What symptoms migraines cause and what helps

Some people only think of headaches when they think of migraines. However, the symptoms can be much more varied – especially in the case of migraines with aura. Read what is behind it and which treatment helps.

Migraine is one of the most common forms of headache worldwide. The disease can occur at any age. But people between the ages of 20 and 50 are most commonly affected, including about three times more women than men.

Definition: What is a migraine?

Migraine is a headache disorder that belongs to the diseases of the brain and thus to the neurological diseases. It is defined by recurring, paroxysmal headaches lasting 4 to 72 hours.

Migraine headaches are moderate to very severe. They are often accompanied by other symptoms such as nausea, sensitivity to noise and light.

In about 10 to 30 percent of cases, migraines are also associated with an aura: these are temporary neurological irritations and deficits that occur before or at the beginning of a migraine attack.

A typical aura is mainly (90%) noticeable as visual disturbances in both eyes: An outdated term for this form of migraine is ophthalmic migraine, colloquially known as eye migraine. But sensory disturbances or speech and language disorders can also make up a typical aura.

Already knew?

A typical migraine aura is not necessarily associated with a headache: sometimes the aura occurs with a migraine without a headache. The French term for this is migraine sans migraine – in English: migraine without migraine. It is most likely to occur at a young age and in those over 60 years of age.

In addition to migraines with a typical aura, there are other forms of migraines with atypical aura symptoms – albeit much less frequently. This includes:

Migraine with brainstem aura, in which brainstem symptoms (such as hearing loss, dizziness, tinnitus, double vision, impaired coordination or consciousness) occur in addition to the typical aura
hemiplegic migraine, in which, in addition to the typical aura, muscle weakness with signs of paralysis develops on one side of the body
retinal migraine, in which, in addition to the migraine headache, there is visual disturbance in one eye similar to a typical aura or temporary blindness
The frequency of migraine attacks can vary greatly. In isolated cases, the symptoms recur so often that they are considered chronic: A chronic migraine is defined as a headache occurring on more than 15 days per month for at least 3 months, which corresponds to a migraine headache on at least 8 days per month.

Good to know

Even if migraine headaches are significantly more severe than ordinary headaches and can severely restrict everyday life: migraines are considered a benign disease, so they are not dangerous.

Migraine: Symptoms

The typical symptoms of migraines are headache attacks. These migraine headaches are characterized in that they

lasting 4 to 72 hours untreated,
only affect one header page and/or
pulsate and/or
are moderate to strong and/or
strengthened by physical activity as well as
are associated with nausea or vomiting and/or aversion to light and noise.

Migraine attacks occur at irregular intervals. Sometimes migraines are only noticeable from time to time, sometimes the symptoms occur on several days every month.

Most sufferers have their first migraine attack between the ages of 15 and 25. Many describe migraine headaches as throbbing or nagging. However, the symptoms can vary from attack to attack. After the age of 45, the severity and frequency of seizures usually decrease.

Unilateral migraine headaches can switch sides within a migraine attack or from attack to attack. They are usually located in the area of ​​the forehead and temples and/or behind the eyes. However, over a third of people with migraines feel the headache all over their head.

In addition to nausea and/or aversion to light and noise, migraines can cause other accompanying symptoms. For example, almost all sufferers experience a loss of appetite, many suffer from easy watering of the eyes, and some experience hypersensitivity to certain odors.

In addition, about a third of people with migraines develop early symptoms that announce the actual migraine attack hours to two days in advance. Experts refer to such accidentals as prodromes. An impending seizure is often indicated by:

Mood swings

Cravings or loss of appetite
Frequent yawning
difficulty concentrating
increased thirst with increased drinking
increased urine output
When the migraine headaches subside, some similar symptoms can occur: Many sufferers have mood swings during this recovery phase, feel cravings for certain foods, are tired, not very resilient and/or physically more or less active.

Migraine with aura – with or without a headache

In a migraine with aura, the symptoms of the aura usually appear before the migraine attack – similar to the prodromes. However, the aura can also overlap in time with the headache and accompanying symptoms. A typical aura develops over a minimum of five minutes and lasts at most an hour.

Now and then it happens that a migraine with aura goes without a headache. However, the symptoms of the aura itself are the same as those associated with a migraine headache aura.

A migraine with a typical aura usually manifests itself as visual disturbances. The symptoms of these so-called ocular migraines typically occur on both sides. Those affected perceive flashes of light, points of light, zigzag lines and a wave-like flickering in the eye – technically called ciliated scotoma.

The ciliated scotoma limits the perception of certain areas of the outside world: This so-called visual field loss lasts about 15 to 30 minutes in migraine with aura. The symptoms slowly migrate from the center of the eye to the edge of the eye, eventually disappearing from the field of vision.

Sensitivity disorders (such as tingling and numbness in parts of one side of the body, in the face and/or on the tongue) or speech and language disorders occur less frequently in migraine as aura symptoms.

Occasionally, migraine occurs with an aura whose symptoms differ significantly from the typical migraine aura. Possible signs of such an atypical aura are, for example:

Hearing loss, dizziness, tinnitus, double vision, impaired coordination or consciousness (in migraine with brainstem aura)
Unilateral muscle weakness with symptoms of paralysis that can last much longer than the typical aura symptoms (in hemiplegic migraine)
unilateral visual disturbances similar to a typical aura or temporary blindness (in retinal migraines)
Good to know
With migraines, all symptoms of the aura are usually only temporary, i.e. they disappear completely.

Vestibular migraine

Vestibular migraine is a special form of migraine with aura. Although its symptoms also include the signs of a typical migraine aura, it is characterized by dizzy spells. Most of the time it is a matter of rotary vertigo, but it can also lead to staggering vertigo. Dizziness is typically associated with nausea and unsteady gait.

Dizziness often worsens with vestibular migraines when people bend over, lie down, roll over while lying down, sit up from a lying position, or move their head. Many respond to movement with such severe discomfort that they remain on bed rest.

In addition to the dizziness and increased sensitivity to movement, the aura in vestibular migraines can present with other signs, such as:

Eye trembling (nystagmus)
Pressure on the ear (often on both sides)
ringing in the ears (tinnitus)
slight hearing loss
The typical migraine headaches often set in after or together with the aura. However, vestibular migraines can also occur without headaches.

Unlike other forms of migraine, vestibular migraine symptoms can sometimes occur between migraine attacks. Eye movements, for example, are often slightly disturbed. The eyes can, for example

follow a moving object only jerkily or
tremble at rest, in certain head positions, or when looking in a certain direction.
In principle, vestibular migraines can develop at any age. However, the symptoms usually first appear in young adulthood.

migraines in children

Migraines usually progress differently in children than in adults. The duration and nature of the symptoms can differ significantly from a typical migraine attack:

Migraines usually last less in children – the symptoms can go away in as little as two hours.
Migraine headaches in children are more common on both sides.
Accompanying symptoms such as nausea and vomiting can be much more difficult for children than headaches.
Instead of headaches, migraines in children often only show up as gastrointestinal symptoms (such as abdominal pain, severe nausea, vomiting).
Possible complications of migraines

Sometimes migraines can cause particularly severe symptoms or be associated with other complications. The main complications include:

Chronic he migraine: The migraine attacks occur more frequently (on at least 15 days/month for at least 3 months, with the typical migraine headache occurring on at least 8 days/month).
Status migraenosus: This denotes a debilitating migraine attack that lasts over 72 hours.
Persistent aura without stroke: In this rare complication, the aura persists for more than a week without imaging showing a stroke.
Migraine infarction: A stroke occurs during a typical migraine attack with aura, which can be detected as brain damage in an imaging study.
Epileptic seizure triggered by migraine aura: This rare complication is also known as migralepsy.
Good to know
For many women, migraines weaken during pregnancy or temporarily stop altogether. At the beginning of the menopause, i.e. in the time before and after the last menstrual period (menopause), the symptoms can initially worsen. However, as the menopause progresses, there is often an improvement – ​​sometimes the seizures even go away forever. In men, too, migraines often improve with age.

Migraines: causes

It is not known exactly what causes migraines. What is certain, however, is that migraine is a primary headache: Primary means that it is an independent disease that did not arise as a result of another underlying disease.

Certainly hereditary causes play a role in the development of migraines. This is because the headache disorder occurs frequently in many families: around 70 percent of all people with migraine have first-degree relatives – i.e. parents, siblings or children – who are also affected.

Since significantly more women than men have migraines, hormonal influences are also possible causes. This is also supported by the fact that menstruation, hormonal contraception, pregnancy and menopause affect the frequency and severity of migraine attacks in many women. This is probably due to the associated changes in estrogen levels.

In addition, numerous factors are suspected of being able to trigger an existing migraine attack. Experts refer to such stimuli as triggers. They vary greatly from person to person and are therefore often difficult to determine.

Many sufferers blame the weather as the trigger for migraines – for example, a change in the weather or the influence of cold. Other possible triggers for migraine attacks include:

Alcohol consumption (red wine) and smoking
Stress, tension (although the attack usually only occurs afterwards as a “holiday migraine”)
Lack of sleep, altered sleep-wake cycle, time differences
irregular meals, hunger
lack of exercise
Medications (certain heart medications, birth control pills)
depression, anxiety disorders
very bright or fluorescent light
Migraine: Diagnosis
In the case of migraines, the diagnosis is often based on the symptoms described. However, it is sometimes difficult to clearly differentiate other types of headache from migraine headaches. It is therefore helpful to keep a diary if there are any signs of a migraine.

In order for the migraine diary to contribute to the diagnosis, those affected should keep it for a period of at least four to six weeks. The time, type, severity, duration and possible triggers of the symptoms as well as any medication taken to counteract them should be recorded.

A physical examination is also important, during which the doctor pays particular attention to the nervous system: If neurological tests and examinations do not provide any indication of disorders of the nervous system when migraines are suspected, this confirms the diagnosis.

For headaches with unusual symptoms or other abnormalities, further investigation is needed to rule out causes other than migraines. Imaging methods such as magnetic resonance imaging (MRI) are then particularly useful.

Important NOTE

If you have been diagnosed with migraines, but your headaches suddenly change or become extremely severe, it is essential that you have the symptoms clarified by a doctor: This is the only way to be sure that there is no other (new) illness behind it.

Treatment: What helps against migraines?

During an acute attack of migraines, there are several things that sufferers can do themselves. Many then retire to a quiet, darkened room and lie down. Because movement and external stimuli such as light and loud noises increase the symptoms.

Some people with migraines also use home remedies to relieve the pain. For example, a cold, damp cloth on the forehead can provide temporary relief during an acute attack.

But above all, migraine tablets are used to treat acute symptoms. Most sufferers take pain relievers (mostly over-the-counter) for the headache. For example, anti-inflammatory agents such as acetylsalicylic acid (ASA), diclofenac and ibuprofen or paracetamol.

At the same time, those affected can have medication prescribed to treat severe nausea or vomiting associated with migraines. For example, the active ingredients domperidone or metoclopramide are suitable.

If the symptoms do not improve enough or if they are very severe, triptans against migraines are an alternative: These medications were specially developed to treat migraine attacks. In addition to pain, triptans also relieve sensitivity to light and nausea. Some of these migraine tablets are available without a prescription, but most require a doctor’s prescription.

Important NOTE

Painkillers and migraine tablets work better if they are taken as early as possible in the migraine attack. But be careful: If you have migraines with aura and want to take a triptan to treat them, you should wait until the aura has passed and the headache has started.

Sometimes migraine attacks are so severe that treatment by an emergency doctor or in an outpatient clinic may be necessary. The medication against migraines can be administered by injection into a vein.

Important NOTE

Excessive consumption of painkillers and migraine tablets can lead to headaches getting worse in the long term. Experts therefore recommend treating migraines with it for a maximum of ten days a month. If this is not enough for you to be pain-free, it is best to seek medical advice.

Treat migraines with piercing?

If you are looking for ways to treat migraines on the Internet, you will quickly come across information and testimonials on the subject of ear piercings. According to this, migraines can be improved primarily by a piercing that is pierced through the cartilage fold over the ear canal: the so-called daith piercing.

The daith piercing sits in a spot that serves as an acupuncture point for migraine treatment. However, while previous research shows that migraines can be less painful and less frequent with acupuncture than without therapy, there is still no scientific evidence to support the effectiveness of ear piercing.

Healing with needles: what acupuncture does and how it works

In addition, daith piercing is associated with health risks: Compared to piercings in tissue with a good blood supply, such as the earlobe, piercing the ear cartilage is much more likely to lead to inflammation or problems with wound healing. Therefore, the German Migraine and Headache Society e. V. urgently discourage getting a piercing to prevent migraines.

Migraine prophylaxis

Treatment for migraines is not only aimed at relieving acute symptoms. Preventive measures are advisable, especially in the case of frequent and severe migraine attacks.

In certain cases – such as people who have three or more attacks per month – such migraine prophylaxis can include long-term treatment with medication. Various active ingredients are suitable for this purpose: such as beta blockers (such as metoprolol and propranolol), the calcium channel blocker flunarizine, anticonvulsants (such as topiramate and valproic acid) or the antidepressant amitriptyline.

However, the most important contribution to migraine prophylaxis is what those affected can do themselves: namely, recognize and avoid the individual triggers of the migraine attacks. If you want to prevent migraines in general, you should above all pay attention to a healthy lifestyle. For example, cope well with stress, eat regularly and exercise enough. Endurance sports, relaxation methods, biofeedback methods and cognitive behavioral therapy are helpful.