Migraines: Diagnosis And Therapy

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Migraines: Diagnosis And Therapy
Migraines: Diagnosis And Therapy
Video: Migraines: Diagnosis And Therapy
Video: Diagnosis and Management of Headache 2023, February

Migraines: Diagnosis & Therapy

The most important tool for migraine diagnosis is a medical consultation, with a detailed survey of the medical history (anamnesis). The precise descriptions of the patient, for example with the help of a headache diary, are particularly informative.

Treatment includes acute therapy for individual attacks and the prevention of migraine attacks (prophylaxis / interval therapy).


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  • more on the subject
  • Advice, downloads & tools
  • How is a migraine diagnosed?
  • How is an acute migraine treated?
  • How to prevent migraines
  • What can those affected do themselves?
  • Whom can I ask?
  • How are the costs going to be covered?

How is a migraine diagnosed?

A headache diary helps to describe the pain better and makes it easier for the doctor to make a diagnosis. A physical and neurological examination is also necessary. If necessary, further clarifications (e.g. an EEG, CT or MRT) are necessary in individual cases in order to rule out other diseases. In addition, laboratory tests, X-ray procedures to visualize blood vessels or the examination of the nerve fluid (cerebrospinal fluid) can be used if necessary.

One speaks of migraine when the typical symptoms occurred at least five times. Once the diagnosis of migraine has been made, comprehensive information about the disease and advice on therapeutic measures should be provided. The aim is to enable an understanding of the clinical picture. Likewise, the sensitivity for possible triggers is strengthened, since these must be avoided.

A migraine may get better over the years. A migraine rarely becomes chronic. With chronic migraines, symptoms occur for at least three months on more than 15 days per month.

How is an acute migraine treated?

Treatment includes measures to shield against stimuli (eg retreating into a dark room, lying down), cold compresses on the forehead / head and, if necessary, a cup of coffee or tea. Medicines play an essential role in treatment.

Medicinal migraine therapy

For drug treatment, pain relievers with only one active ingredient should be the first choice, especially:

  • Acetylsalicylic acid,
  • Ibuprofen (especially in children and adolescents),
  • Diclofenac,
  • Metamizole as well
  • Naproxen.

Note Your doctor or pharmacist will inform you about effects, side effects and interactions.

There are also headache supplements that contain only caffeine or caffeine combined with a pain reliever. However, there are currently no comprehensive findings on the effectiveness in this regard. In order to avoid drug-induced headache, pain relievers should not be taken more than 15 days per month (in the case of combination preparations, not longer than ten days). In the case of severe nausea or vomiting, medication against nausea, such as domperidone or metoclopramide, can also be prescribed.


The so-called triptans were specially developed for migraine therapy. They have peripheral and central approaches. Among other things, they inhibit neurotransmitters that promote inflammation. Almotriptan, Eletriptan, Frovatriptan, Naratriptan, Rizatriptan, Sumatriptan and Zoilmitriptan show the best effectiveness in this substance class. Triptans relieve pain, sensitivity to light and nausea and are used when pain pills do not work well enough. The earlier triptans are taken during an attack, the better they work. Triptans should not be taken more than ten days a month for three months. Otherwise a headache can result from taking the medication.

Another group of drugs that were used for migraine attacks were the ergotamines. They were withdrawn from the market in Europe due to more common side effects than triptans. Therefore, they should no longer be used for migraines.

In the case of very strong seizures, emergency treatment by an emergency doctor or in a hospital outpatient department may be necessary. Medicines can also be administered intravenously.

Note Excessive use of pain medication can lead to dependence and kidney failure or liver damage, among other things. Therefore, a doctor should always be consulted in order to avoid these complications. In addition, pain medication can itself be the cause of headaches, the so-called pain medication-induced headache.

Migraine Treatment During Pregnancy

Migraines tend to decrease during pregnancy. Between the first and second trimesters, migraines can be treated with acetylsalicylic acid or ibuprofen. Paracetamol can be used during this period if acetylsalicylic acid must not be given. Learning about relaxation exercises can be helpful and make managing migraines without medication during pregnancy easier.

How to prevent migraines

To prevent migraines from occurring in the first place (or at least to a lesser extent), preventive measures can be helpful. Drug prevention with appropriate medication is especially recommended for:

  • frequent migraine attacks (three or more attacks each month that significantly reduce the quality of life) and
  • severe seizures lasting more than three days,
  • Attacks that regularly last longer than 72 hours,
  • for seizures that are associated with a very stressful aura (e.g. symptoms of paralysis) and

In addition, drug prophylaxis is an option if conventional painkillers or triptans for therapy of acute headaches are not tolerated, do not bring about an improvement or are taken for more than ten days a month.

Non-drug therapy strategies

In principle, a non-drug treatment strategy should be used for all patients. Regular endurance sport (3x30min / week) has shown results that are as good as those of drug prophylaxis in studies.

Other important non-drug measures for the prevention of migraine attacks are psychotherapy or clinical-psychological treatment. Above all, these are used to reflect on how to deal with the disease and to better cope with stress and pain psychologically, and in the context they are primarily oriented towards behavioral approaches. Relaxation techniques can also be learned in this context (e.g. progressive muscle relaxation according to Jacobson (PMR)). In addition, biofeedback has proven itself in migraine prophylaxis.

In general, a healthy lifestyle and avoiding stress make sense.

Drugs for migraine prophylaxis

Most of the previous oral medications for the preventive treatment of migraines were first developed and used for other diseases, but were also able to prove their effectiveness in clinical studies and in practice. The following medications are used individually depending on the other state of health:

  • The anti-epileptic drugs topiramate and valproic acid have an anticonvulsant effect. Valproic acid may no longer be used in women of childbearing potential and is therefore only a reserve preparation with strict indications.
  • Botlinum toxin A (“Botox”) is only approved for chronic migraines, as the studies showed that it was not effective in episodic migraines. It is injected in small doses into several muscles in the neck and head area and should only be administered by neurologists who are experienced in this therapy.
  • The calcium channel blocker flunarizine inhibits metabolic processes in the development of migraines.
  • Amitriptyline, a so-called tricyclic antidepressant.
  • Blood pressure drugs / beta blockers (primarily metoprolol and propanolol).

However, the drugs mentioned are not equally effective for everyone and, as with any drug, side effects can occur.

Antibodies (erenumab, fremanezumab and glacanezumab) are a new approach to migraine prophylaxis. Antibody treatment is also known as a “migraine vaccination”, although this is technically incorrect as it is not a vaccination.

For more information and scientific background, see

  • Erenumab (Medicine Transparent) as well
  • Fremanezumab and glacanezumab (informedhealth.org).

There are also a number of measures advocated for migraines that have not yet been proven to be effective - including diets. Special features of prophylaxis in the presence of other illnesses will be taken into account by your doctor (e.g. if there is a mental illness, high blood pressure or epilepsy).

What can those affected do themselves?

Patients can make a significant contribution to the success of the therapy. This includes a lifestyle that is as healthy as possible (identification and avoidance of triggers, endurance sports) as well as the practice of relaxation methods and stress management. Identifying possible (co-) triggers (such as too little sleep, stress, etc.), for example using a migraine diary, can also help to avoid them.

Whom can I ask?

If you suffer from a headache, do not hesitate to consult a general practitioner or neurologist. It is advisable not to wait too long to see the doctor so that the cause is identified and the headache does not become chronic. Even if you consume a lot of pain medication you should seek advice on this. Psychotherapists and clinical psychologists can also be included in the treatment.

The Austrian Headache Society and the German Migraine and Headache Society also provide information on their websites on the subject of headaches and migraines (including a search for specialized outpatient clinics / headache centers, headache diaries and calendars as well as other, sometimes multilingual, downloads on special topics, etc.).

In any case, you should immediately seek medical help if you have the following symptoms:

  • new daily headaches,
  • existing headaches change in intensity or frequency,
  • Fever and severe headache.

The following symptoms represent medical emergencies in which the ambulance must be called at 144:

  • sudden extreme headaches that get worse within minutes,
  • Headache and stiff neck and high fever,
  • Headaches that are accompanied by paralysis, changes in character or sensory disturbances,
  • Headache followed by impaired consciousness and epileptic seizures.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Rehabilitation & cure
  • Medical aids & aids
  • Health Professions AZ

as well as the online guide to reimbursement of social insurance costs.

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