Headaches and migraines are THE diseases of our time – but they are rarely diagnosed and treated correctly. There are proven therapies and many new ways.
How often does your head hurt? Never or only if you drank too much the night before? Congratulations, then you can click on the next article. But stop! Actually, that’s exactly what’s been happening for far too long: headaches are being ignored. They are played down and stigmatized. It is more than high time to deal with them – and has never been more justified than today. Five truths we should all know:
Everyone is affected – just not always directly
Headaches are a widespread disease with us: 28 percent of women regularly have tension headaches, which admittedly rarely develop a high degree of suffering, just as many suffer from migraines. Although not all are equally severely affected, the World Health Organization (WHO) ranks migraine among the most disabling diseases.
And headaches are not a private matter: “Unfortunately, I have to cancel, I have a headache”, maybe not everyone has already said it, but at least this has been heard from friends, relatives, colleagues. Because of migraines alone, Germany loses around 146 billion euros a year, as determined by the Wifor Institute in Darmstadt. That is 4.4 percent of our gross domestic product.
Data from health insurance companies shows that there are more and more headache and migraine patients: in Schleswig-Holstein, for example, migraine diagnoses have increased by 38 percent in men and by 28 percent in women in ten years. “But I don’t see that only negative, it also speaks for more attention from doctors and for more courage to admit the disease to yourself and others,” says Professor Dagny Holle-Lee, head of the West German Headache and Dizziness Center at the University Medicine Essen.
But there is also this aspect: Our everyday life full of deadline pressure and permanent stimuli as well as a lack of sleep and time off are a permanent burden, especially for people who have a hereditary tendency to migraines. Stress is also a main risk factor for tension-related complaints, days in front of the screen – especially in the home office at the kitchen table – do the rest. Above all, more and more children and young people are affected: just a few years ago, 40 percent of 9 to 19 year olds stated that they regularly took headache pills. “The fact that going to school is also becoming a problem because of headaches has obviously become more common,” says associate professor Dr. Gudrun Gossrau, Head of the Headache Outpatient Clinic at the University Hospital of the TU Dresden. “The pandemic has probably increased this increase again.”
The aches and pains dilemma
“Because we now know more about headaches and migraines, acceptance of the disease is also improving,” says Gudrun Gossrau. “But this change is taking a long time. Unfortunately, there are still resentments and prejudices even among colleagues.” The trivialization does not only affect medicine: “You don’t see the headaches or migraines of those affected, it’s software malfunctions and not a broken leg that everyone sees directly from the outside and recognizes as a problem,” says Dagny Holle-Lee. “A migraine comes on suddenly and cannot be planned, often at the weekend. If an appointment is then canceled, many people still believe that it was a pretense.” Even those who are back at work the next day after an attack, as if nothing had happened, sometimes get crooked looks.
According to neurologist Holle-Lee, even those affected sometimes tend to play it down: “After all, you don’t always want to be the one who suffers. I know that from mothers in particular. Despite the severe headaches, they try not to let their child show anything and to be as normal as possible.” Not taking a break then exacerbates the symptoms.
Every headache is unique
There are over 200 different types of headaches. They differ in cause, strength and duration. And of course in therapy. “Unfortunately, the care is still not what we would like. Many patients do not go to the doctor, do not receive a professional diagnosis and therefore no specific therapy,” says Stefanie Förderreuther, senior physician at the neurological clinic of the LMU Munich. Mistakes are particularly common with migraines, which are often misunderstood as a problem of the cervical spine. According to the expert, examinations such as magnetic resonance imaging or computer tomography are often carried out without making any sense. There is also a gap in terms of prophylaxis, which is recommended for tension headaches from ten days of pain and for migraines with more than three attacks – each based on one month. “Patients are rarely informed about preventive measures and receive no appropriate therapies.”
The fact that a migraine often goes undetected is also due to the fact that it is highly individual. The full spectrum is not always shown with one-sided throbbing, nausea, and sensitivity to light and noise. The personal history of migraines is just as variable: “Every pregnancy is different, every job change, every new partner, the contraceptive method, a change in the weather,” says Dagny Holle-Lee. “There are 1000 ways that a migraine can change, and it also changes all by itself. Anyone, even with severe form, has a good chance of getting better on their own. With the right medication and other measures, we try to get into these good times faster.”
“You have to live with that” was yesterday
“Many sufferers think that having a headache is normal,” says Dagny Holle-Lee. Even doctors often convey that you have to live with it. “But that’s nonsense, of course: it’s normal not to have a headache.” Self-medicating with over-the-counter painkillers is fine for now, but regular and severe ailments that interfere with everyday life should definitely be checked out. “Basically, you need someone who is interested in pain. That can also be the family doctor,” says the expert. Specialists can be found on the website of the German Migraine and Headache Society (dmkg.de).
The good thing is that headaches and migraines are becoming easier to treat. The range of therapy options has become significantly broader, even if not all of them are currently available from us. In the case of migraine, for example, after the triptans, the first migraine-specific drugs that revolutionized therapy almost 30 years ago, there have been so-called Ditans since this spring. Unlike triptans, they do not constrict the vessels and are therefore also suitable for people who have had a heart attack, for example. And in addition to the so-called CGRP antibodies, a CGRP antagonist was approved in 2022, which has a dual effect: in the attack and for prevention. Dagny Holle-Lee: “At the moment I would recommend anyone who was told maybe five or six years ago ‘We don’t have anything’ to check with the doctor to see if there isn’t something new for them after all.”
The trick: become your own expert
There are also developments beyond medication, for example an app that uses personalized nutrition to prevent migraines. Another approach comes from studies led by Gudrun Gossrau in cooperation with the olfactory expert Professor Dr. Antje Hähner of the University Hospital Dresden. The starting point was the experience of many of those affected to be extremely sensitive to odors. These can not only trigger or intensify attacks, but are often perceived as unpleasant overall.
“What totally surprised us is that, contrary to this perception, the ability to smell is actually worse,” says the doctor. Olfactory stimuli are also processed differently in the migraine brain. However, if you sniff pleasant scents regularly in the morning and evening and thus train your sense of smell, the pain threshold increases. “Of course you always have to know where the limits are. For patients who are severely restricted by migraines, smell training should not be the only method,” says the expert. “But we use this option often and successfully with children and young people, for example.”
Basically important for headaches: your own behavior. “The best therapy will always be that you have to work, or better yet, you can work,” says Dagny Holle-Lee. Pay attention to individual triggers, relaxation techniques and sport are essential building blocks to prevent. “Everyone has to become an expert on their illness to a certain extent,” says Dagny Holle-Lee, while warning: “Even if you behave perfectly, it doesn’t mean that you don’t have a headache.” It also means, “No one who has a headache has done anything wrong.”
Not only do those affected, who often see an attack as their own failure, make this accusation, they also hear it from those around them. “Statements like ‘Why don’t you do this or that? Then the migraine would go away’ suggest that you are to blame for your illness,” says neurologist Dagny Holle-Lee. The shame and the pressure to justify oneself increase and continue to turn the spiral of pain. Conversely, studies show that those who feel understood and supported by those around them have fewer complaints.
Ultimately, it stays like this: there is no off switch. We have to live with headaches, but we still can’t just endure them. We have more and more ways to treat and prevent them. And all of us – even those who are not affected – can contribute, if not well, then at least better to live with them.
Our experts
Prof. Dr. Dagny Holle-Lee Head of the West German Headache and Dizziness Center at Essen University Medicine and is the author of, among other things, “Headache and Migraine Diagnosis” (Herbig)
dr Gudrun Gossrau heads the headache outpatient clinic at the University Hospital of the TU Dresden and is Vice President of the German Migraine and Headache Society
dr Stefanie Foerderreuther is senior physician at the neurological clinic of the LMU Munich and one of the leading authors of the current migraine guideline