Migraine-free without tablets



The best migraine attack is the one that doesn't happen in the first place. And if it does happen, it should at least be less violent than usual. That is the topic of this chapter: How can seizure frequency and severity be reduced? Both are possible in many cases - without any medication.

But that doesn't come for free. It takes work, from the patient and the doctor. Both have to pull together, consistently and permanently. The usual relationship between doctor and patient – ​​prescriber of medication and consumer of medication – must be fundamentally changed for this process. It must be a partnership in which the doctor optimally informs the patient and the patient in turn gives the doctor all the information he needs about his illness. What this means for the patient during the course of the treatment is that they record every attack in detail using the headache diary.

Separate cause and trigger

In order to understand the development of migraine attacks, the patient must learn to differentiate between the cause of the migraine - a particular reactivity of the brain - and the triggers of a headache attack. Your doctor's explanation could be something like this:

“To make you understand why you suffer from migraines, I want to give you an example of similar processes in another illness. If two people lie down in the sun on the beach, the occurrence of sunburn does not solely depend on the sun. People with fair skin will develop sunburn very quickly. On the other hand, people with very dark skin don't get sunburn at all. Here it becomes clear that the ability to react with sunburn is due to the innately low concentration of dark skin pigments as the actual cause. Sunlight itself only serves as a trigger and can lead to the disease if the cause is “low concentration of dark skin pigments”. A specific innate willingness to react is crucial for its development. The scientific data on the development of migraines indicate that the cause of migraines is a particular sensitivity to sudden changes in the nervous system. This condition appears to have to be present for people with migraine attacks to respond. This special sensitivity cannot yet be “magnified away” by any therapy, just as you cannot change your skin color. However, just as you can avoid the sun to prevent sunburn, you can also avoid migraine triggers. Sudden changes in the nervous system can occur in many different ways and can be caused by a variety of mechanisms. We have to identify these and then develop a strategy against your migraines.

Strategies to better deal with migraines

A causal treatment of migraine would mean normalizing the specific migraine reactivity. But to date we do not know exactly how this specific willingness to react comes about. And even if one were to know exactly the mechanisms behind this willingness to react, in order to influence the mechanisms one would have to intervene directly in the functioning of the brain. Whether this will ever be possible cannot be answered today. Likewise, we cannot say whether this is what we should wish for humanity: the brain is not replaceable and that is a good thing.

But if the predisposition to migraines cannot actually be changed, that does not mean that nothing can be done against this suffering. The sentence “Migraines cannot be cured” is true in principle, as we cannot “get rid of” the brain’s special reactivity. However, it is also misleading because it seems to say that nothing can be done. But that's not true: There are indeed effective methods to prevent the predisposition to migraines from taking effect, or to effectively stop an attack if it has broken out. There are basically three strategies available:

  • Prevention by avoiding trigger factors
  • Prevention by reducing the likelihood of seizures
  • the treatment of the acute effects of the migraine attack

Avoid triggers

A trigger checklist can help you remember possible trigger factors and give you an idea of ​​what triggers might be. If you now spontaneously say “these are my triggers”, you should still check this using the headache calendar. Please always enter the potential triggers that preceded the attack.

Below you will find the most important trigger factors:

  • stress
  • Fear
  • Care for
  • sadness
  • depression
  • emotion
  • shock
  • excitement
  • Overexertion
  • Physical exhaustion
  • Mental exhaustion
  • Sudden changes
  • Changed behavior at the weekend
  • Late bedtime
  • Start or end of vacation
  • Travel
  • Skipping meals
  • Weather change
  • Climate change
  • Foehn wind
  • Bright light
  • Eye strain
  • Hot baths or showers
  • Noise
  • Intense smells
  • Spices
  • alcohol
  • Medication
  • diet
  • Menstruation
  • Blood pressure changes
  • Carrying heavy weights

Once you are clear about which triggers seem to be responsible in your case, you can start eliminating them. Of course, we are only talking about the factors that you can influence yourself. Please be sure to discuss the procedure with your doctor. He always has to be up to date. You know: it only works if you both pull together. What's important is that even if you think you've found your triggers, you continue to carefully keep your headache calendar. Only with its help can you recognize new developments in the course of your migraine and incorporate them into your strategy.

The be-all and end-all: A regular daily routine

One of the most important conditions for triggering migraine attacks is sudden changes in normal daily routine. The top priority and simplest measure is therefore to implement a daily routine that is as regular as possible.

Become your own legislator, set rules for your regular daily routine! And demand that those around you also take these rules into account when dealing with you. What you should do specifically:

  • Prepare a lesson plan for the week. Make sure that you set aside fixed times for meals, work and free time. Post the timetable and declare it the law.
  • Eat regular, carbohydrate-rich meals and drink enough throughout the day. Start the day with a healthy, carbohydrate-rich breakfast and make sure not to skip any meals. A small, carbohydrate-rich meal (e.g. cereal, whole-grain bread, whole-grain porridge) shortly before bedtime can help prevent nighttime and morning attacks. These often arise from a drop in blood sugar during the night.
  • Leave room for spontaneous decisions in your timetable. The plan should not tie you to a rigid time constraint. The point is rather to exchange an uncontrolled time schedule for a clear structure.
  • Every day you should plan at least 15 minutes for your relaxation training. The best time for this is when there is something positive and pleasant on the agenda afterwards, such as a tea break or a daily walk with your dog.
  • Schedule a reward day. If you have followed your planned routine, there is enough reason to treat yourself to something pleasant. This could be going to a concert, going on a trip, or something else that you enjoy.
  • Don't give up straight away if things don't work out as desired at the beginning. Usually nothing works right away. Your schedule can be optimized as you gain experience.

Bring movement into your life

The bad news first: Exercising too quickly can trigger an attack in some migraine sufferers. The good thing: Conscientious warm-up before training usually helps to avoid the attack.

There are individual case reports of physically active people who can stop an incipient migraine attack by jogging or other endurance sports. But that is the exception. Movement usually worsens the pain and should be avoided during an attack.

In general, however, moderate endurance training is an important component within the overall strategy for preventing migraines. In addition to the well-known effects such as training the cardiovascular system, respiratory function and improving fat metabolism, sport reliably reduces stress hormones and trains the body and mind to switch healthily between tension and relaxation. Physical exercise therefore has a balancing effect on the autonomic nervous system, which, in the event of an imbalance, plays a key role in triggering the attack and in the severity of the attack.

Pay attention to heart rate

If you decide to exercise because you don't like exercise, you should talk to your doctor and, if possible, have your optimal training heart rate determined. Endurance sport only really makes sense if it is practiced at the right intensity for each individual. Neither too much is good nor too little. It is best to discuss this with a sports doctor who can carry out the appropriate tests.

  • Please don't overdo it: almost all beginners tend to overextend themselves. According to the motto “a lot helps a lot”, they end up in a heart rate range that not only does no good, but is even harmful. It is therefore essential that you stick to the pulse guidelines given to you by your doctor. A little tip: When you jog, run at a maximum pace that allows you to have a good conversation while you're at it. And don't let others drag you along. Stick to your pace.

How often and for how long?

To achieve the desired effects, you should plan half an hour three or four times a week. Of course, the same applies here: enter the times in your weekly plan and stick to them if possible. By the way, studies have shown that training in the late afternoon leads to better adaptive reactions than in the morning. If it is compatible with your work, a start time between 4:00 p.m. and 6:00 p.m. would be optimal.

Choose the right sport

Four sports are ideal: walking, jogging, cycling and swimming. Which one you choose is essentially a question of taste. Not entirely, however. Cycling and swimming, including walking with restrictions, are also suitable for people with joint damage and/or overweight. For these overweight people, jogging can cause serious problems. Walking is particularly recommended for older people who have never exercised or have not exercised for a long time. Cycling is ideal for almost everyone, especially since it can be practiced outdoors in summer and in your own home on an ergometer in winter. Swimming is particularly gentle on the joints thanks to the buoyancy of the water

The quick way to relaxation: progressive muscle relaxation

If you ask around, when you ask about a relaxation method you will most likely hear autogenic training (AT). Of course, if you really master it, AT is an excellent instrument to influence your autonomic nervous system in a variety of ways. But the method is not for everyone. In addition, it takes months to years before you really achieve good results. Jacobson's progressive muscle relaxation, on the other hand, can be learned by anyone and achieve good results almost immediately. I would therefore like to warmly recommend this method to you. You can then deepen the whole thing through additional literature, through courses at adult education centers or through suitable CDs. With a CD you can learn the training very easily and effectively. Detailed information can be found at Sound recordings for relaxation exercises .

Biofeedback – a help for some

In biofeedback therapy (feed back

[English]: to return), the therapist usually measures a specific body function using a technical device and passes this information back to the patient. In the case of headache disorders, this is often the activity of the head muscles or the pulse rate. In scientific studies, attempts are also made to measure the width of blood vessels or the speed of blood flow. The measurement results are usually displayed to the patient on a screen or with a measuring device. If the body function changes, the display also changes. This feedback on body function allows the patient to see directly whether their muscles are relaxed, their pulse beats regularly, or their blood flow is increasing or decreasing. In further therapy he can then learn to influence these body functions directly and deliberately.

The aim of biofeedback therapy is to enable direct, voluntary control of bodily functions that are normally only controlled involuntarily. Biofeedback can thus help to make existing malfunctions visible and to get them under control. As a rule, however, with biofeedback it is only possible to provide feedback on a single body function. This means that a very specific section of the body's function is depicted and brought to the attention of the patient. Biofeedback differs significantly from other relaxation methods - such as progressive muscle relaxation according to Jacobson - which attempt to influence the entire body.

Different biofeedback procedures are used for migraines. These are initially the so-called autogenic feedback, the blood volume pulse biofeedback and, in experimental studies, the transcranial Doppler biofeedback. EMG biofeedback (electromyography = measurement of muscle tension) is also often used for migraines to enable general relaxation.

Blood volume pulse biofeedback

Blood volume pulse biofeedback is also based on the theory that migraines are caused by vasodilatation of the superficial temporal artery. In this therapy method, the blood volume pulse curve is reported back using a sensor on the temple. The patient now learns to use active mechanisms to cause the superficial temporal artery to narrow. For this reason, this training is also called vasoconstriction training.

However, the procedure is not very widespread in practice. On the one hand, this is because the necessary technology is not available everywhere. On the other hand, trained therapists are necessary. And finally, use during an acute attack - and that's the point - is often not effective. It has also been shown that patients cannot be motivated to carry out this procedure in the long term. In addition, according to current studies, the involvement of the superficial temporal artery plays a minor role in the development of migraines.

But with this procedure too, it is probably the case that dealing with the body's processes as well as the perception of possible self-control are responsible for the success of the therapy. Performing blood volume pulse biofeedback therapy in isolation is not recommended. It can only make sense if it is embedded in other therapeutic measures.

Disadvantages of biofeedback

Biofeedback therapy has several disadvantages compared to other therapy methods: It usually binds the patient to a therapist and a machine in space and time. This involves organizational problems and means at least a temporary loss of independence. In addition, this form of therapy is very expensive compared to other procedures. Since no significantly better therapy results are achieved than with forms of relaxation that can be carried out independently, these methods appear uneconomical and cumbersome in everyday life.

However, biofeedback procedures are important for patients whose attacks do not respond adequately to other relaxation methods and for whom medication often has to be used due to a high frequency of attacks. Biofeedback can help prevent migraines from becoming chronic due to medication. Biofeedback is particularly important for patients who have forgotten how to perceive body signals and cannot differentiate between tension and relaxation. This situation occurs in severely affected patients with frequent, severe and long attacks. Regardless of this, as already indicated above, scientific testing of such methods is important because the procedures can provide insights into possible disease processes.

Less stress, more self-confidence

Stress management training should enable patients to perceive internal and external conditions that trigger stress in them and to change these through targeted behavioral measures. The affected person learns techniques that allow him to deal with stressful situations independently.

The first step in stress management training is always analysis. Together with the therapist, the patient creates a list of stress-inducing situations and ranks them according to importance or frequency. The patient should then mentally imagine the various stressful situations and possibly prepare behavioral strategies in their minds.

Following the stress analysis, the patient should learn to view stress-triggering factors as requests that they respond to with targeted defensive behavioral measures. In order to achieve this, the person affected should use self-observation procedures, such as stress diaries, in order to better perceive stressful situations in everyday life and to be able to deal with them later using their logs.

The patient then learns defensive behavioral measures. This can be done in both individual and group therapy. In group therapy, role games are a good way to practice the necessary behavior in stressful social situations with others. After the behavior patterns have been learned and tested in the group, they can be practiced in daily life through homework.

Self-confidence training

Self-confidence training is intended to enable patients to stand up for their personal rights and to be able to express their own thoughts, feelings and attitudes. More self-confidence and social skills can mean that you can live your life with significantly more inner serenity and calm and thus also make a significant contribution to migraine prevention.

During self-confidence training, patients are given tasks on social skills. These exercises are practiced either in role play in a group with a therapist or trainer, or as homework “live”. The content of the exercises is aimed at building a self-confident and more socially competent behavioral repertoire.

Since social situations in particular represent particular sources of stress, the following skills are important here:

  • The ability to say no.
  • The ability to ask someone for a favor or to express a wish.
  • The ability to express positive and negative emotions appropriate to the situation.
  • Ability to start, maintain and, when desired, end general conversations.

Everyday life situations

Due to the immense importance of social skills, a number of different exercise programs have been set up to teach those affected how to behave appropriately. Essentially, they all aim at the same learning goals, but are structured differently. The programs should always be led by trained psychologists, as a lot of experience and practice are necessary to achieve the greatest possible effectiveness. Below I would like to introduce you to the contents of some exercise programs:

  • Reduce the announced visit of a relative from the desired period of three weeks to a weekend.
  • Urgently ask a roommate not to slam the front door in the evening as usual, but to close the house and apartment door quietly.
  • Ask your boss for a day off for a special situation.
  • Have the homeowner repair a water pipe.
  • Exchange a faulty item of clothing.
  • Wishing to speak to the superior of an unpleasant official.
  • Ask a fellow passenger on the train to stop smoking in the non-smoking compartment.
  • Ask for a raise.
  • Resist unfair criticism from a superior.
  • Ask your spouse to also take on their household and child-rearing duties.
  • Take advantage of a pre-reserved seat on the train or in the restaurant.
  • Have a variety of shoes shown to you in a store, try them on and then leave the store without buying them.
  • Be able to recognize and interpret facial expressions and gestures of people (surprise, sadness, contempt, happiness, interest).
  • Be able to perceive your own fear-avoidance behavior and reduce it through thoughts.
  • Recognize social behavior and emotional states, differentiate and develop appropriate behavioral reactions.

As the examples show, the programs are not about any theoretical things, but about very practical situations that every man and woman can find themselves in every day. It is always about becoming aware of incompetent social behavior, fear, avoidance behavior and withdrawal in order to achieve a stress-free reaction in the respective situations through self-control and effective behavior.

Simple tips for more social skills

  • Use “I” instead of “man” or “we”.
  • Use direct phrases and requests instead of indirect suggestions.
  • Formulate demands and wishes clearly and clearly (e.g. “I demand from you...”, “But I wish...”).
  • Make direct eye contact.
  • Use your posture to convey unexpected physical closeness.
  • Underline your words with appropriate gestures.
  • Use a facial expression that fits your statement.
  • The volume and modulation of your voice should match what is being said.

Concordance therapy

A similar technique for social skills training is called concordance therapy, which was developed specifically for migraine therapy. Concordance therapy attempts to achieve the following learning goals for patients:

  • Learning body perception in stressful situations.
  • The active control of body processes.
  • To be able to recognize the connection between thoughts and body processes.
  • The ability to change thoughts.
  • Learning behavioral strategies to influence body processes.
  • Learning to match thoughts, body processes and behavior.

The main goal of concordance therapy is to create harmony (concordia [Latin]: unity) between thoughts, feelings and behavior. This makes it possible to realize wishes and goals without spending a lot of energy, instead of doing the opposite with a lot of psychological energy. An example: If someone wants to ask their boss for a raise, it actually takes a quarter of an hour (regardless of whether it is successful or not). However, if you go to work every day for a quarter of a year without making a firm intention to talk to your boss, you are investing a huge amount of energy in your avoidance behavior.

Concordance therapy initially attempts, as in stress management training, to develop a systematic analysis of the body perception processes in stressful situations. To do this, the patients have to be placed in different stressful situations that are unexpectedly produced by the therapists. Patients can learn to directly and actively perceive corresponding stressful situations and their body processes.

Exercises are then carried out to learn how to control the perceived body processes. In addition, relaxation training - usually progressive muscle relaxation according to Jacobson - is also integrated into concordance therapy. The further exercises aim to establish and make people aware of the connections between the perceived body processes and the situations. In the subsequent practice sessions, the patients learn appropriate behavior to cope with stressful situations.

Effectiveness of psychological procedures

There are a number of well-controlled studies on the effectiveness of psychological therapy procedures. As is to be expected given the wide range of the disease, there are certain patients who respond very well to psychological therapy procedures. Other patients, on the other hand, cannot achieve any positive effects. However, an analysis of many studies showed that on average 43 percent of patients who carried out relaxation therapy or biofeedback therapy for their migraine disease achieved a positive effect, while in a corresponding placebo control group, on average only around 14 percent had a positive effect effects could be achieved.

This naturally leads to the conclusion that there is little room for drug prophylaxis: Why should one accept long-term drug therapy with possible side effects when simple non-drug therapy methods have almost the same or even better effects? In fact, drug prophylaxis only makes sense if the patient has already carried out non-drug prevention of migraines - primarily progressive muscle relaxation according to Jacobson - with inadequate success, although of course he must also have practiced sufficiently. No patient should expect that long-term therapeutic effects in migraine therapy will be achieved without their intervention, just by taking medication.

Experience has shown that the therapeutic success of stress management training programs and self-confidence training methods are less easy to estimate because these are complex procedures. In addition, they are aimed less specifically at improving migraines and more at a general reduction in anxiety and an overall increased quality of life. But here too, well-controlled studies have been carried out that show that concordance therapy, stress management training and self-confidence training are certainly able to positively influence certain aspects of migraines. Similar effects were found here as with drug prophylaxis. However, cognitive therapies are very complex. This suggests that a simple relaxation training that the patient can carry out themselves, such as progressive muscle relaxation according to Jacobson, is the first option.

Good long-term results

Interestingly, very positive long-term effects can be achieved with psychological therapy methods. It was shown that 50 to 66 percent of patients who responded well to psychological therapy procedures right from the start were able to maintain the positive effects for a period of one to five years. Similar good long-term results cannot be achieved with the options of drug prophylaxis.

This is another reason why you should first try non-drug prophylaxis before taking medication. If the effects wear off, refresher sessions can be carried out at any time. Especially with progressive muscle relaxation according to Jacobson, the patient can use the CD to familiarize themselves with relaxation training at any time years later - without having to see a therapist again.

Psychological therapy procedures are of course particularly relevant in children and adolescents, as drug prophylaxis is particularly unfavorable for this group. Appropriate therapy offers should therefore be used more in the future, especially for these young patients.