Neuromodulation, specifically occipital neuromodulation (ONS), was approved in 2012 as a new treatment option for chronic migraine. Frequently asked questions about this new procedure are answered in the NDR report above and in the text below

What types of migraines are there, and how many people are affected?

Migraine affects approximately 14% of the adult population. Today, 22 different forms of migraine are distinguished. The most common form is migraine without aura, accounting for about 80-90% of cases. Migraine with accompanying neurological symptoms occurs in approximately 10% of attacks. Migraine typically begins between the ages of 5 and 6. The peak incidence is between 30 and 40 years of age. During this lifespan, approximately one in three women is affected. About two to three times more women than men suffer from migraine. Migraine is not solely an age-related disease; its frequency decreases significantly after the age of 65. Migraine is therefore most debilitating during the productive phase of life. Approximately 0.5% of the population suffers from very severe migraine, known as chronic migraine . These individuals may experience migraine attacks on 15 to 30 days per month.

How can you recognize chronic migraine?

Chronic migraine is a particularly severe and often devastating form of migraine. Affected patients suffer from severe headaches on more than 15 days per month. This high frequency of headache days per month has persisted for at least three months. Medication overuse is not present, meaning that chronic migraine is characterized by a spontaneously high primary attack frequency, and even a medication break provides no relief. Preventive medications, despite adequate dosage and duration, do not improve the severity of the condition. All therapeutic measures have proven ineffective. Due to the highly complex symptoms and lack of responsiveness to conventional treatment, severe cases of migraine should be diagnosed at a headache center to ensure the fastest possible effective treatment. This can prevent complications and the progression of the migraine.

What effect does neuromodulation have on chronic migraines? How does it work?

For the particularly severely affected patient group with chronic migraine, there are few effective treatment options. Peripheral nerve modulation is a specific application of neurostimulation. This has been used for several decades to alleviate and treat chronic pain. Successful application is possible for back pain, neck pain, and arm and leg pain. Thanks to the increasing advancements in microelectronics, it is possible to implant a pacemaker-like device under the skin, thus enabling continuous peripheral nerve stimulation with electrical current. A special system can be implanted to treat chronic migraine. This system sends subtle electrical signals to the occipital nerve, located directly under the skin of the neck. Due to this specific location, this treatment option is also called occipital nerve stimulation (ONS). The mechanism of action of occipital nerve stimulation is explained by changes in electrical regulation in the brainstem. The pattern of pain signals is modulated and masked by the continuous stimulation. This balances and reduces the constant hypersensitivity in the nervous system. The function of the neurostimulator system and peripheral nerve stimulation is comparable to that of cardiac pacemakers. The device sends impulses via the occipital nerve to the trigeminal nerve complex in the brainstem. It is assumed that this activates and stabilizes the body's own pain defense system, thus naturally reducing sensitivity to pain signals. Occipital nerve stimulation (ONS) offers new treatment options for patients with therapy-resistant chronic migraine pain. These patients typically have suffered from a chronic form of migraine for years. All guideline-recommended preventive medications and other therapies have been ineffective or poorly tolerated. For this patient group, treatment options are otherwise very limited. Another option is treatment with botulinum toxin (Botox). This drug has been approved for the treatment of chronic migraine since September 2011. Since May 2012, peripheral nerve stimulation, specifically occipital nerve stimulation (ONS), has been approved for the treatment of chronic migraine. Affected patients can therefore discuss with their doctor whether this treatment option is suitable for them. This treatment is performed in certified specialized centers. Crucial factors include a precise analysis of the headache pattern, the determination of the indication, implantation by a certified neurosurgeon, and long-term care with therapy and progress monitoring by the migraine center. The goals of the therapy are a reduction in headache days per month, a significant reduction in headache intensity, a reduction in acute medication use, and an improved quality of life.

Is it possible to prevent migraines from becoming chronic?

With very frequent attacks, the nervous system becomes highly hypersensitive, leading to significant irritability in those affected. Migraine is now understood as a chronic and, if left untreated, progressive disease of the central nervous system. Prolonged and frequent migraine attacks cause structural changes in the nervous system, thereby increasing the risk of a number of associated conditions. These include, in the neurological field, seizure disorders, medication-overuse headache, and strokes; in the psychiatric field, depression, anxiety and panic disorders; and in the internal medicine field, heart attacks, coronary artery disease, and hypertension. Early and effective treatment is the most effective way to prevent the progression of migraine and such complications.

What can you do yourself to prevent it?

Migraine prevention is a central component of modern and effective migraine therapy. Prevention through information and behavior must be the primary basis of treatment. Medication can then be used as a secondary preventative measure. The most important behavioral guidelines are a regular day-night rhythm and a regular daily routine. This includes going to bed and waking up at the same time each day. Eating meals at fixed times is also essential. A substantial, carbohydrate-rich breakfast is the most important step at the start of the day. Eating lunch and dinner at fixed times are also important for migraine prevention. Taking breaks during the day, exercise therapy, and learning relaxation techniques (www.neuro-media.de) are effective measures that every migraine sufferer can and should implement.

Which medications help?

For mild attacks, over-the-counter medications such as aspirin, paracetamol, ibuprofen, and similar drugs can be helpful. Triptans are a specific type of migraine medication. They are very well tolerated and were specifically developed to improve tolerability, safety, and effectiveness in acute migraine treatment. Several triptans are now available without a prescription at pharmacies.

Various medications are available for headache prevention. Medication is prescribed when headache attacks occur on more than seven days per month. Preventive medications include beta-blockers, calcium channel blockers, antiepileptics, antidepressants, and many other drugs.

How do you find migraine specialists?

Migraines manifest in a wide spectrum. Some people experience only a few mild attacks. Unfortunately, many sufferers experience particularly severe, long-lasting, and frequent attacks. Especially in the latter case, it is important to consult a specialist to access up-to-date, specialized knowledge. Germany now has a nationwide headache treatment network. Approximately 450 physicians specializing in migraine treatment can provide a specific headache diagnosis, develop a treatment plan, and coordinate therapy locally. In particularly severe cases, patients can be admitted to the Migraine and Headache Center at the Kiel Pain Clinic for intensive inpatient treatment. Afterward, patients can continue their care regionally with a pain specialist, including monitoring of therapy progress and treatment adjustments. Headache specialists near your location can be found on the Kiel Pain Clinic website at https://schmerzklinik.de . Up-to-date and comprehensive information and exchange among those affected is made possible through the self-help community www.headbook.me .