Cause of Migraines
Migraine is an often hereditary condition resulting in over sensitivity of the brain to various stimuli. Exposure to certain activators leads to a cascade of changes in the brain, trigeminal nerve and blood vessels that produces all the symptoms that are associated with migraine. Having a migraine brain is such a common human variant in 20% of people that we consider it to be a disturbance that needs to be controlled rather than a disease process. Everyone has a threshold for triggering a migraine but most never reach that threshold while people who have migraine disorder may reach that threshold occasionally or as often as on a daily basis.
When the migraine generator in the brain is activated, it may trigger brain electrical activity that produces an aura before the headache. The migraine aura only happens in about one in five people with migraine and may include a visual symptoms such as scintillating lights or spreading tingling on one side of the body or disturbances of speaking or thinking. Sometimes this occurs without being followed by the headache pain but most of the time it is a warning that the migraine headache pain is soon to follow.
Whether or not the person has the aura, the migraine pain is due to activation of the trigeminal nerve that travels to all regions of the face and head so may cause pain to many different areas and can change from time to time. The nerve activation causes a release of inflammatory chemicals onto the blood vessels surrounding the brain that triggers some of the most severe pain known to man. The inflammation that occurs can be analogous to that of repeated episodes of meningitis producing painful inflammation around the brain. What can be further disabling if the migraine is not stopped, is the subsequent additional sensitization of the brain called allodynia that turns normal sensations such as light, sound, smells and touch into painful sensations.
There are many factors that are often unique to each individual that can activate this migraine process in the brain to include weather changes, changes in estrogen levels pre-menstrually or peri-menopausally, changes in stress levels, changes in sleep duration, relative hypoglycemia such as skipping a meal, neck muscle spasm and especially exposure to many foods or food chemicals that may be specific for each person. It is important to note that it may take an accumulation of triggers over days to overcome the migraine threshold so each individual trigger factor may not activate the migraine each time.
Our goal at Puget Sound Neurology in controlling migraine is to raise the threshold for activation of migraine so the migraine events occur less often, decrease the triggers for migraine and to be able to stop the migraine in its tracks when it starts before it can interfere with life. This is done through life style changes, dietary changes and medication programs in a formula specific for each person.
For more information on the pathophysiology of migraine, view this webinar presented by Dr. Hogan and Joan Hogan RD. https://www.youtube.com/watch?v=_7vaQTL90qI