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What Happens To Your Brain During A Migraine

Dispelling Common Misconceptions About The Lasting Effect Of Migraine On The Brain

What happens to your brain during a migraine – Marianne Schwarz

The intensity of a migraine attack can be so severe, people with migraine sometimes question whether their headaches may be causing permanent damage. While there is evidence that brain scans of people with migraine will sometimes detect changes in the form of white matter lesions, a systematic review of migraine and structural changes in the brain from 2013 indicates that these lesions are generally not associated with any neurological issues, and dont indicate any increased risk of cognitive decline.

Peter Goadsby, M.B., B.S., a neurologist and professor of neurology at the NIHR Wellcome Trust at Kings Clinical Research Facility in London and the University of California, San Francisco, who led the 2013 study and continues to examine migraines lasting neurological effects, says many migraine patients he sees are unnecessarily concerned about long-term brain damage.

To the best of our understanding, thats completely wrong, he says. Theres no association with cognitive function or thinking problems associated with these changes.

What Does Migraine Look Like On An Mri

In some people with migraine, MRI scans of the brain may show white spots or areas. These are caused by lesions or irregular areas in the white matter of the brain. White matter tissue is deep in the brain and is mostly made up of nerves.

Everyone has some tiny brain lesions theyre a normal part of aging. They can happen when blood flow is reduced or stopped to a small area of the brain. This can damage some brain cells, causing a lesion.

Researchers arent sure why people with migraine have these lesions. These lesions seem to be more common in people who experience migraine with aura.

Chronic or severe migraine may cause more lesions than normal in some people. However, the white matter lesions dont cause migraine symptoms. Researchers say that theyre also not linked to dementia or memory loss in older adults.

Medical researchers also use MRI scans of the brain to help find out why migraine episodes may happen in some people and not in others.

In one study from 2015, researchers looked at how the brain responded to sight, smell, and pain stimulation. They found that people with migraine may have irregular or more sensitive brain responses to normal stimuli.

MRI scans are often used to help diagnose migraine because they can provide a complete and detailed picture of the brains structure. Theyre also used to research the cause of migraine and the effects on the brain.

Do You Ever Delay Treating Your Migraines

Its a fairly common thing to do. You think to yourself, this one wont be all that bad. Ill: eat lunch, have a cup of coffee, lie down for half an hour, drink a glass of water or diet sodawhatever thing you think might work thats never really worked before. But you have hope. You have hope that this time you can beat this thing, this space alien invading your brain.

Why do we do this? Ive done it myself. It never works. And yet, there is that hope that we can be in control, and not the migraine. I have a colleague who believes that this mistaken belief is part of the migraine itself, that there is cognitive confusion altering good decision-making because of the early stages of the migraine process. If we were thinking clearly, wed just take our medication. Im not so sure its that clear-cut, although that may be the case for some people. There are also issues of weighing out the risk-to-benefit ratios of whether the adverse effects of medication are worth the severity of this headache. There is also the issue of whether you have enough medication to last all month, and if this headache is medication-worthy in light of that.

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Is A Migraine The Worst Pain Ever

The biggest difference between a severe migraine and a thunderclap headache is the severity of the pain. The pain of a thunderclap headache will be the worst headache pain youve ever felt. This is true even for those who have migraines. A thunderclap headache can also feel similar to a crash migraine.

Why It Is Important To Identify Triggers


It would seem that the cause of the pain is easy to identify: it is enough to listen to your body. Some people may realize that, for example, a particular type of wine is giving them headaches. But many at the same time are not able to figure out what exactly leads to the onset of migraines. In 2013, neurologistsat Winston-Salem Medical Center, North Carolina, interviewed migraine sufferers about what exactly they believed to be triggers. They then looked at what factors caused these triggers and found no pattern.

Lets say you suspect a migraine starts every time your period starts. But usually it is accompanied by discomfort and cramps, and you drink red wine to relieve tension. So what causes migraines: menstruation or wine? Maybe you like to have a glass of white, but often after it you have an unbearable headache? Sometimes everything works out, but after a couple of days a migraine occurs. What is the reason: white wine or just an evening with a glass of alcohol?

Neurophysiologists believe that even what seems insignificant can trigger full-blown migraines: weather, barometric pressure, not getting enough rest, sleep, and stress levels. Doctors advise keeping a diary and writing down absolutely everything in it: what you ate, whether you drank alcohol, whether you played sports, how much you slept and what pills you took. Perhaps, sooner or later, together with your doctor, you will be able to identify patterns and make your life much easier.

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Can You Prevent Brain Lesions

Scientists are still looking for ways to protect against brain lesions. They think keeping your migraines in check can help. Having frequent attacks is linked with a higher risk of lesions, so fending off migraines or treating them early on may help lower your risk. These simple steps could help:

  • Talk to your doctor. You may need to take medicine or get treatments, like Botox injections, to head off migraines.
  • Know your triggers. Bright lights, weather changes, and certain foods could set off your migraines. Once you know your triggers, you can learn to avoid them.
  • Keep a lid on stress. Make time to unwind and do things you enjoy every day.
  • Get moving. Exercise eases tension and boosts blood flow to the brain, which can help stave off headaches. Research also shows that physical activity may prevent white matter lesions.
  • Practice good sleep habits. A bad night could set off an attack. Try to go to bed and wake up at around the same time.

American Migraine Foundation: âMigraine and Brain Lesions.â

Cleveland Clinic: âBrain Lesions.â

Mayo Clinic: âBrain Lesions,â âMigraine,â âMigraine with Aura,â âMigraines: Simple steps to head off the pain,â âPatent foramen ovale.â

Neurology: âMigraine and Structural Changes in the Brain,â âPhysical Activity, Motor Function, and White Matter Hyperintensity Burden in Healthy Older Adults.â

Dana Foundation: âWhy the White Brain Matters.â

American Stroke Association: âSilent Stroke.â

What Are The Symptoms Of Migraines

The primary symptom of migraine is a headache. Pain is sometimes described as pounding or throbbing. It can begin as a dull ache that develops into pulsing pain that is mild, moderate or severe. If left untreated, your headache pain will become moderate to severe. Pain can shift from one side of your head to the other, or it can affect the front of your head, the back of your head or feel like its affecting your whole head. Some people feel pain around their eye or temple, and sometimes in their face, sinuses, jaw or neck.

Other symptoms of migraine headaches include:

  • Sensitivity to light, noise and odors.
  • Nausea and vomiting, upset stomach and abdominal pain.
  • Loss of appetite.
  • Feeling very warm or cold .
  • Pale skin color .
  • Euphoric mood.

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What Happens To Your Brain During A Migraine

byCurrent DigestJuly 1, 2021, 9:10 AM

A throbbing, pounding headache. Bright zigzagging lines across your field of vision. Sensitivity to light, lingering fatigue, disrupted sleep. A migraine can include any of these symptoms. While an incapacitating headache is one of the most common experiences of migraine, the word headache doesnt really capture the wide array of experiences a migraine can entail. No two are alike, and some dont even involve a headache. So what then is a migraine? Whats happening in the brain to cause it?

To trace a migraines anatomy, we have to begin in the days and hours leading up to a migraine, when people often identify warning signs ranging from fatigue or mood changes to bursts of yawning, sleep disruption, nausea, light and sound sensitivity, or even increased thirst. These warning signs point to a particular part of the brain: the hypothalamus.

The hypothalamus normally controls the systems behind these symptoms our bodys internal hormonal balances, circadian rhythms, and water regulation. It has wide connections throughout the brain and is more active than usual in the days before migraines.

During the headache phase, the trigeminal nerve plays a key role. The trigeminal nerve normally transmits touch, temperature, and other sensations from the skin to most of the face, part of the scalp, and some of the blood vessels and layers covering the cerebral cortex. Once activated, the trigeminal nerve transmits pain signals.

What Are The Types Of Headaches What Type Of Headache Is A Migraine

Migraine Headaches : What Happens to the Brain During a Migraine?

There are over 150 types of headaches, divided into two categories: primary headaches and secondary headaches. A migraine is a primary headache, meaning that it isnt caused by a different medical condition. Primary headache disorders are clinical diagnoses, meaning theres no blood test or imaging study to diagnose it. A secondary headache is a symptom of another health issue.

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What Else Can I Do To Prevent Migraines

While there are no sure ways to keep from having migraine headaches, here are some things that may help:

Eat regularly and do not skip meals.

  • Keep a regular sleep schedule.
  • Exercise regularly. Aerobic exercise can help reduce tension as well as keep your weight in check. Obesity can contribute to migraines.
  • Keep a migraine journal to help you learn what triggers your migraines and what treatments are most helpful.

What Happens In The Brain During A Migraine

Until the 20th century it was a mystery what caused migraine and what happened in the body during an attack. However, in recent years scientists have discovered many of the mechanisms that are involved when migraine attacks start and develop. This article will describe the most important of these mechanisms.

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Brain Scans Show Dopamine Levels Fall During Migraine Attacks

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ANN ARBORUsing PET scans of the brain, University of Michigan researchers showed that dopamine falls and fluctuates at different times during a migraine headache.

This could help scientists better understand dopamine-based therapies for migraines as well as a patients behavior during an attack.

The connection between dopamine and migraines has long been a poorly understood therapeutic and research area, says Alex DaSilva, assistant professor at the U-M School of Dentistry and Center for Human Growth and Development at the University of Michigan.

Outfitted with a joystick and special glasses, Assistant Professor Alex DaSilva examines 3D images of the brain to better understand brain chemical fluctuations during a migraine headache. DaSilva is in the Michigan Immersive Digital Experience Nexus, or MIDEN, on North Campus. Images credit: Scott Soderberg, Michigan Photography

Dopaminesometimes called the brains feel-good neurotransmitterhelps regulate emotion, motivation and sensory perception.

Physicians and emergency rooms often give migraine patients dopamine antagonists, drugs that block overactive dopamine receptors, to level off wild dopamine fluctuations and ease migraine attacks.

When migraine patients were between headaches, their dopamine levels were as stable and even as the healthy patients, DaSilva said. But during an attack, the migraine patients dopamine levels fell significantly.

The Migraine Spreadsthen Stops

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The initial migraine pain that starts with the activation of the neurons in the brainstem changes after about 1 to 2 hours. The migraine then moves to a second stage, where the central nervous system becomes hypersensitive and involved.

If you can take medication before the second stage of the migraine occurs, you are more likely to be able to stop the . Triptan medication can shut down the initial pain by narrowing the blood vessels and blocking pain transmission.

But if the pain cycle continues to the central nervous system, medication becomes less effective. If untreated, migraine can last up to 72 hours, before the nervous system response finally quiets and your brain returns to its normal, pre-activation state.

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Whats A Migraine Journal

  • Keeping a migraine journal is not only beneficial to you, but it helps your healthcare provider with the diagnosis process. Your journal should be detailed and updated as much as possible before, during and after a migraine attack. Consider keeping track of the following:
  • The date and time of when the migraine began specifically when the prodrome started, if youre able to tell its happening. Track time passing. When did the aura phase begin? The headache? The postdrome? Do your best to tell what stage youre in and how long it lasts. If theres a pattern, that may help you anticipate what will happen in the future.
  • What are your symptoms? Be specific.
  • Note how many hours of sleep you got the night before it happened and your stress level. Whats causing your stress?
  • Note the weather.
  • Log your food and water intake. Did you eat something that triggered the migraine? Did you miss a meal?
  • Describe the type of pain and rate it on a one to 10 scale with 10 being the worst pain youve ever experienced.
  • Where is the pain located? One side of your head? Your jaw? Your eye?
  • List all of the medications you took. This includes any daily prescriptions, any supplements and any pain medication you took.
  • How did you try to treat your migraine, and did it work? What medicine did you take, at what dosage, at what time?
  • Consider other triggers. Maybe you played basketball in the sunlight? Maybe you watched a movie that had flashing lights? If youre a woman, are you on your period?

Focus On Symptoms Not Perceived Risks

Dr. Goadsby says patients are often concerned that brain changes correlate with stroke or cognitive dysfunction later in life. This is not the case, and Goadsby says in fact, the stroke risk for migraine sufferers become less prominent after the age of 45.

Patients with migraine with aura face a small risk of stroke compared to population controls , or patients with migraine without aura, he says. Because of the low risk, Goadsby says migraine patients who have regular normal physical examinations do not need to get regular brain scans. He says that the pain of migraine attacks is the symptom that patients and their care teams should prioritize, not the possibility of lesions or the fear of increased stroke risk. It should also be noted that the presence of these lesions should not influence the use of any particular medication.

Migraine is an inherited episodic brain disease, Goadsby says. It doesnt shorten life: it ruins it. Migraine patients do not have to be worried about long-term brain damage. It simply doesnt happen.

To learn more, visit the American Migraine Foundation, where neurologists like Dr. Goadsby and others share information and resources about the disease, including the various treatment options available to people living with migraine and head pain.

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Changes In Your Braincortical Spreading Depression

We know that there are waves of electrical changes that go across the brain, starting at the back and moving slowly towards the front. First there is a wave of excitation, followed by what is called spreading cortical depression. This has been known since the 1940s, when it was discovered in rabbits by a Brazilian neurologist named Leão, although it wasnt immediately associated with migraine at that time. Interestingly, though, there was another neurologist at about that time who tracked the spread of his own visual auras, and found that they moved at about 2-3 mm/minute. This is about the same speed as cortical spreading depression.

We have since made an association between cortical spreading depression and migraine aura. And, in fact, we have been able to demonstrate very slow changes moving across the brain during migraine aura on both blood oxygen level dependent MRI studies and magnetoencephalography. These changes move at a rate consistent with the speed of cortical spreading depression. Although most of these studies have been done in migraine with aura, there is one PET study done in a single patient who has migraine without aura showing slowing of blood flow in a similar pattern, suggesting that cortical spreading depression may occur in migraine without aura as well. Obviously, it is much harder to study in migraine without aura, as it is more difficult to determine when the beginning of the attack is in order to test it.

Postdromal Or Recovery Phase

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This is an extremely poorly understood phase of migraine. The fact is that for a long time, scientists did not consider recovery from the painful phase as an independent stage of the disease. However, after the pain is over, you still feel unwell. A study published in the journal Neurology states that 89% of migraine sufferers go through the postdrome phase. The list of symptoms is very extensive: fatigue, dull pain, weakness, loss of energy, dizziness, difficulty concentrating, and mood changes. However, scientists do not find any physiological or biological reasons for the development of this phase: it is not clear what exactly causes this hangover.

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