The Science Behind Migraines
While the effect may be sensory – a pulsating headache with an inability to deal with light, sound, smell, or even a gentle touch – the root cause of migraine pain is chemical. We’ve got the latest on the headache that has been called the sixth most disabling disease in the world.
The result of neurological and vascular changes in the brain, migraine pain is three times more common in women than in men. It can be triggered by anxiety, flashing lights, sleep deficiency, dietary choices, or hormone fluctuations, and it will leave you feeling dizzy, nauseated, and sensitive to light.
For many years, scientists linked mi-graine to the dilation and constriction of blood vessels around the brain. Now, we know it’s likely a combination of genetics, chemical changes, and inflammation of blood vessels in your brain. To put it plainly, it’s a brain disorder, and when it attacks, it affects your ability to function in any capacity.
The Migraine Research Foundation reports migraine is the sixth most debilitating disease in the world, affecting 1 out of every 10 people. Yet, many people who suffer go undiagnosed. Often, this is because they attribute their pain to a more common tension headache or sinus headache, both of which can also cause intense pain at times.
The term ‘migraine’ technically refers to the disease. Someone with migraine experiences a migraine attack, most commonly called a migraine.
“There are certain features of a headache that will characterize it as a migraine,” says Dr. Taylor Bear, a neurologist with Tennova Neurology of Cleveland. “The most common symptoms are throbbing headache, pain affecting just one side of the head, sensitivity to light or sound, and nausea.” They also tend to last between 4 and 72 hours and will worsen with exertion.
If diagnosed with migraine, your physician will want to classify the activity as episodic or chronic, based on the characteristics and frequency of your symptoms. Episodic migraine means you experience fewer than 15 headache days each month. Chronic migraine presents as 15 or more days of any form of headache per month – tension headache included – for at least three months, plus migraine-specific headaches for at least eight days a month.
The science behind migraine is complicated, but there are certain aspects scientists tend to agree on. Dr. Juan Gonzalez, a neurologist with Hamilton Physician Group – Neurology, explains, “Our current understanding is that migraine is a global brain disease associated with abnormal electrical production by the brain cells. To create the electrical discharge, the brain’s demand for blood increases. Then the brain, engorged with blood, reacts abnormally strong to all stimulation. That’s why lights are bright, sounds are loud, smells are strong, mild movements could lead to serious dizziness, and the prolonged headache leads to fatigue as more blood is being consumed.”
New research shows serotonin levels also drop, resulting in the release of neuropeptides (small protein-like molecules that send signals) that travel to the outer regions of the brain and cause pain.
For some people, there are four distinct phases of migraine:
In The Prodrome Phase, which may be experienced hours or even days before an attack, you may notice a stiff neck, unexplained fatigue, bowel issues, mood changes, or disorientation.
People have a misconception that a migraine is just a severe headache. The severity of the pain is not an identifier. Most people with chronic migraines describe a constant, mild background pain that is unrelenting."
The Aura Phase, which happens with 1 in 5 patients, may include visual symptoms like blind spots, difficulty speaking, or strange sensory issues like numbness or a prickling sensation.
While frightening, aura symptoms are reversible and should clear up within an hour. This phase usually precedes the attack but can also occur simultaneously.
The Migraine Phase is made up of two separate stages. The first is when the trigeminal nerve (the largest cranial nerve) is activated. With this, you’ll likely notice initial pain around your temple and eyes. The second stage of the migraine phase involves the entire central nervous system. In a sense, the pain takes on a life of its own, independent from the singular nerve that tripped the pain in the first place. Medication at this point is unlikely to succeed.
The final phase of migraine is known as The Postdrome Phase. You may feel hungover, depressed, or have difficulty concentrating. It’s difficult to know if this physical and mental fatigue is a result of medication or the migraine itself.
While it’s impossible to keep all migraine pain at bay, identifying your triggers can reduce the frequency and severity of your episodes. “Migraines often fit a very familiar pattern,” says Dr. Bear. “Many people will have the same triggers each time.” Common triggers include:
- Sensory stimuli. This can be as simple as a glare from the sun or the overpowering smell of perfumes or paints.
- Stress. An all-around infringement on your health, stress can trigger migraine pain in addition to a bevy of other issues.
- Inconsistent sleep. A sudden night of too little – or even too much – snooze time can set you up for a migraine.
- Pain medication. It may seem counterintuitive, but taking headache medication too often can increase your sensitivity to future headache pain.
- Environmental changes. Drops in barometric pressure related to changes in weather or travel to higher altitudes can trigger a headache.
- Hormone fluctuations. Changes in hormones, especially estrogen, can trigger headaches in women around their menstrual cycle, during hormone replacement therapy, or when taking oral contraceptives.
- Food additives. The sweetener aspartame and monosodium glutamate (MSG) are both well-known migraine triggers. This means you need to stay away from highly processed foods like potato chips, instant ramen noodles, and frozen dinners.
- Alcohol. While alcohol of all types has been linked to migraines, red wine high in tannins is often considered the main offender.
Treating the Ache
Treatment for migraine is dependent upon the frequency with which you experience symptoms, as well as their severity. “We typically divide treatment into preventative treatments and rescue treatments,” says Dr. Bear. If the migraine attacks are infrequent (3-5 a month) and not severe, over-the-counter nonsteroidal medications like Advil or Excedrin taken at the headache’s onset are the best option.
If migraines are infrequent but severe, triptans, which are a rescue therapy, are recommended. Dr. Gonzalez explains, “Triptans should be taken during the aura or at the onset of the headache to work. They decrease blood supply to the brain in order to arrest the evolution of the migraine. Without the blood, there are no raw materials for the brain cells to produce aberrant electricity.” However, since triptans limit blood supply to the brain, they are not recommended for use more than three a week or nine a month.
Caffeine. A dose of coffee or soda may provide quick headache relief, but you’ll build up a tolerance to the treatment over time and set yourself up for a rebound headache when the drink wears off.
If you experience five to 15 migraines a month, preventative medications like beta-blockers, tricyclics, anti-epileptics, antihistamines, and antidepressants are recommended.
Meant to be taken daily, these drugs were originally designed to treat high blood pressure, depression, and seizure activity but can be prescribed by your doctor for migraine prevention.
And for those suffering from more than 15 migraines a month, the best preventative therapy is Botox injections in the head and neck.
Could Genetics Be at Fault?
In 2010, a research team located a gene mutation that affects potassium channels responsible for keeping nerve cells “at rest,” reports the National Institute of Neurological Disorders and Stroke. The mutation leads to cell over-activity that could be the cause of abnormal electrical production and migraine pain.
Talking to Your Physician
It is easy to unintentionally report an inaccurate history of your headache activity to your doctor based on recollection alone. To ensure you receive the best possible treatment from medical professionals, keep a written log of migraine frequency and length, possible triggers you were exposed to, and medications taken (including non-headache-related prescriptions or supplements). This habit will ensure the history you report has the detail and accuracy necessary to make a plan to keep your migraine pain at bay.
Dr. Juan Gonzalez
Neurologist, Hamilton Physician Group - Neurology
Dr. Taylor Bear
Neurologist, Tennova Neurology of Cleveland
