Migraine with aura and chronic migraine – symptoms, neurological symptoms, and headache attacks

Migraines are characterized by episodic, throbbing, pulsating, and recurring headaches. They usually affect only one side of the head. Without pain medication, a migraine attack is almost unbearable. People who suffer from migraines report episodic headaches that steadily worsen.

The exact cause remains unclear. 

Doctors believe that migraines are caused by various factors, such as:

• Food and beverages
• Sleep disturbances
• Temperature changes
• Trigger points (muscle tension)

Currently, about ten percent of the population suffers from migraines, with women being affected far more frequently than men. For this reason, migraines were long considered a women’s ailment. However, men and children can also be affected.

In most cases, symptoms are exacerbated by:

• Movement
• Light and
• Loud noises

As a result, patients feel most comfortable in quiet, dimly lit rooms. The causes and symptoms are varied, which is why migraine attacks are difficult to treat. It is noteworthy that an increasing number of children are complaining of severe headaches, which is why stress is considered one of the main causes.

Doctors are still debating the causes of migraines. Often, several family members suffer from migraines. 

For this reason, experts suspect that headaches are caused not only by external factors but also by genetic factors.

Among the most common causes are:

• Hormonal fluctuations
• Stress
• Lack of sleep
• Dehydration
• Sensitivity to weather changes
• Low blood sugar (from dieting or irregular meals)
• Sensory overload (noise, bright light)

However, headaches can also be caused by muscle tension (so-called trigger points). 

They most commonly occur in the neck and throat region.

Certain foods and beverages can also contribute to headaches, such as:

• red wine
• Cheese
• Nicotine
• Chocolate
• Bananas and
• citrus fruits

They cause an increased release of the body’s own neurotransmitter norepinephrine, which has a vasoconstrictive effect. A thyroid dysfunction has a similar effect on the body. A healthy thyroid gland produces the hormones T3 and T4, which stimulate metabolism. 

If hormone levels are too high or too low, the following symptoms may occur:

• Fatigue
• Difficulty concentrating
• Exhaustion
• Sleep disturbances
• Sweating spells
• Nervousness
• Migraines

Scientists also believe that there is an imbalance in serotonin levels. Serotonin is a neurotransmitter also known as the “happiness hormone.” Serotonin lifts one’s mood; in addition, the hormone influences both our sleep cycle and our bowel function. The neurotransmitter is stored in red blood cells (platelets).

During a migraine attack, serotonin levels in the body rise. Serotonin concentrations are particularly high during menstruation, which is why women are more likely to complain of headaches during this time.

Doctors typically divide migraines into four phases.

Phase 1 – Prodromal Phase

During this phase, those affected often report:

• Mood swings
• Increased irritability
• Frequent yawning
• Difficulty concentrating or
• Loss of appetite

Phase 2—Aura Phase

Approximately 10 to 30 percent of patients suffer from migraine with aura. Migraine with aura means that headaches are accompanied by neurological symptoms. 

These include:

• Speech disturbances
• Flashes of light
• Disturbances in color perception
• Sensory disturbances

Phase 3—Headache Phase

In this phase, patients suffer from severe headaches that increase slowly but steadily. 

In addition to the headaches, the following symptoms usually occur in the temple or forehead area (usually on one side):

• Dizziness
• Nausea and vomiting, as well as
• Increased sensitivity to light and sound

Phase 4 – Recovery Phase

During the recovery phase, although the symptoms gradually subside, those affected feel irritable, tired, and exhausted. It is also common for them to have no appetite.

The primary goal of treatment is to eliminate the factors that trigger the pain. This helps reduce the pain symptoms. 

These include:

• Stress, as well as 
• Consumption of alcohol, nicotine, chocolate, and citrus fruits

Relaxation exercises (muscle relaxation, yoga) and endurance sports (jogging, Nordic walking) can also help reduce the frequency of migraine attacks. For trigger points in the neck area, massages and stretching can be helpful.

Most patients are particularly sensitive to noise and light during the acute phase. They should stay in a darkened room. Distracting noises (radio, TV) should be turned off if possible. Cold compresses, for example on the forehead or neck, can help reduce pain.

For headache attacks, migraine medications—including NSAIDs (aspirin, ibuprofen) and acetaminophen—have proven effective. For an acute migraine, triptans are used, which the patient receives as suppositories or in tablet form. However, these medications are not suitable for pregnant women or people with high blood pressure.

Unlike tension headaches, migraines cannot be relieved by essential oils or relaxation exercises. 

If you suspect you have a migraine, therefore, consult a specialist right away. See a neurologist or a general practitioner with in-depth knowledge of migraines. 

The German Migraine and Headache Society maintains directories. There you can also find a migraine specialist near you.

Migraine without aura is the most common form of the condition, though variants involving an “aura” or neurological symptoms can also occur. Rare forms include familial hemiplegic migraine, sporadic hemiplegic migraine, retinal migraine, and migraine with brainstem aura (also known as basilar-type migraine).

Migraine is diagnosed based on typical symptoms, additional signs, and the patient’s individual medical history. Symptoms of migraine often include severe headaches, nausea, sensitivity to light, and other neurological symptoms. The causes of migraine and its development are complex and can be influenced by genetic factors or various triggers. The causes of migraine vary from person to person and range from stress to hormonal changes.

Migraine treatment encompasses both acute management of migraine attacks and long-term migraine prevention. Targeted treatment of migraine is particularly important in cases of status migraenosus or chronic symptoms. The German Society of Neurology recommends the S1 guideline “Treatment of Migraine Attacks” for this purpose. In addition, those affected can prevent migraines by avoiding known triggers and maintaining a regular lifestyle. Treatment should also be individually tailored for migraine during pregnancy. International medical literature, such as “of Migraine,” describes modern approaches to the treatment and prevention of this neurological disorder.