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Keep your headache diary in brite, identify your triggers and get reminded about your prophylaxis — with a clear overview for your next doctor's appointment. Free of charge.
A sudden, never-before-experienced "thunderclap headache", a headache with fever and a stiff neck, or one with paralysis needs immediate assessment — when in doubt, call the emergency number 112. This is not an ordinary migraine.
Migraine is not an ordinary type of headache but a distinct neurological condition. It is characterised by recurring attacks with a usually one-sided, pulsating, throbbing headache that worsens with physical activity and is often accompanied by nausea as well as a pronounced sensitivity to light and noise. Left untreated, a single attack lasts between 4 and 72 hours — from a few hours up to three days.
Unlike a simple tension headache, during an attack those affected are often barely able to work or function. Many retreat to a darkened, quiet room and wait out the worst lying down. Migraine is therefore not only painful but one of the world's leading causes of years of healthy life lost in middle adulthood — precisely during the most productive years.
What happens in the brain is far better understood today than it once was. During an attack, there is a temporary overexcitability of the brain and an activation of the so-called trigemino-vascular system — a network of nerves that supplies the blood vessels of the meninges. In the process, messenger substances are released, above all a protein called CGRP, which dilates vessels and transmits the pain. It is precisely this messenger that modern migraine medications target. Migraine is therefore not a "sign of weakness" and not purely a consequence of stress, but has a clear biological basis — it is very treatable, but not curable in the sense of disappearing permanently.
Broadly, two main forms are distinguished: migraine without aura (formerly "common migraine") and migraine with aura (formerly "classic migraine"). Around two thirds of those affected have no aura, while a third experience one at least occasionally.
An aura is a temporary neurological disturbance that usually precedes or accompanies the headache. It typically develops slowly over 5 to 20 minutes and does not, as a rule, last longer than 60 minutes. Visual disturbances are the most common: flickering, flashes of light, zigzag lines or a blind spot that slowly spreads across the field of vision. Less commonly, there is a tingling or numbness that slowly "travels" from the hand up the arm to the face, or word-finding difficulties. What is crucial for distinguishing it from a stroke is that a migraine aura builds up slowly and then resolves completely — a stroke, by contrast, begins suddenly.
An attack often runs through several phases, which not everyone experiences with the same intensity. Knowing them means you can counteract earlier:
| Phase | Timing | Typical signs |
|---|---|---|
| Warning phase (prodrome) | Hours to 2 days beforehand | Yawning, food cravings, irritability, difficulty concentrating, neck stiffness |
| Aura | 5–60 minutes before/with the pain | Flickering, zigzag lines, tingling, speech disturbance (only in about one third) |
| Headache phase | 4–72 hours | Throbbing, often one-sided pain, nausea, aversion to light and noise |
| Resolution & exhaustion (postdrome) | Up to 1–2 days afterwards | "Headache hangover", tiredness, exhaustion, low mood |
Knowing about the warning phase is practically valuable: those who recognise their own early signs — for example increased yawning or a craving for sweets — can better time rest, fluids and taking medication in good time. The treatment window for acute medications is decisive: as early as possible in the headache phase, but not yet during the aura (more on this in the treatment chapter).
The migraine headache has a fairly typical pattern that sets it apart from other types of headache. Not every feature has to be present in every attack, but the combination is characteristic:
By way of comparison: a tension headache feels more dull and pressing, sits like a "band" around the whole head, is bilateral and is not made worse by movement — nausea and marked light sensitivity are usually absent. This distinction matters because the treatment differs considerably.
The underlying predisposition to migraine is to a large extent genetic — migraine tends to run in families. Those affected bring with them an increased sensitivity of the brain to stimuli; their nervous system reacts more sensitively to fluctuations from within and without. On this basis, certain triggers (triggers) can set off a single attack. It is important to understand: triggers are not the cause of migraine, only the spark — and they are highly individual.
Commonly cited triggers include:
The most important protective factor is a regular rhythm: even sleep and mealtimes, adequate fluids and a mindful approach to stress. That sounds unspectacular, but it is one of the most effective levers of all. When it comes to diet, sobriety pays off rather than strict lists of prohibitions: only a few people really have a reliable food trigger. Instead of cutting out many foods across the board, a headache diary helps to tell real triggers from supposed ones.
A migraine diagnosis is as a rule made clinically — that is, from the medical history and the typical pattern of attacks alone, without any device being able to "prove" it. Imaging (MRI/CT) is not necessary for a typical migraine and is only arranged in the presence of warning signs or an atypical course.
By far the most important tool is a headache diary, or attack diary. It helps to confirm the diagnosis, identify triggers and later assess the success of treatment. For each attack, note:
Diagnosing migraine without aura typically requires at least five such attacks with the matching features; with aura, two are enough. You don't need to memorise these numbers — what matters is that a well-kept diary makes it considerably easier for the practice to classify things. The doctor will additionally examine the nervous system and ask specifically about warning signs that argue against a harmless migraine (see chapter 9).
The aim of acute therapy is to stop a single attack as quickly and completely as possible. Two principles decide whether it succeeds: the right substance and the right treatment window. As a rule of thumb: as early as possible in the headache phase, at an adequate dose and not hesitantly in small portions. Anyone who waits too long, until the pain is "really bad", wastes effectiveness.¹
A proven trick against the nausea and the slowed stomach activity during an attack: take an anti-nausea medication about 15 minutes before the actual painkiller. It not only relieves the nausea but also improves the absorption of the painkiller that follows.
While acute therapy tackles the single attack, prophylaxis is meant to reduce the number, severity and duration of attacks over the long term. It is not a treatment for an emergency but is taken daily and on an ongoing basis. Prophylaxis is usually considered when you have three or more attacks a month, when the attacks are particularly severe or long, when acute medications do not work well enough or when there is a looming risk of overuse.¹,²
Important for setting expectations: prophylaxis does not work immediately. The effect builds up over 6 to 8 weeks, and the dose is usually increased slowly. Even a halving of the number of attack days counts as a success — not their complete disappearance. Patience therefore pays off, and the headache diary is the best way to judge the success objectively.
Which prophylaxis fits depends on the number of attacks, any accompanying conditions and your life situation — for instance if you wish to have children, or have high blood pressure or sleep problems. This is a joint decision with the practice. Side effects at the start are no reason to quietly stop: they often ease off, or another substance is a better fit.
brite reminds you about your daily prophylaxis, counts your attack and medication days and makes your progress visible for your next doctor's appointment.
A particularly important but often overlooked problem: if acute medications and painkillers are taken too frequently, they can themselves cause a constant headache — the medication-overuse headache (MOH). Paradoxically, it arises precisely through the very medications that are supposed to help, and it is one of the most common reasons why episodic migraine turns into an almost daily one.
The rule of thumb against it is easy to remember and is called the 10/20 rule:
| Medication group | Limit per month | Examples |
|---|---|---|
| Triptans, opioids, combination painkillers | on at most 10 days | Sumatriptan & other triptans, combination products with caffeine |
| Simple painkillers (NSAIDs/non-opioids) | on at most 20 days | Ibuprofen, Acetylsalicylic acid, Paracetamol, Metamizole |
In short: triptans and combination products on no more than 10 days, simple painkillers on no more than 20 days a month — and this over more than three months. Anyone regularly above this risks an overuse headache. A warning sign is when the number of headache days creeps up and you reach "just to be safe" for a tablet more and more often.
The good news: MOH can resolve. The most important step is to end the overuse — the so-called medication break. This works best with medical support and often together with starting prophylaxis, which paves the way out of the vicious circle. This is exactly where keeping a complete count of medication days pays off: only those who know their intake days notice a looming overuse in good time.
The greatest part of dealing with migraine takes place in everyday life. A few habits make a real difference between frequent and rare attacks:
As distressing as a migraine attack is — it is not in itself dangerous. There are, however, headaches behind which lies a serious cause requiring urgent treatment. The following warning signs (red flags) argue against a harmless migraine and need immediate assessment.
Even without an emergency: if the character of your headaches changes markedly, if they appear for the first time after the age of 50 or become ever more frequent despite treatment, you should have this assessed by a doctor.
Record in brite when attacks occur and what preceded them — so patterns become visible that stay hidden in your head alone.
Migraine isn't treated with a single tablet but with a system of acute therapy, prophylaxis and avoiding overuse. That only succeeds if you keep an eye on attacks, triggers and medication days. That is exactly what brite supports you with.
