Migräne

Migraine is a common brain disorder that causes recurrent attacks of moderate to severe headache, usually throbbing and often one-sided, with nausea and sensitivity to light and sound. Untreated attacks last 4 to 72 hours.

About a third of people have aura: visual zigzags, blind spots or tingling that build over minutes and clear within an hour. Migraine is not dangerous in itself, but it can be highly disabling. It cannot be cured, yet attacks can be made much less frequent and less severe with the right plan.

Symptome

• Throbbing headache, worse with movement
• Nausea or vomiting
• Dislike of light, noise and smells
• Visual aura such as shimmering zigzag lines
• Tingling spreading up an arm or the face
• Yawning, food cravings or neck stiffness in the hours before
• Tiredness and poor concentration for a day afterwards

Ursachen und Risikofaktoren

Migraine runs in families and reflects an inherited sensitivity of the brain's pain and sensory networks, involving the trigeminal nerve and a signalling molecule called CGRP. Attacks are often set off by changes: missed meals, dehydration, too little or too much sleep, stress or its release, alcohol, hormonal shifts around periods, bright light and weather. Frequent use of painkillers or triptans, on 10 to 15 or more days a month, can itself cause daily headache.

Wie es diagnostiziert wird

• Clinical history: Diagnosis rests on the pattern of attacks. No scan or blood test proves migraine.
• Headache diary: Records frequency, triggers, menstrual link and medication days, and guides treatment.
• Neurological examination: A normal examination supports the diagnosis.
• MRI of the brain: Only when there are atypical features: new headache over 50, change in pattern, abnormal signs, or aura that is prolonged or involves weakness.

Behandlungsmöglichkeiten

• Acute treatment taken early: Aspirin, ibuprofen or naproxen with an anti-sickness medicine, or a triptan. Limit to fewer than 10 days a month.
• Gepants: Rimegepant and similar tablets for people who cannot take or do not respond to triptans.
• Preventive tablets: Propranolol, candesartan, amitriptyline or topiramate, tried for 2 to 3 months each at an adequate dose.
• CGRP antibodies: Monthly or quarterly injections such as erenumab, fremanezumab or galcanezumab when tablets fail. About half of users see attacks fall by half or more.
• Botulinum toxin injections: For chronic migraine, meaning 15 or more headache days a month. Given every 12 weeks at around 31 to 39 sites.
• Lifestyle regularity: Steady sleep, meals, hydration, exercise and caffeine intake.
• Neuromodulation and nerve blocks: Device-based stimulation or greater occipital nerve block for selected people.

Wenn es dringend ist

Seek emergency care locally for a sudden thunderclap headache, headache with fever and stiff neck, new weakness, confusion, seizure, loss of vision, a first severe headache after age 50, or headache after a head injury. Aura lasting more than an hour also needs prompt assessment.

Reisen nach Türkiye zur Behandlung

Migraine is managed over months by trial and adjustment, which suits a doctor near home, and flying itself can trigger attacks. A visit can offer a specialist headache review, an MRI if indicated, and a written plan. Botulinum toxin or nerve blocks can be given on a trip, but they need repeating every 12 weeks to keep working, so consider whether you can continue them at home.

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