November 20, 2025, 9:50 am | Read time: 6 minutes
Two out of three adult Germans—that’s about 47 million people—regularly suffer from headaches. About 18 million of them struggle with migraines, a condition that is far more than just a throbbing in the head.1 It can be debilitating, shutting down daily life and dominating one’s existence for years—yet it often goes unrecognized or underestimated.
What Is Migraine?
Migraine is a neurological disorder characterized by recurring attacks. These involve severe, often one-sided headaches that intensify with movement and can effectively immobilize the body. Nausea and vomiting frequently accompany these headaches, often along with sensitivity to light, noise, and a general overstimulation of the senses.
Unlike tension headaches, migraines are not caused by stress or tension but by a misregulation in the brain. According to the Robert Koch Institute (RKI), about 14 percent of women and seven percent of men in Germany suffer from migraines. Women are twice as likely to be affected, with hormonal fluctuations playing a significant role.
Episodic or Chronic Migraine—What’s the Difference?
Not all migraines are the same. For most sufferers, attacks occur at intervals of days or weeks, known as episodic migraines. Between attacks, the body remains pain-free, allowing the nervous system to recover.
In chronic migraines, however, the boundaries blur. Attacks become more frequent, and the intervals between them shorten. Doctors diagnose chronic migraines when headaches occur on 15 or more days per month for at least three months, with at least eight days showing typical migraine symptoms like pulsating pain, light sensitivity, or nausea.
The chronic form often develops gradually, due to persistent stress, lack of sleep, or excessive medication use. The earlier it is recognized and treated, the better the progression can be halted.2
How Migraine Develops
Previously, migraines were thought to be a circulatory disorder. Today, it is known that they result from a complex interplay of nerves, neurotransmitters, and vascular reactions.
In the so-called migraine center in the brainstem, nerve cells react hypersensitively to stimuli. They activate the trigeminal nerve, which transmits pain signals, and release inflammatory messengers like CGRP. This causes blood vessels in the meninges to dilate, fluid to leak out, and the typical pulsating pain to occur.
Additionally, sensory processing is disrupted: light, sounds, or smells are perceived more intensely. Many sufferers report that during an attack, the environment feels “too loud, too bright, too much.” Genetic factors also influence the risk—migraines often run in families.
Triggers and Risk Factors
Migraines arise from a combination of internal and external influences. The most common triggers include:
- Stress and emotional strain
- Lack of sleep or altered sleep patterns
- Hormonal fluctuations (e.g., before menstruation or during menopause)
- Skipped meals, insufficient fluid intake
- Certain foods (cheese, red wine, chocolate, caffeine)
- Weather and air pressure changes
- Bright light, screen work, intense smells
Since everyone reacts differently, it is definitely worthwhile to keep a migraine diary. This helps identify and avoid personal triggers more effectively.
Symptoms and Course
Migraines can progress through four phases:
1. Prodromal Phase
Hours or days before the actual attack, some sufferers notice changes: mood swings, cravings, concentration problems, or fatigue.
2. Neurological Warning Signs (Aura)
About 10 to 15 percent of migraine patients experience neurological warning signs: flickering vision, flashes of light, zigzag lines, tingling, or speech disturbances. This so-called aura usually lasts 20 to 60 minutes.
3. Headache Phase
The pain is often one-sided, pulsating, or pounding. Movement, noise, and light worsen it. Nausea, vomiting, and severe exhaustion often accompany it. The attack can last from four to 72 hours.
4. Recovery Phase
After the pain subsides, many feel drained, irritable, or “dazed.” This state can last up to a day.
Types of Migraine
In addition to episodic and chronic migraines, there are other types:
- Migraine without aura: the most common form with classic headache attacks.
- Migraine with aura: neurological symptoms precede the pain.
- Menstrual-related migraine: hormonally induced, mostly around menstruation.
- Vestibular migraine: dizziness and balance disorders are prominent.
- Silent migraine: aura symptoms without subsequent headache.3
Diagnosis
The diagnosis primarily relies on a detailed conversation with the doctor. Questions include:
- How often do the headaches occur?
- How severe are they?
- What accompanying symptoms are there—such as nausea, light sensitivity, or dizziness?
- And what might trigger them?
This helps determine whether it is indeed a migraine or another type of headache.
Technical examinations like MRI or CT are generally not necessary—they are only used if the symptoms are unusual or suddenly change.
A headache or migraine diary is also helpful. It records when the pain occurs, how long it lasts, and under what circumstances it arises, allowing the doctor to better assess the course and plan treatment more precisely.4
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Treatment Options
Migraine is not curable, but it is treatable. Therapy includes acute measures and prevention.
Acute Treatment
- Pain relievers: ibuprofen, acetylsalicylic acid (ASA), naproxen, or acetaminophen
- Triptans: specifically developed for migraines, they inhibit inflammation and vascular reactions
- Antiemetics: relieve nausea and vomiting
Medications should be taken early in the attack, but not used more than ten days a month to avoid medication-overuse headaches.
Prevention (Prophylaxis)
For frequent or severe attacks, prophylactic treatment can help.
Proven agents include:
- Beta-blockers (e.g., propranolol, metoprolol)
- Antiepileptics (e.g., topiramate)
- Antidepressants (e.g., amitriptyline)
- CGRP antibodies—new medications specifically developed for migraines
- Botulinum toxin (Botox) for chronic migraines
Additionally, regular sleep, structured meals, endurance sports, and relaxation techniques like progressive muscle relaxation or yoga can help.
Migraine in Daily Life
Migraine affects not only the body but also mental balance.
The fear of the next attack, work absences, and withdrawal from social life can lead to stress and depression.
An important part of treatment is psychological support. Behavioral therapy helps regulate stress and improve coping with the condition. Self-help groups can also provide relief and promote exchange.
Prognosis
Migraine is a chronic condition that can change over time.
Many sufferers experience less frequent and milder attacks as they age, especially after menopause. With a combination of medication, lifestyle measures, and psychological support, the frequency of attacks can be significantly reduced.5