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What Is Happening In The Brain During A Migraine

What Else Can I Do To Prevent Migraines

What happens to your brain during a migraine – Marianne Schwarz

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 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.

It Comes On Suddenly And Severely

A brain aneurysm occurs when weak blood vessels in the brain start expanding or ballooning out. Usually they dont cause symptoms, although if they get very big, they can cause headaches. But a ruptured aneurysm, which occurs when the ballooned vessel pops and leaks blood around the brain, can cause a massive, sudden headache.

The classic presentation is the worst headache of your life, says Jonathan J. Russin, MD, assistant professor of clinical neurological surgery at the Keck School of Medicine of USC and a neurosurgeon at Keck Medicine of USC. They call it a thunder clap headache.

It may also be accompanied by nausea, vomiting, weakness or drowsiness. If you experience a major headache like this, call 911 immediately.

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What Are Some Migraine Risk Factors And Triggers

Some things make you more likely to get migraine headaches . Other things may bring on a migraine .

Common migraine risk factors include the following:

  • Family history: You are much more likely to have migraines if one or both of your parents had migraines.
  • Sex: Women are more likely than men to have migraines.
  • Age: Most people have their first migraine during adolescence, but migraines can start at any age, usually before age 40.

Common migraine triggers include the following:

  • Food and drink: Certain food and drink may cause migraines. Dehydration and dieting or skipping meals may also trigger migraines.
  • Hormone changes: Women may experience migraines related to their menstrual cycles, to menopause, or to using hormonal birth control or hormone replacement therapy.
  • Stress: Stress may trigger migraines. Stress includes feeling overwhelmed at home or work, but your body can also be stressed if you exercise too much or dont get enough sleep.
  • Senses: Loud sounds, bright lights , or strong smells may trigger migraines.
  • Medicines: Certain medicines may trigger migraines. If you think your migraines might be related to your medicine, talk to your doctor. Your doctor may be able to prescribe a different medicine.
  • Illness: Infections, such as the cold or the flu, may trigger migraines, especially in children.

Foods that may trigger migraines:

  • aged, canned, cured, or processed meat
  • aged cheese
  • soy sauce

Pathophysiology: What Happens In Your Brain During A Migraine

brain image migraines

First, what is pathophysiology? Pathophysiology refers to the changes that occur in the bodys systems, resulting in abnormal function, as a result of an illness, a disease, or an abnormal condition such as migraine. Scientists are constantly learning new information about what happens in your brain at the start of a migraine and during a headache.

Most of us have probably heard about changes in blood vessels associated with migraine headaches. It might seem that blood vessels constrict during a migrainethat would seem logical, wouldnt it? And so they do, some of thembut the entire situation is not as simple as originally thought.

Initially, it was thought that the blood vessels on the surface of your brain dilate, and with each heartbeat, the blood surging through throws the dilated blood vessel wall up against your skull, resulting in that throbbing pounding pain you are so familiar with. And migraines were termed vascular headaches. Recently, that phenomenon has been thrown into doubt, although various experts disagree. Certainly, though, it is not as simple as just blood vessel changes.

Migraine mostly happens within your brain. Several things happen at the beginning of a migraine attack, and we are not yet sure exactly what happens first, or whether one leads to another.

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Why Does The Inside Of My Head Hurt

Tension headaches occur when the muscles in your head and neck tighten, often because of stress or anxiety. Intense work, missed meals, jaw clenching, or too little sleep can bring on tension headaches. Over-the-counter medicines such as aspirin, ibuprofen, or acetaminophen can help reduce the pain.

How Are Headaches Treated

One of the most crucial aspect of treating headaches is figuring out your triggers. Learning what those are typically by keeping a headache log can reduce the number of headaches you have.

Once you know your triggers, your healthcare provider can tailor treatment to you. For example, you may get headaches when youre tense or worried. Counseling and stress management techniques can help you handle this trigger better. By lowering your stress level, you can avoid stress-induced headaches.

Not every headache requires medication. A range of treatments is available. Depending on your headache type, frequency and cause, treatment options include:

Stress management

Stress management teaches you ways to cope with stressful situations. Relaxation techniques are helpful in managing stress. You use deep breathing, muscle relaxation, mental images and music to ease your tension.

Biofeedback

Biofeedback teaches you to recognize when tension is building in your body. You learn how your body responds to stressful situations and ways to settle it down. During biofeedback, sensors are connected to your body. They monitor your involuntary physical responses to headaches, which include increases in:

  • Breathing rate.
  • Brain activity.

Medications

Occasional tension headaches usually respond well to over-the-counter pain relievers. But be aware that using these medications too often can lead to a long-term daily headache.

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A Closer Look At Pain

Pain is the brains way of telling you that things are bad for you. For example, a hot stove or a slammed door can damage your skin and muscle. If you, say, burn your finger or slam a door on it, information about the damage is sent to your brain.

When it arrives there you will, unfortunately, experience it as pain.

As most of us know, pain feels terrible, but it is actually very useful. It is the brains way of convincing you not to do things that can hurt you.

Come on, mate, you whisper, rubbing your temples, get to the headaches already.

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What Is A Migraine

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

A Migraine is an intense and often debilitating, form of headache which is often localized to one side of the head. A migraine feels like a deep throbbing pain or pulsing sensation in the head and the pain is often felt behind the eyes or temples. Migraine attacks often include additional side effects such as light sensitivity, nausea, or vomiting and are more common in women than men with roughly 1 out of every 5 women suffering from migraine headaches opposed to 1 out of every 15 men. Individual attacks can last anywhere between four and 72 hours and migraines may strike multiple times a week or have years between attacks.

Symptoms Of a Migraine Include:

  • Nausea or vomiting
  • Increased sensitivity to light, sound, or smell
  • Dizziness or vertigo
  • Pain on one side of your head or behind the eyes or temples
  • Pulsing or throbbing head pain

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Who Gets Migraines What Are The Risk Factors

Its difficult to predict who may get a migraine and who may not, but there are risk factors that may make you more vulnerable. These risk factors include:

  • Genetics: Up to 80% of people who get migraine headaches have a first-degree relative with the disease.
  • Gender. Migraine headaches happen to women more than men, especially women between the ages of 15 and 55. Its likely more common in women because of the influence of hormones.
  • Stress level. You may get migraines more often if youre high-stress. Stress can trigger a migraine.
  • Smoking.

Can Migraines Be Prevented Or Avoided

Medicine to prevent migraines may be helpful if your headaches happen more than 2 times a month. You may want to consider this medicine if your headaches make it hard for you to work and function. These medicines are taken every day, whether you have a headache or not.

Preventive medications for migraines can include prescription drugs often used to treat other ailments. Anti-seizure medicines, antidepressants, medicines to lower blood pressure, and even Botox injections are some of the preventive medications your doctor may prescribe. Calcitonin gene-related peptide inhibitors can also help prevent migraines. They do so by blocking a gene-related peptide in your sensory nerves. This peptide is known to increase during a migraine attack, so blocking it can help prevent migraines.

There are also a number of non-medical treatments designed to help minimize migraine pain and frequency. One is an electrical stimulation device, which has been approved by the FDA. It is a headband that you wear once a day for 20 minutes to stimulate the nerve linked to migraines. Another non-medical treatment is counseling aimed at helping you feel in more control of your migraines. This counseling works best when paired with medical prevention of migraines, as well.

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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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What Are The Symptoms Of Migraine

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The main symptoms of migraine are an intense, throbbing or pounding headache often affecting the front or one side of the head, nausea and sometimes vomiting , and an increased sensitivity to light smells and sound. The throbbing headache is often made worse by the person moving.

Other symptoms of migraine might include poor concentration, feeling hot or cold, perspiration , and an increased need to pass urine. This can occur before, during or after the migraine attack.

People might also experience stomach aches and diarrhoea.

It is common for people to feel tired for up to two or three days after a migraine.

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What Questions Should I Ask My Healthcare Provider

  • Will my child grow out of their migraines?
  • What medications do you recommend for me?
  • What should I change about my lifestyle to prevent my migraine headaches?
  • Should I get tested?
  • What type of migraine do I have?
  • What can my friends and family do to help?
  • Are my migraines considered chronic?

A note from Cleveland Clinic

Migraine headaches can be devastating and make it impossible to go to work, school or experience other daily activities. Fortunately, there are some ways to possibly prevent a migraine and other ways to help you manage and endure the symptoms. Work with your healthcare provider to keep migraines from ruling your life.

Last reviewed by a Cleveland Clinic medical professional on 03/03/2021.

References

A Note From Cleveland Clinic

The good news for headache sufferers is that you can choose from many kinds of treatment. If your first treatment plan doesnt work, dont give up. Your healthcare provider can recommend other treatments or strategies to find the right fix for you.

Last reviewed by a Cleveland Clinic medical professional on 06/03/2020.

References

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Imaging The Pain Network In Chronic Migraine

Pain experience is a complex process involving sensory, affective, and cognitive brain networks. Similar to previous findings in episodic migraine patients , an altered functional recruitment of brain areas involved in the sensory-discriminative and affective aspects of pain, including the insula, prefrontal, anterior cingulate and somatosensory cortex, has been demonstrated in chronic migraine patients . Maladaptive functional activation of brain networks involved in attentive and executive functions, such as the executive control, default mode and dorsal attention network, have also been revealed in patients with chronic migraine. Thus, suggesting that the reaction to painful stimuli, preparation of responses, and allocation of attentional resources to pain are impaired in chronic migraine patients . Whether cognitive symptoms, particularly deficits in attention and executive functions, might influence the functional activity of brain cognitive networks has never been investigated. A comprehensive neuropsychological assessment should be included in future studies. The salience network has a key role in defining the saliency of incoming painful stimuli. In chronic migraine patients, the presence of cutaneous allodynia was associated to an increased activity of the salience network. These findings support a possible involvement of the salience network in central sensitization .

Research Data On Race And Ethnicity

Functional Changes in the Brain During Migraine

Migraine can be a debilitating condition that is underdiagnosed and challenging to treat. This can be seen especially in BIPOC populations. People of Color are less likely to receive the diagnosis of migraine and the treatment than white people.

In fact, only 47% of African Americans have an official migraine diagnosis, compared with 70% of white people in the country. And other research found that Latino people are 50% less likely to receive a formal migraine diagnosis than white people. These disparities can impact treatment and therapies.

While these figures could lead to the conclusion that white people experience more migraine episodes than other groups, looking at the average prevalence of severe headache or migraine from 2005 to 2012 in the U.S. found that the prevalence rates of episodes across all groups were similar:

  • 17.7% of Native American people
  • 15.5% of white people
  • 14.45% of Black people
  • 9.2% of Asian people

Furthermore, females in all groups were approximately twice as likely to experience migraine episodes than males.

Overall, studies that discuss migraine and use racial and ethnic differences for clarity often do not consider contributing factors. Further research is warranted, and this should consider behavioral, environmental, genetic, and socioeconomic factors, as well as access to healthcare.

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What Happens In Your Brain During A Migraine

    Scientists used to think migraines were caused by blood vessels on the surface of your brain dilating and constricting, leading to the pulse of pain people often experienced. They saw migraines as being primarily a vascular disorder. Thats changed. We now know that these changes are the end result of a more complex nerve pathway in the brain.

    Today, researchers believe migraines are a neurological disorder thats largely genetically based. They still dont understand everything that happens during a migraine, such as why certain symptoms occurbut they are closer to untangling the mystery of the migraine.

    Heres what researchers believe happens inside your brain to cause the symptoms you are experiencing.

    What Happens During A Migraine Attack

    The figure above shows our understanding of what happens during a migraine attack. It is now thought that a migraine is triggered when a wave of electricity which starts in the trigeminal nerve on the side of the face stimulates the release of peptides such as CGRP and other substances that cause inflammation and makes other nerves more sensitive to pain. The wave of electricity then enters the brain and ripples across the surface of the brain and together with CGRP causes blood vessels to dilate, as shown in Inset A above. In this way sensitization of the nerves often progresses from peripheral nerve cells on the skin to central neurons in the brain.

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