I have a childhood memory in which my mother appears. We are on vacation, on a magnificent estate in Schleswig-Holstein, when she suddenly turns to the side and pukes into the bushes, without any warning, at least to me. Mom had migraines, they said at the time, and that there were a lot of them in my family. So quite early on I witnessed how miserable it can be. Migraine sufferers just want to lie in the dark, a cool pack on their forehead, waiting for it to finally be over. Migraines are a greeting from hell. And those who almost never get headaches can count themselves lucky. So do I.
And if it does, then for me it’s more like a “stupid head”, a diffuse discomfort in the skull after too little sleep, maybe even a hangover feeling after too much wine. Or a so-called tension headache, which is incidentally the most common type of headache. Studies say that around two thirds of the population deal with it in the course of a year, and that still seems small to me. According to the German Neurological Society (DGN), tension headaches are usually mild to moderate and dull and oppressive throughout the head. The DGN guidelines talk about the hat being too tight, which is sometimes perceived as being too tight.
The comparison is apt, I think. In contrast to migraines, a tension headache doesn’t get worse when you move, nor does it make you vomit. A tension headache episode can last a few minutes, sometimes a few days. And even if we still don’t know exactly how tension headaches arise, we have identified some triggers and aggravating factors: stress, feverish infections, and incorrect muscular strain, which can lead to tension.
What do I take when my head speaks up? At first nothing. I drink a large glass of water because often enough headaches are simply caused by dehydration. In the next step I would eat something good, ideally a warm meal, optionally something sweet – those who have hypoglycemia often have a “stupid head”. And then I go out into the fresh air for ten minutes. If none of this helps or is simply impossible for the person affected, peppermint oil can also be applied. Individual studies show that it has an effect when rubbed over large areas on the temples and neck.
Most of the time I just take ibuprofen, also because I always carry it with me but don’t always have oil on hand. I swallow 400 milligrams – I would only recommend the low dose of 200 milligrams to those who are shorter than 1.50 meters and weigh no more than 45 kilos. Other over-the-counter remedies that have been shown in studies to be effective for tension headaches: acetylsalicylic acid (ASA) and paracetamol, each in doses of 500 to 1000 milligrams, also naproxen (500 mg) and the combination of 250 milligrams of acetylsalicylic acid, 250 milligrams of paracetamol and 65 Milligrams of caffeine, pressed into one tablet. However, such combination preparations are not without controversy. Critics complain that the caffeine in it encourages excessive use. And if side effects occur, it is not known which of the ingredients they are caused by. On the other hand, some customers want nothing other than these “fixed combinations” because they help them so much.
All of these remedies are also useful for migraines; the effect of ASA and ibuprofen is best proven. According to official recommendations, you should first treat “mild to moderate migraine attacks” with such over-the-counter painkillers, in a quick-acting dosage form, for example with an effervescent tablet or, if you are really nauseous, as a suppository. And knowing that you have an additional ace up your sleeve for migraines, a wild card: the triptans. These are remedies that only work on migraines.
I always can’t believe how many migraine sufferers have never heard of the substance class. Triptans have been around for over 20 years. But many pharmacists hesitate to address them on their own initiative. You are only allowed to give them away if a doctor has previously made an official diagnosis of “migraine”.
Triptans are similar to the body’s own messenger serotonin and dock onto certain serotonin receptors. This causes the blood vessels in the brain that dilate during migraines to contract and the pain decreases. However, such receptors also exist outside the skull, and triptans could in principle constrict blood vessels there too – a side effect that makes them unsuitable for patients with coronary heart disease and other vascular diseases. Anyone who has diabetes or smokes a lot should also avoid it. Triptans work best if you take them as soon as you feel the headache. They don’t do anything beforehand. Anyone who feels their migraine coming on due to visual, smelling or other disorders is warned, but should still wait.
Since 2006, Naratriptan has been available without a prescription (at least in packs of two tablets, you cannot take more within 24 hours), Almotriptan and Sumatriptan followed, and next comes Rizatriptan. If one of the active ingredients doesn’t work for you, it’s worth trying the next best thing. According to studies, the chance that the second triptan will take effect is around 50 percent.
Are you unsure whether your day is really being ruined by a migraine or just a normal headache? You should have this checked by a doctor. Neurologists are the right specialists, but if you go there unexpectedly, there is probably a migraine or headache clinic at the nearest university clinic. This is a good tip because there are now some effective (and prescription) methods to prevent migraine attacks.
Endurance exercise and sufficient breaks help, and a headache diary is worth keeping track of triggers. After all, when it comes to headaches, the pharmaceutical peculiarity must also be taken into account that both triptans and other painkillers can cause a “drug-induced headache” if you use them too often (no joke, unfortunately, but widespread).
The theory behind it: Anyone who regularly takes painkillers will eventually experience stimuli that are normally below the pain threshold as painful. You take even more painkillers and a vicious circle develops that can result in a constant headache. Ten days a month or three days in a row is the upper limit for triptans and fixed combinations; for painkillers with only one active ingredient it is 15 days a month.
By the way, women have the most headaches in midlife. Before estrogen production stops in the ovary, estrogen levels fluctuate enormously. Over many years you sometimes have a lot of estrogen, and sometimes none. And that’s exactly what a migraine brain doesn’t need. Migraines are also becoming an issue for gynecologists. Seizures that are triggered by a sudden drop in estrogen can be easily controlled with certain hormone preparations. Once the hormonal fluctuations are over, things get much better for many women. Unfortunately not for everyone. But my mother, you remember, is now in her mid-80s – and hasn’t complained about a headache for a very long time.
In this episode of the podcast “Meno to me” from BRIGITTE magazine, I talk to the gynecologist Dr. Anneliese Schwenkhagen from the German Menopause Society about migraines during menopause.
Follow me on Instagram: @apothekerin_ihres_vertrauts
Note: The column can neither replace individual advice in the pharmacy nor the package insert or medical diagnosis and treatment.
