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What Is Happening To The Brain During A Migraine

What Can I Do To Prevent Migraines

What happens to your brain during a migraine – Marianne Schwarz

One of the best ways to prevent migraines is to try to avoid the things that might trigger your attacks. Most people benefit from trying to get stable sleep, eating regular meals, drinking plenty of fluids to keep hydrated, and trying to manage stress. Taking regular exercise may also help prevent migraines since it helps with breathing, improving blood sugar balance and maintaining general wellbeing. Although you should take care not to engage in very strenuous activity that your body is not used to as this can sometimes act as a migraine trigger.

Keeping a diary of your migraines can be a useful way to record when and where you experience attacks, check for any patterns, and try to identify your triggers. Take the diary when you see your GP so you can communicate your symptoms with them and they can find the best way to help you.

What If Treatment Doesnt Work

There are many different ways to address headaches. When you start a treatment program, keep track of your results. A headache log can help you measure progress.

Ask yourself:

  • Are my headaches less frequent?
  • Are they less severe?
  • Do they go away faster?

If you dont notice an improvement, talk to your doctor at the next follow-up exam. You may need to try something new.

Can Lack Of Vitamin D Cause Migraines

Though research to prove that low vitamin D causes migraine is ongoing, several recent studies shed some light on the link. A report presented at a meeting of the American Headache Society found that 40% of people with migraines had low vitamin D levels. Those with deficiencies also developed migraines earlier in life.

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The Migraine Spreadsthen Stops

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.

Preventative Medication And Therapies

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If you experience frequent migraines, your GP might discuss preventative medication options with you.

It is important to note that preventatives for migraines are not pain medication, but help to reduce the number of migraines. They take time to work, so the minimum time period required may be three to six months. Contact your GP or specialist for further information. All of these treatments have their advantages and disadvantages and some of the medications might not be suitable for everybody.

You might find that this medication reduces the frequency and severity of your attacks but does not stop them completely. You will need to continue your other migraine treatments when you experience an attack.

National Institute for Health and Care Excellence recommends that GPs and specialists should consider the following drugs and therapies if they think you might benefit from preventative treatment:

Beta blocking drugs

These drugs are traditionally used to treat angina and high blood pressure. It has been found that certain beta-blockers prevent migraine attacks. Beta-blockers are unsuitable for people with certain conditions.

Topiramate

This drug is typically prescribed for the treatment of epilepsy but has also been found to help reduce the frequency of migraines. Again, it is not suitable for everyone. In particular, women who are pregnant or thinking about getting pregnant should be advised of the associated side effects.

Amitriptyline

Acupuncture

Botulinum toxin type A

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What Triggers Headaches And Migraines

Common triggers of tension headaches or migraines include:

  • Alcohol use.

Cluster headaches

Cluster headaches are the most severe type of primary headache. Cluster headaches come in a group or cluster, usually in the spring or fall. They occur one to eight times per day during a cluster period, which may last two weeks to three months. The headaches may disappear completely for months or years, only to recur later. The pain of a cluster headache is:

  • Intense with a burning or stabbing sensation.
  • Located behind one of your eyes or in the eye region, without changing sides.
  • Throbbing or constant.

New daily persistent headaches

New daily persistent headaches come on suddenly and last for more than three months. They typically occur in people who werent having frequent headaches before. The pain of NDPH is:

  • Constant and persistent without easing up.
  • Located on both sides of the head.
  • Not responsive to medications.

Sinus headaches

Sinus headaches are the result of a sinus infection, which causes congestion and inflammation in the sinuses . People, and even healthcare providers, often mistake migraines for sinus headaches. Symptoms of sinus headaches include:

  • Bad taste in mouth.
  • Pain that gets worse with sudden head movement or straining.
  • Mucus discharge .

Medication overuse headaches

  • Headaches becoming more frequent.
  • More days with headaches than without.
  • Pain thats worse in the morning.

Headaches in children

What Happens Before The Migraine Attacks

A fair amount of research has gone into looking at what happens to the brain during migraine attacks, but not so much investigation has gone into what goes on in your brain before a migraine occurs. Now researchers from Kings College Hospital are looking to find out more about which areas of the brain that are activated before an attack. What goes on during symptoms the patient experiences before the start of a migraine headache , and what happens during the headache pain itself, and throughout the symptoms experienced after the pain has settled ? The plan is to monitor and find this out by using a form of brain scanning called functional Magnetic Resonance Imaging .

Researchers hope that the study will help them to understand the mechanisms behind the different stages of migraine attacks and this will help to guide any future work looking at treatments that might work early on in attacks before the pain hits.

Participants in the study will have 3-4 day-long visits to the Clinical Research Facility at Kings College Hospital , and during these visits will complete a series of MRI brain scans and clinical and questionnaire assessments to try to correlate clinical observations with their MRI findings.

The study is being funded by The Migraine Trust. For more information on the ongoing study interested parties can e-mail

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When Migraine Mimics Stroke

The symptoms of some types of migraine can mimic stroke, such as hemiplegic migraine where there is weakness down one side.

Migraine auras can be confused with transient ischaemic attack , where someone has stroke symptoms that pass in a short time. For instance, a migraine with only a visual aura but no headache may be mistaken for TIA.

Like a stroke, a migraine can be sudden and can lead to mild confusion. However, migraine aura symptoms tend to develop relatively slowly and then spread and intensify, while the symptoms of a TIA or stroke are sudden.

Migraine can sometimes be mistaken for a stroke caused by bleeding on the brain, called a subarachnoid haemorrhage , which is often characterised by a sudden, very severe headache. Unlike SAH, migraine headache is usually one-sided and throbbing, slow to come on and lasts for a shorter period of time. Vomiting usually starts after a migraine headache starts, but is likely to happen at the same time as headache during a SAH. Patients with a SAH also develop neck stiffness, which is uncommon during a migraine attack.

Why Does The Inside Of My Head Hurt

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

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.

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What Are The Types Of Headaches What Type Of Headache Is 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.

A Chain Reaction Begins

When the CSD wave arrives at a nerve cell, its normal Na+ and K+ concentration differences break down, which again makes CSD spread further.

The next step of this vicious cycle happens, when enough K+ has entered the ECF around a nerve cell. The excess K+ acts as a key which unlocks a specific type of channel in the wall of the nerve cell:

When this large number of Na+ molecules enter the molecule it becomes depolarized , meaning that it loses its normal battery charge and cannot work properly again before it has been recharged by its Na+/K+-pumps.

Importantly, the opening of the NMDA channels also allows even more K+ to escape into the ECF :

This chain reaction spreads from nerve cell to nerve cell, opening NMDA channels, strongly depolarizing each cell in turn and overturning the normal concentrations of Na+ and K+. It is this late part of the CSD chain reaction which in some migraine patients is experienced as a migraine aura, because of the way that CSD disrupts the cells normal function.

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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?

A Migraine Attack Is Triggered

What Happens in Your Body During a Migraine

There is a lot of evidence that migraine attacks are triggered when the concentration of K+ in the ECF becomes too high. This corresponds to the situation where the dancer has dropped so many marbles around her feet that she ends up slipping on one of them. This increase in K+ in the ECF can happen for a number of reasons:

  • If the Na+/K+-pumps are not being supplied with enough oxygen and/or blood sugar, K+ cannot be pumped out of the ECF fast enough and the concentration of K+ in the ECF will increase . This can happen if the arteries supplying this part of the brain are very contracted so that too little blood flow is coming through, starving the Na+/K+-pumps of the oxygen and blood sugar that is normally being delivered in sufficient amounts by the blood. If it is too long since youve eaten a meal, your blood sugar may also be so low that the Na+/K+-pumps are not getting the energy they need to remove K+ from the ECF at a fast enough rate.
  • If the nerve cells have been firing at a very high frequency for a very long time, K+ in the ECF will increase . This can happen when you have been very stressed for a long time or have not had enough sleep.
  • If too little K+ is being removed by the blood flow that normally helps sweep up some of the excess K+ in the ECF. This happens if the blood flow to that part of the brain is insufficient.

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Understanding Migraine And Stroke

Stroke and migraine both happen in the brain, and sometimes the symptoms of a migraine can mimic a stroke. However, the causes of the symptoms are different. A stroke is due to damage to the blood supply inside the brain, but migraine is thought to be due to problems with the way brain cells work.

In a stroke, the blood supply to part of the brain is cut off, killing brain cells. This causes permanent damage to the brain, and can have long-lasting physical, cognitive and emotional effects.

A migraine causes pain and sensory disturbances, but the changes inside the brain are usually temporary.

The relationship between migraine and stroke is complex. The symptoms can sometimes seem similar, and they may share some underlying risk factors.

Migrainous infarction

Occasionally migraine and stroke can happen together, but there is no evidence to suggest that one causes the other. Migrainous infarction is the term given to an ischaemic stroke that happens during a migraine. This tends to happen alongside prolonged aura symptoms, but is extremely rare.

Stroke risk and migraine

If you have migraine with aura, you’re about twice as likely to have an ischaemic stroke in your lifetime, compared to those without migraine. However, the overall risk linked to migraine is still very low, and you’re far more likely to have a stroke because of other risk factors like smoking and high blood pressure.

Women and migraine

Other health conditions

Treating And Preventing Migraine With Aura Or Retinal Migraine

For infrequent attacks, medications that target symptoms can be effective, from NSAIDs for pain to anti-nausea medications. Preventative therapies including calcium channel blockers, antiepileptic or tricyclic medications. Quitting smoking is recommended and cessation of oral contraceptives may be advised in certain circumstances. Some options for relief without drugs can include resting your eyes, removing yourself from bright sunlight or other harsh lighting, and taking a break from looking at a screen. As with all types of migraine, try to avoid triggers like stress, dehydration, high altitude, low blood sugar, excessive heat and extensive time spent staring at a screen.

While the symptoms can be disorienting and distressing, they are often short-lived, and almost always reversible. Take some time away from triggers and wait for the symptoms to fade. For more information, visit the American Migraine Foundations resource center, which includes content specifically related to Migraine with Aura, Retinal Migraine and more. The American Migraine Foundation is committed to providing comfort and information to people living with this disease. You are not alone: find your support network today.

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Migraines Can Alter Brain Structure Permanently

Scientists have discovered that migraines may affect the long-term structure of the brain and increase the risk of brain lesions, according to a study published in the journal Neurology.

Researchers from the University of Copenhagen in Denmark analyzed six population-based studies and 13 clinic-based studies to see whether there was a link between migraines and brain lesions, silent abnormalities or brain volume changes.

The study authors looked at MRI brain scans of patients with common migraines or migraines with aura. Migraine with aura is when a person experiences symptoms before the onset of the migraine. These scans were compared with those of people not suffering from the disorder.

The results of the study revealed that those who had migraines with aura showed a 68% increased risk of white matter brain lesions, compared with those who did not have migraines.

Patients who experienced common migraines showed a 34% increased risk of brain lesions compared with those not suffering from migraines.

Infarct-like abnormalities in the brain symptoms that indicate a disruption in blood flow to the brain increased by 44% in those who had migraines with aura compared with those who had migraines without aura.

Additionally, brain volume changes were more prevalent in both people with common migraines and migraines with aura than those without the conditions.

The study authors explain:

Should People With Migraine Have A Brain Scan

What Is a Migraine Headache?

Some people with migraine feel they would benefit from a brain scan or are referred for one by their GP. However, if you have a diagnosis of migraine, have had a normal physical examination and there are no other concerns, such as a sudden agonising headache or a new headache in someone over 50, a brain scan is not usually needed.

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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.

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