- Diseases, Disorders & Conditions
The Science Behind Migraines
Everyone has the occasional headache, but about 10% of the population worldwide suffers from migraines. Migraines are one of those things that most people do not fully understand until they have experienced one. I am one of the unlucky 10% that suffers from them almost daily.
What is a Migraine Headache
I am sure everyone reading this knows what a migraine is, but here is a brief definition:
Migraine: a severe headache localized to one side of the head associated with a pulsating pain, nausea, sensitivity to light and sound, which can last anywhere from four to 72 hours and sometimes longer.
Migraine severity can range from a dull throb to excruciating. The excruciating migraines are the ones with the infamous pounding hammer in the head, nausea and vomiting, extreme sensitivity to sound and the vampire-like aversion to light.
These headaches tend to get worse as they progress, and the sufferer will feel one of two ways. They will either want to bang their head against a wall, or crawl into bed and not move. Sometimes even breathing feels like it’s making the pain worse.
Stages of Migraine
There are four stages to a migraine. The prodrome is the first stage and occurs hours or days before the actual pain starts. Prodrome symptoms include any or all of the following:
- Scotoma (partial loss of an area in the peripheral vision)
- Aphasia (impairment of language ability, which can vary from not being able to remember words to not being able to speak, read or write.)
- Photosensitivity (light sensitive)
- Altered Mood
- Yawning (excessive)
- Excessive sleepiness
- Craving for certain foods (one of the most common is chocolate)
- Stiff muscles (especially the neck)
- Dizziness and/or Vertigo
- Hot Ears
- Constipation or diarrhea
- Increase or Decrease in Urination
This is one of the main reasons a migraine diary can be helpful. Knowing what prodrome symptoms you have prior to a migraine can be invaluable in stopping the migraine before it even starts.
My prodrome starts with irritability, yawning, aphasia (I typically forget medical information that is normally second nature to me) and stiff neck muscles. You might notice all of these are also PMS symptoms. For women, the monthly menstrual cycle can exacerbate not only the frequency, but the severity of these headaches.
The next phase of the migraine is the aura. The aura only affects about 20 to 30 percent of migraine sufferers and gradually builds in intensity over a period of five to 20 minutes.
The aura can sometimes be mistaken for an ocular migraine, a migraine that affects the eye only with no headache. The main difference between the aura and an ocular migraine is that the aura involves both eyes, whereas the ocular migraine affects only one eye.
The headache starts either during the aura or within an hour of the end of the aura. In silent migraines, there is no aura; the prodrome is the only warning.
The third phase is, of course, the migraine itself. The pain is an intense, pounding or throbbing sensation. In typical migraines, it is located on one side of the head and starts gradually.
The pain will peak, and then start to subside. All of this can last from two to 72 hours or even longer in adults. In children, migraines typically last one to 48 hours.
Atypical migraines can be located anywhere, and can be a throbbing sensation or excruciating dull ache.
The pain is exacerbated by any movement at all including breathing. Sometimes I think my heartbeat makes the pain worse. The only thing that really helps in these situations (aside from awesome medication) is sleep.
Why does sleep help? When we sleep, we essentially hit a reset button. The sodium/potassium pumps that govern cell signaling in our brains are completely reset during sleep. Many times, this is enough to also reset serotonin levels and alleviate the headache.
Remnants are the residual leftovers from the migraine. It’s a sore sensation where the pain was located; some people even experience problems in their thought process. You know, the “that-neuron-just-doesn’t-want-to-fire” feeling otherwise known as “brain farts.” This phase of the migraine is called the postdrome, and can last one to several days.
How Does a Migraine Occur?
While there are several schools of thought on this issue, the general consensus is that migraines are neurovascular events starting in the brain and spreading to the blood vessels. They are typically the result of blood vessels in the brain constricting and then dilating too quickly. New scientific evidence has shown this constriction and subsequent dilation is triggered by a drop in serotonin levels.
Serotonin is the “feel good” neurotransmitter that affects mood, pain sensation by the brain, and sleep. When serotonin levels drop, the blood vessels in the brain constrict and then dilate rapidly. This dilation is what triggers the migraine; however, the fundamental cause of migraines remains a mystery.
Both sleep and exercise are the brain's reset button. Exercise also raises serotonin levels while causing the release of endorphins, the brain's painkillers.
What Triggers a Migraine?
There is much debate over possible migraine triggers. Stress, food (including chocolate and MSG), fatigue, hunger, weather changes and hormones are just a few of the possible triggers. Menstruation is typically blamed for migraines in women as is pregnancy and menopause. Scientific research has not been able to prove consistently a connection between these triggers and migraines, however.
What many people don’t know is that muscles in the neck are a common trigger for many headaches, not just migraines. Neck muscles can cause compression in the vertebra just below the skull, specifically C1 (cervical vertebrae one), C2 and C3 (I know this from personal experience).
When compressed, these vertebrae can constrict the flow of the cerebrospinal fluid (the fluid that is supplied to the brain via the spinal cord), which can trigger a drop in serotonin levels, and well you know the rest.
These migraines are considered atypical, and the pain is usually located on one side of the head but near the back of the skull just above the neck. Pushing on one side of the vertebral column near the base of the skull during a migraine can indicate where the migraine was triggered. These headaches have the same symptoms as typical migraines, and they hurt just as bad.
A Brief History of Migraines
Migraines are nothing new. They can actually be traced back to ancient Egypt. In these ancient times, the main treatment for these types of headaches was trepanation.
Trepanning involved drilling holes into the head of the patient in order to allow the evil spirits causing the headache to escape. In the 17th century, William Harvey, and English physician, recommended trepanning as a treatment specifically for migraines.
Some patients did actually survive these “treatments.” However, the majority of those who underwent trepanning died of infection. In 1868, the first vasoconstrictor was used successfully to treat migraines, alleviating the need for the barbaric procedure.
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