2024-09-05 21:39:33
Migraine is more than just a headache: it significantly affects the lives of many people. New therapeutic approaches and medications can help those affected.
Pounding, pulsating headaches, hypersensitivity to light, noise and smells, nausea and even vomiting: migraines can manifest themselves in very different ways in different patients. The list of possible triggers is just as varied. This makes them difficult to treat. However, new treatment options have emerged in recent years.
For a long time, migraines were not recognized as a serious illness. However, “migraines are one of the most common neurological diseases and can also lead to significant limitations in quality of life,” emphasizes Christian Maihöfner, spokesman for the Pain Commission of the German Society of Neurology (DGN). A severe migraine can have similar health-economic consequences to a stroke.
According to the Robert Koch Institute (RKI), 14.8 percent of women and 6 percent of men in Germany suffer from migraines. Another 13.7 percent of women and 12 percent of men probably have migraines, according to a 2020 survey.
Many sufferers resort to classic painkillers such as ibuprofen, paracetamol or acetylsalicylic acid (ASA), which are also recommended in the guidelines of professional societies. However, overuse can trigger headaches again, warns Gudrun Goßrau, Secretary General of the German Migraine and Headache Society (DMKG): “As a rule of thumb, you should not take these on more than nine days per month.” An untreated migraine can also become chronic, says Goßrau.
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These painkillers often fail, especially in cases of severe migraines. In these cases, special migraine medications – so-called triptans – can be used, explains Maihöfner, chief physician of the neurology clinic at Fürth Hospital. These are now available in various forms: “Triptans can be administered as an injection, as a tablet or now even as a nasal spray.” The latter is advantageous for migraines with nausea.
A new class of active ingredients, ditans, has recently become available – especially for those who should avoid triptans due to cardiovascular disease or a previous stroke, says Maihöfner. So far, one such drug has been approved in Germany.
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Ditans work in a similar way to triptans in that they prevent nerves from releasing substances that trigger migraines. Understanding of these neurological triggers has recently improved significantly, says Maihöfner: “Today we assume that inflammatory processes in the dura mater play a role: certain nerve fibers can trigger inflammation, with the so-called CGRP – Calcitonin Gene-Related Peptide – being particularly important.” CGRP causes vessels in the dura mater to dilate, which in turn stimulates the pain processing of important nerve fibers.
“The identification of the key role of this neuropeptide has enabled a breakthrough in preventive migraine therapy: namely the development of so-called CGRP antibodies,” says Maihöfner. Four drugs are currently approved in Germany that either block the CGRP receptor or intercept the messenger substance itself: “But these should be in the hands of neurologists or pain therapists who are well versed in this area.”
Beta blockers, antidepressants and occasionally anti-epileptic drugs are also used as a preventative measure. The latter can, however, have a fertility-threatening effect. Some sufferers report positive experiences with magnesium or vitamin B2. In the case of chronic migraines, which occur more than 15 days a month, botulinum toxin injections (Botox) can also be prescribed.
Before taking prophylactic medication, however, non-medicinal options should be tried. “Relaxation techniques such as autogenic training or progressive muscle relaxation play an important role here, as do meditation and mindfulness,” says Maihöfner. Endurance sports such as swimming, jogging or Nordic walking can also help.
Goßrau also emphasizes the importance of a regular daily routine: “Eat at the same time, get enough sleep at the same time, don’t pack your daily routine too full: This is especially important when you have recurring migraines.”
Men are often undertreated
The neurologist also stresses the importance of education: Triptans are used too rarely for fear of side effects, and men are undertreated – not least because migraines are considered a women’s disease. In addition, the occurrence at a young age is neglected. In fact, according to the DMKG, almost ten percent of children and adolescents are affected.