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Enxaquecas: sintomas, causas e tratamento em Lisboa

FLOODS - Treatment in Lisbon

Specialised assessment and treatment for Episodic and Chronic Migraine in Lisbon - differential diagnosis, preventive therapy and neuromodulation with EMT

WHAT IS MIGRAINE?

Avaliação neurológica de Enxaqueca — NeuroPsyque Lisboa

Pain originating in the brain

Migraine is a chronic, recurring neurological disease characterised by episodes of moderate to severe headache - usually one-sided and pulsatile - accompanied by nausea, vomiting, photophobia (light) and phonophobia (sound). It is the 2nd leading cause of disability worldwide and the 1st in women between the ages of 15 and 49 - a clinical reality that requires specialised diagnosis and treatment.

Phases of the crisis and characteristic symptoms

  • Prodrome - hours to days before the pain
    Mood swings, fatigue, frequent yawning, neck stiffness, and increased sensitivity to light or sound - early signs that precede the crisis and which, if identified, allow for more effective treatment.
  • Aura - temporary neurological symptoms
    It happens in around 30% of cases. It can cause visual changes, tingling or speech difficulties, which last between 20 and 60 minutes and disappear completely.
  • Headache - the main phase
    Moderate to severe, unilateral (in 60% of cases), pulsating pain, lasting 4 to 72 hours, which leads the patient to seek a dark, quiet environment.
  • Post-drome - the "migraine hangover"
    After the pain resolves, many patients experience intense fatigue, difficulty concentrating and a sense of cognitive emptiness, which can persist for 24 to 48 hours and also compromise their quality of life.

CLINICAL FORMS AND ASSOCIATED FACTORS

Migraine Without Aura - The Most Common Form

It accounts for around 70% of cases. Diagnosis is clinical and requires exclusion of secondary causes. Early abortive treatment and prevention are fundamental pillars.

Primary Headache

Migraine With Aura - Focal Neurological Phenomena

Present in 30% of patients. Migraine with aura is associated with increased cardiovascular risk, especially in female smokers on oral contraception - which has direct therapeutic implications.

Higher CV risk

Chronic Migraine - 15 or More Days of Pain per Month

It is defined by the presence of headache on 15 or more days a month for more than 3 months, with migraine characteristics on at least 8 of those days. Often associated with symptomatic drug abuse. Requires powerful preventive therapy and, in refractory cases, anti-CGRP antibodies or botulinum toxin (botox).

Chronic migraine

Triggering Factors and Genetic Predisposition

Migraine has a strong hereditary component - the risk is 3 to 4 times higher in first-degree relatives. The main triggers include sleep disturbances, stress, hormonal changes (menstruation, ovulation), fasting, alcohol, certain foods and intense sensory stimuli. Identifying and managing triggers is a central part of the therapeutic plan.

Genetics and Environment
Enxaqueca — mecanismos neurológicos, sistema trigeminovascular e CGRP

Migraines are 3 times more common in women - fluctuating oestrogen levels are one of the main modulators of cortical excitability.

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FLOODING: IMPACT, PREVALENCE
AND EFFECTIVENESS OF TREATMENT

The most disabling neurological disease in young adults - and one of the most underdiagnosed in Portugal

1in 7
adults suffer from migraines - around 2 million Portuguese, the 2nd leading cause of disability worldwide
50%
of migraine patients never received adequate preventive treatment, maintaining repeated cycles of seizures and analgesics
70%
reduction in monthly seizure frequency obtained with anti-CGRP antibodies in patients with refractory chronic migraine
4years
is the average delay between the first symptoms and the correct diagnosis - often confused with tension headache or sinusitis

* Data based on published epidemiological studies and clinical trials. Individual results may vary.

TECHNOLOGY AND THE THERAPEUTIC ENVIRONMENT

Neuroimagem
Estimulação Magnética Transcraniana
tDCS
Acupuntura
tDCS - Estimulação Eléctrica Transcraniana
qEEG
Clínica Lisboa
Ondas Cerebrais
Fisiologia
Sala Fisioterapia
Espaço Movimento e Saúde

IMPORTANCE OF SPECIALISED CONSULTATION

Migraine can be extremely disabling. What's more, it is inadequately treated by the health system, with over-the-counter painkillers. This reality has direct consequences: without adequate preventive treatment, episodic migraine tends to become chronic, the frequency of attacks increases, and the growing use of symptomatic analgesics creates a cycle of dependence and aggravation - medication abuse headache - which overlaps and potentiates the underlying disease.

💡 Migraine has effective preventive treatment, including state-of-the-art options such as anti-CGRP antibodies and Transcranial Magnetic Stimulation, which can radically transform the patient's quality of life.

At NeuroPsyque, the Migraine consultation includes a structured neurological assessment with full characterisation of the pattern of crises, identification of triggering factors and chronification, assessment of the functional impact and quality of life, and preparation of an individualised therapeutic plan. We offer access to the entire therapeutic chain - from optimised abortive treatment to oral preventive therapy, to neuromodulation protocols with EMT - with continuous follow-up and adjustment according to clinical response.

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Frequently Asked Questions

FAQ's about Migraine

How do I know if I have a migraine or another headache?
The diagnosis of migraine is clinical and based on the ICHD-3 criteria. A thorough neurological assessment is essential to exclude secondary causes and establish the correct diagnosis.
What is a migraine aura and who has it?
The aura consists of transient, completely reversible neurological symptoms that develop gradually over 5 to 20 minutes and last less than 60 minutes. The most common are visual - scintillating scotoma (zig-zag luminous spots or lines that expand across the visual field), photopsias (flashes) or narrowing of the visual field. Sensory (wave-like paresthesias), language articulation (dysphasia) or, rarely, motor (physical) symptoms can also occur. They are present in around 30% of migraine patients and have specific therapeutic implications - particularly in terms of contraception and vascular risk.
What is the difference between abortive treatment and preventive treatment?
Abortive treatment is taken at the start of the crisis, with the aim of stopping it or reducing its duration and intensity - it includes triptans, NSAIDs and, in the most severe cases, ergotamine derivatives. Preventive treatment is taken daily, regardless of whether there is a crisis, with the aim of reducing the frequency, duration and intensity of episodes - it includes topiramate, valproate, propranolol, amitriptyline and, in refractory forms, anti-CGRP antibodies. It is indicated when seizures occur on 4 or more days a month or when they have a significant functional impact.
What are anti-CGRP antibodies and for whom are they indicated?
Anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) are state-of-the-art preventive treatments, administered by monthly or quarterly subcutaneous injection, which block CGRP - the main neuropeptide involved in migraine pathophysiology - or its receptor. They are more effective than oral preventatives in patients with chronic or episodic migraine who are highly resistant to treatment. At NeuroPsyque we assess eligibility and coordinate access to these treatments.
What role does EMT play in migraine treatment?
A Transcranial Magnetic Stimulation has two indications in migraine: (1) single pulse EMT applied in the aura phase - can abort or attenuate the crisis by interrupting the spreading cortical depression in the first few minutes; (2) low frequency rTMS on the occipital or motor cortex, in regular sessions, with a preventive effect by reducing cortical hyperexcitability - has been shown to significantly reduce the monthly frequency of crises in clinical trials. It's a non-invasive, safe treatment with no systemic side effects, particularly valuable in patients who can't tolerate or don't respond to preventive pharmacotherapy.
Does menstrual migraine have a specific treatment?
Yes. Menstrual migraine, which occurs 2 days before and 3 days after the start of menstruation, is related to the drop in oestrogen levels in the perimenstrual period. Treatment can include mini-perimenstrual prophylaxis (triptans or NSAIDs taken preventatively on risk days), hormonal contraception to suppress oestrogen fluctuations, or anti-CGRP with a continuous preventative effect. Specialist assessment allows the best approach to be individualised.
Can migraine have a cognitive or emotional impact?
Yes. In addition to pain, migraine is associated with cognitive difficulties (during and between attacks - "cognitive fog") and mood disorders. Anxiety and depression are also 2 to 4 times more frequent in migraine sufferers - there is a significant impact on quality of life, relationships and work performance. These aspects should be an integral part of the assessment and therapeutic plan, with integrated psychological counselling when indicated.
Do migraines get worse during the menopause?
The perimenopause - a period of transition with great hormonal instability - tends to aggravate migraine in many women, increasing the frequency and intensity of attacks. After the menopause is established, with the stabilisation of oestrogen levels, most women experience significant improvement or even remission (elimination of symptoms). Hormone replacement therapy can have a positive or negative influence on migraine, depending on the type, dose and route of administration - neurological assessment can guide this decision in coordination with the gynaecologist.
Does NeuroPsyque support migraine patients at all stages of the disease?
Yes, we follow patients from the first diagnostic assessment (Neurology) - including cases with previous misdiagnosis or insufficient treatment - through to ongoing follow-up in patients with established migraine and an ongoing preventive plan. We offer access to the entire therapeutic chain available, including neuromodulation with EMT. Contact us to book your assessment or request a second neurological opinion.