Migraine is not the same as headache, it’s a brain disease

September 12 is the International Day of Migraine. A good thing that this day is there, thinks neurologist and migraine expert professor Gisela Terwindt. Because despite the fact that 18 percent of men and 33 percent of women have it, there is a big taboo on brain disease.

Eight questions about migraine

You say there is a taboo on migraine. What do you mean by that?

“The World Health Organization (WHO) lists migraine as number two in the list of the most incriminating diseases. Migraine is incredibly stressful, because during an attack you can get disabled, unable to work or go to school or participate in social life with family and friends.”

“Nevertheless, many migraine patients find it difficult to come out for their illness, they are afraid of being seen as a whiner. Moreover, it is often misunderstood by others. The idea is that everyone has a headache anyway, so there are still many prejudices about migraine and migraine patients. ”

So migraine is not the same as headache?

“Certainly not, no. Migraine is a brain disease. A third of patients first have aura symptoms before the headache, then they see, for example, flickering and glare in their field of vision.”

“The headache with a migraine attack is intense, often thumping and on one side of the head. In addition, nausea can occur up to vomiting, or hypersensitivity to light and sound. In the worst case, someone can only go to bed in a darkened quiet room lie down and wait for it to pass. An attack can take a few hours, but often it takes much longer. Sometimes up to three days. ”

Migraine is three times more common in women than in men. What makes that possible?

“Probably because female hormones play a role. We don’t know exactly how yet. We think of a link with hormones because boys and girls have migraines just as often before puberty. Only then does it occur much more frequently in women.”

“In addition, women often have migraine attacks around their menstrual period. During pregnancy, the attacks disappear. Also during other hormone-distressed periods, such as the onset to menopause, symptoms become more severe. In addition, we have found in a small study that male migraine patients have more female hormones than men without migraines. ”

Are there treatment options?

“Many migraine patients use regular painkillers, but for many patients it does not work properly. Since the 1990s, there have been so-called triptans: migraine-specific medicines that you can take if you have an attack. In addition, there is preventive medication that you can use to attack These drugs can be hugely effective, but only reduce the seizures by 50 percent in half. ”

“So we can never make someone pain free forever. Go to the doctor if you suspect or know that you regularly have a migraine. It is important to treat the migraine under supervision.”

Why is that important?

“On average, 50,000 migraine patients get into trouble every year because they use too much headache medication. If you take painkillers or triptans for more than fifteen days a month, you can actually maintain the migraine: you develop medication-dependent headache. The medication worsens the headache complaints then, because the headache keeps coming back if you don’t take anything. ”

Is there anything to do about that?

“Our research in the LUMC shows that the best treatment is to stop all medication acutely under the supervision of a headache nurse. There is worldwide debate about botox, but that has no additional benefit in withdrawal. However, if someone has chronic migraine after successful withdrawal, possibly botox can be considered. ”

Are there new developments in the field of treatment?

“We have known for a long time that the CGRP protein plays an important role during a migraine attack. A group of new drugs has been developed that are, as it were, flattening that protein, so-called CGRP antibodies. They have since been approved by the European Medicines Agency (EMA), but the Zorginstituut Nederland has yet to decide on the reimbursement. ”

And the What! Study? What exactly are you going to investigate?

“What! Stands for women, hormones, attacks and treatment. Several studies are ongoing. One of the most important is research into the contraceptive pill. Female patients always ask me if it is useful to use the pill, but there are never any good studies there We have started two practical studies to see if the contraceptive pill can prevent seizures in young women and menopausal women. ”

“It would be fantastic if we could resolve migraine patients in the future of their complaints. We are still looking for migraine patients who want to participate in the study.”