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Know your Type




The headaches associated with a migraine attack are typically severe enough to stop you from working or even doing anything much at all. Migraines typically also make you feel nauseous and sensitive to light, noise and smells. All you can do is lie down – ideally in a dark room – and wait for it to pass. That doesn’t mean migraineurs are less productive than other people. In fact, the migraine brain has special abilities. Some of the world’s most brilliant achievers were migraineurs, including Pablo Picasso, Richard Wagner and Marie Curie.

  • Migraine is caused by certain genetic variants that make the brain super-responsive to sensory stimuli, among other effects. Migraine brains are permanently ‘on overdrive’, hard-wired to pick up sensory information quicker and process it faster.

    Migraine genetics has been studied extensively, with researchers combing through the genome in search of the tiniest mutations linking to migraine. Genetic association studies of this kind are challenging because of the very large sample sizes required.

    The main research outcomes are presented in a 2016 paper, revealing 44 loci in the human genome where tiny variations are associated with an increased risk of migraine disorder.

    Further research showed that some genes with these mutations are primarily needed in the blood vessels, suggesting possible vascular involvement in the mechanism underlying migraine attacks. Inflammatory processes have long been thought to play a key role in triggering migraines.


  • A brain that over-responds to sensory stimuli uses up a lot of energy. And if the brain isn’t getting enough, the nervous system malfunctions.

    As well as being amazingly powerful, our brain – the central organ that enables us to think and regulates every process in our body – is one of the biggest energy-consuming organs of them all, using up about 20% of the energy we need in a day. Although brain nerve cells (neurons) are highly energy-efficient, they’re also very sensitive and work best in a stable environment. Part of that is a continuous and plentiful supply of rapidly utilizable energy as fuel. Glucose provides this. Despite needing a lot of energy, our brain does not have a large energy storage system. Our metabolism steps in with ready supplies of glucose to fuel the demand, and an intricate network of blood vessels carries it to where it’s needed.

    A consistent supply of energy is crucial for neurons in particular. Even minor fluctuations may interfere with proper functioning, potentially causing a number of neurological disorders – including migraine attacks. That’s why keeping blood sugar levels stable is so important for people with migraine. The best way to accomplish this is by eating several main meals and snacks spread throughout the day and making sure you get enough carbohydrates. A light snack before going to bed helps keep your energy supply stable at night.


  • Neurons now release pain-triggering chemical messengers (neurotransmitters) non-stop. The blood vessels in the membranes that protect the brain become inflamed, setting off a throbbing headache.

    The current understanding is that blood vessels in the brain are the starting point for a migraine event. Nerve endings in the vessels send out signals to warn the brain about impending vascular damage. The brain reacts with a protective response, resulting in the release of chemical messengers that widen the blood vessels. The end result is neurogenic inflammation, which ultimately triggers the pain.

    Some nervous system chemical messengers (neuropeptides and other neurotransmitters) also play a key role in these processes. One of them is serotonin, which may be involved in initiating and ending a migraine attack. What we do know for sure is that a fall in serotonin levels in the blood might be part of the cascade of events resulting in a migraine attack. Another indication of serotonin’s important role is that anti-migraine drugs (‘serotonin receptor agonists’) replace the lost serotonin, in that way suppressing the neurogenic inflammation associated with migraine.

    Researchers have also identified other chemical messengers as potential targets for novel medicines, including antibody-based drugs that block certain docking sites (receptors) of those substances. This is a vibrant area of research right now.


  • Basically anything that disrupts the flow of energy to the brain can trigger a migraine, for example:

    › skipping meals › not taking enough fluids

    › an irregular sleep schedule

    › not enough exercise

    › not enough relaxation

    › poor ergonomics in the workplace


  • About 10% of people with migraine experience an aura ahead of an attack. Migraine aura happens when the nervous system is fatigued. An aura manifests with neurological symptoms such as

    › Visual symptoms: zigzagging lines, flickering and flashes of light, blurred vision and blind spots

    › Sensory symptoms (tingling, pins and needles in the fingertips)

    › Numbness, paralysis, poor coordination (feeling dizzy, clumsy gait)

    › Speech and language symptoms, confusion or mental clouding


  • Migraineurs may experience a prodrome (pre-headache phase) about 4 to 48 hours before an actual attack. Early warning signs – not to be confused with root causes – may include:

    › A creative high, elevated mood, restlessness

    › Feeling low, fatigue/no energy, irritability

    › Yawning, food cravings (chocolate...), feeling cold, sweating

    The actual migraine attack typically begins in the morning and lasts 4 to 72 hours. The pain is pulsing, throbbing, pounding and one-sided. Physical exertion and movement make it worse.

    Pain intensity is moderate to very severe. Most people also experience nausea (or actual vomiting) and hypersensitivity to light, noise and/or smells.


  • You may feel drained and more sensitive to pain (your scalp may be sore to the touch, for example) for up to 2 days after a migraine attack. Some people experience sudden stabbing pain during this stage, and many need much more sleep than usual. Studies show that postdrome lasts about 24 hours on average, but may be as long as 14 days in migraine with aura.









von Nervengewebe oder seinen Bausteinen, den Neuronen (Nervenzellen), verursacht bzw. aus ihnen hervorgehend. Der Begriff neurogen setzt sich zusammen aus den Wörtern neũron (griechisch für Nerv) und genere (lateinisch für erzeugen oder hervorbringen). Neben der neurogenen Entzündung, die ursächlich mit Migräneattacken in Verbindung gebracht wird, kennen wir noch weitere Krankheitsbilder, die mit dem Nervensystem in Zusammenhang stehen, so etwa neurogene Muskelschmerzen oder auch neurogene Tumoren.

Die Aura


Aura ist die altgriechische Bezeichnung für Hauch, Dampf. Mutmaßend, dass aufsteigende kalte Dämpfe ursächlich seien, wurde in früherer Zeit mit dieser Begrifflichkeit das Phänomen sich im Körper ausbreitender neurologischer Störungen bezeichnet. Die Migräneaura ist ein vielfältiges Phänomen. Es kann optische und taktile Wahrnehmungen beinhalten. Erhöhte oder auch reduzierte Erregbarkeit der Sinnesorgane wird ebenso beschrieben, wie Veränderungen des Bewusstseins, Störungen des Denkens, des Gedächtnisses, der Sprache, sowie Störungen des motorischen Systems.



Im Fokus der Ankündigungsphase steht ein Teil des Zwischenhirns: der sogenannte Hypothalamus. Er ist wesentlich beteiligt am Schlaf-Wachzyklus, dem Bedürfnis nach Nahrungsaufnahme und hormonalen Veränderungen, insgesamt also wichtig für die Stabilität der Körperfunktionen. Störungen der Abläufe zwischen Botenstoffen und Nervensignalen im Hypothalamus können sich zu einer Fehlregulation aufbauen, die über Stunden oder sogar Tage anhält. Die derzeitigen Hypothesen besagen, dass die Symptome während der Ankündigungsphase Folge einer Überaktivität des Hypothalamus sind.