Migraine: What really helps against them and brings relief

This text first appeared in May 2023.

The migraine is considered a genetically related brain organic disease. Stress, hormone fluctuations and disposition decide how often and seriously you are affected. In addition to the hammering or throbbing headaches, people with migraines are sensitive to light, smells and noises, they are sick, sometimes they even have to vomit. In a quarter of those affected, the pain attacks are announced with an “Aura”. This includes visual disturbances such as flashes of light, but also tingling and numbness feelings or language problems. In the past, those affected were dependent on conventional pain relievers.

At the beginning of the 1990s, the first triptans came onto the market that intervened more specifically into the inflammatory processes for migraines. For a few years now there have been even better effective means that can quickly end acute attacks or can reduce the number of pain attacks in advance.

In migraines, overactive nerve cells in the brain stem cause a special cranial nerve, the trigeminal nerve, pour more so-called calcitonin gene-related peptides (CGRP). “CGRP is considered the most important messenger of migraines,” says Charly Gaul, head of a headache center in Frankfurt. He binds to special receptors and triggers a chain reaction: the blood vessels in the area of ​​the brain skins swell, change inflammatory and cause pain. Here the so-called CGRP antibodies start. At first only approved as pen, there are now also tablets that block CGRP. Non -drug therapies such as relaxation procedures and endurance sports are the second indispensable pillar of migraine treatment. Medicines combined with alternative therapy approaches achieve the best therapeutic effects.

Migraine therapy distinguishes between acute attacks and prophylaxis so that pain does not occur:

Painkillers
The majority of all people with migraines are treated with (anti -inflammatory) pain relievers such as acetylsalicylic acid, ibuprofen, diclofenac.

Triptane
They dock in acute cases of serotonin receptors and prevent the release of CGRP. Some are freely for sale; Triptans can be taken orally, rectally, as a syringe or nasal spray.

Ditane
Look like triptans, but only on the vessels in the head area, so that people with vascular diseases can also take them for which triptans are not allowed. In Germany, the active ingredient Lasmitidan is currently approved.

CGRP antibodies
Are injected from a few weeks. To put it simply, prevent the CGRP molecules from playing their pain-mediating role.

Pant
They look like the CGRP antibodies, but are swallowed. The first representative RimeGepant can be used in acute migraine therapy and in prophylaxis. Available from spring 2025.

prophylaxis
For the preventive treatment of episodic migraines, beta blockers, topiramate, flunar medicine, amitriptylin have established themselves as standard; Botulinum toxin, Botox for short, is used for chronic migraine form.

Since medical cannabis is legalized, doctors have also prescribed it against headache. Active ingredients such as tetrahydrocannabinol (THC) and cannabidiol (CBD) have a pain reliever. A review from 2021 showed that medical cannabis can reduce the duration and frequency of migraines and headaches.

But: According to other studies, migraine sufferers who consume cannabis against their pain have a risk of getting a headache six times higher. Apparently there is a connection between the therapeutic cannabis consumption and headache, which is created by “medication use”.

Conclusion: The data situation is confusing; It is unclear the amount of which active ingredient is necessary to improve the headache.