This is the third and last post of a three-part series dealing with the most frequently asked questions about migraine and headache, based on the Karger publication “Migräne & Kopfschmerzen. Ein Fachbuch für Hausärzte, Fachärzte, Therapeuten und Betroffene” (“Migraine & Headache. A Reference Book for General Practitioners, Specialists, Therapists and Persons Concerned”).

This article focuses on and answers seven frequently asked questions about migraine.


Migraine & Headaches (source: iStock)


Tension headache or migraine?

Tension headaches are usually dull and pressing; migraine headaches are usually strong and pulsating. There are exceptions in both cases, so the accompanying symptoms are the key differentiator.


What does migraine pain typically feel like?

Typical migraine pain is severe, pulsating, one-sided, and disabling in everyday life. However, it can also be less severe, constant, and holocranial, i.e., distributed over the entire head. The most important distinguishing feature from tension headache is the complete absence of accompanying symptoms such as nausea, vomiting, hypersensitivity to light, noise and smell.


Do migraine attacks occur more frequently during menopause?

In general, women are more frequently affected by migraine than men (menstrual migraine, menopausal migraine). In at least one third of all female migraine patients, migraine attacks accumulate before, during or after menstruation, but also around the time of ovulation. Eighty percent of all migraine patients notice a significant decrease in the frequency of migraine attacks during pregnancy. After the birth of the child, they then suffer from migraines again as frequently as before. After menopause, the frequency and severity of migraines usually decrease slowly.


At what age do migraines usually occur?

Most often between the ages of 12 and about 50, but also as early as infancy and old age.


How does a migraine develop?

The development of migraine is now understood as an interaction of several subsystems of the autonomic nervous system, whereby firstly the pain pattern in the head and neck is altered, secondly sensory organs become hypersensitive and thirdly control circuits of the gastrointestinal tract, alertness, blood vessels and other organ systems deviate from their normal function. However, how individual attacks are triggered is still unclear. Dysfunctions of nerve cells seem to be in the foreground.


Is migraine inherited?

Migraine is clearly an inherited predisposition, but it is controlled by numerous known and as yet unknown genes with quite different penetrance. This is a measure of how strongly individual genes actually affect life. Identical twins have a concordance (migraine occurs in both) of about 80%, while in normal siblings this is about 40%. The chance that somebody affected by migraine will have others affected by migraine among first- and second-degree relatives is about 80%. Since migraine is about three times more common among women, maternal inheritance seems to be present, but this is probably an artifact.


How is migraine treated?

Migraine treatment is based on three pillars: 1. attack treatment, 2. drug prophylaxis, 3. complementary medicine prophylaxis. For the treatment of attacks, highly effective triptans are available today, in case the conventionally applied painkillers do not work. Far too many people affected by migraines treat themselves inadequately with conventional painkillers.


Information based on “Migräne & Kopfschmerzen. Ein Fachbuch für Hausärzte, Fachärzte, Therapeuten und Betroffene” (Karger, 2015).

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