In the past, doctors believed migraine symptoms were due to fluctuations in blood flow in the brain. But now, researchers have established that the pain and other symptoms of a migraine attack are due to a mix of chemical compounds and hormones such as serotonin and estrogen, according to John Hopkins Medicine. Here’s what gets this painful concoction brewing.
The Anatomy of Migraine
Migraine is more than a headache. It is a neurological disease that starts in the brain. According to the Association of Migraine Disorders, people with migraine have an oversensitive nervous system that overreacts to certain stimuli: stress, hormonal fluctuations, lack of sleep, dehydration, or specific foods or drinks. These triggers are different for everyone, but they bring on the same cascade of events: First, the trigeminal nerve, which extends from the brain and branches throughout the face, becomes inflamed and dilated, says Medhat Mikhael, MD, a pain management specialist and the medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California. This causes pain sensations to spread between the face and brain. It often causes a throbbing pain, usually on one side of the head, which is where the trigeminal artery dilates, according to Dr. Mikhael. The head pain can be so intense, though, that it triggers other migraine symptoms, such as nausea. “Most people with migraine will tell you, ‘I didn’t throw up, but I felt so sick in my stomach, I thought I was going to,’” says Mikhael. Another common migraine symptom is light sensitivity, also called photophobia. During a migraine attack, light can worsen pain by activating nerve cells between the eyes and in some areas of the brain. Phonophobia, or sensitivity to sound, may be due to nerve stimulation in the brain stem, according to a study published in the European Journal of Neuroscience in 2021. A minority of people with migraine experience aura — visual disturbances, such as seeing zigzag lines or flashing lights — or temporary vision loss shortly before the pain sets in. This is due to a chemical or electrical wave that moves across the brain in speech centers or areas that process sensory signals or control movement, according to Mayo Clinic. Some people experience neurological disturbances, such as tingling in their face or arms, or, rarely, trouble speaking. Although any of these symptoms can be disconcerting, Mayo Clinic says aura does not cause damage to the brain.
How to Stop and Prevent Painful Migraine Attacks
As soon as you feel a migraine attack coming on, try to head it off. “Treating early in a migraine attack is believed to be the most effective strategy,” says Gina Dumkrieger, PhD, a senior research fellow and assistant professor of neurology at Mayo Clinic in Tempe, Arizona. You may be able to stop, or at least minimize, a migraine attack with an over-the-counter pain medication: aspirin, acetaminophen, or a nonsteroidal anti-inflammatory drug (NSAID), such as naproxen or ibuprofen. Use these with care, though, as taking them too often — more than 15 days per month — can backfire and lead to medication-overuse headaches, according to the American Migraine Foundation. If over-the-counter drugs don’t work, talk to your doctor about a prescription for a migraine medication such as a triptan or calcitonin gene-related peptide (CGRP) inhibitor. Triptans work by constricting the trigeminal artery, which helps block the pain pathways to the brain, but because they also constrict other arteries, they can cause side effects, such as flushing of the face or chest tightness, Mikhael says. CGRP inhibitors inhibit the CGRP protein, which is involved in pain transmission during a migraine attack, and don’t typically have side effects. “If you are having two disabling migraines a month, or four migraine headache days in a month, see a neurologist, pain specialist, or headache specialist who can be able to accurately diagnose and initiate the preventive therapy,” says Mikhael. Some people can benefit from taking prescription preventive medications, including beta-blockers, calcium channel blockers, anti-seizure medications, botulinum toxin injections, and CGRP inhibitors. With the right treatment, it can be possible to stave off some of your migraine attacks and ease the pain of them.
