, however, because they can easily be controlled using medication,” explains Gantenbein. However, vegetative symptoms such as loss of appetite, concentration problems and sensitivity to stimuli remain. In addition, those affected are exhausted, sensitive to pain and experience reduced performance for one to two days after a migraine attack.

What is migraine with aura?

Around 10 to 20 percent of sufferers have an aura before a migraine attack. These are often visual disturbances – from flashes of light to zigzag lines to blind spots – that start out small in size and slowly spread. They may also be accompanied by dizziness and sensory disturbances in the face, hands or legs. In rare cases, the sufferer’s speech may be disturbed. “An aura lasts on average 10 to 20 minutes, sometimes up to an hour,” explains Gantenbein.

The aura does not leave any permanent damage. However, the risk of a heart attack or stroke is slightly increased. This can be a problem especially if other risk factors such as smoking, birth control pills or high blood pressure are involved.

Treatment of migraine attacks: from acupuncture to essential oils and lemon juice

Migraine is a chronic disease that cannot be cured. However, painkillers, medication, therapies and lifestyle adjustments reduce the number of attacks and the intensity of the headaches. As a result, sufferers regain their quality of life. “The treatment is built on three pillars: acute therapy, prophylaxis and non-medicinal treatments,” explains Gantenbein. “But there is no one-size-fits-all treatment. For doctors, the diagnosis is made quickly, but patients need sound advice and someone who really listens to them.”