What happens during a migraine?

What Happens in Your Body During a Migraine?

Ever wonder what’s happening inside your body to cause migraine pain and discomfort? While researchers still don’t know exactly what causes a migraine, you can learn the phases of what happens in your body—and how you can fight back. The video below provides a visual analysis of how a migraine impacts your brain and your body before, during, and after an attack.

Phase 1: Onset

At the start of a migraine, an external or internal trigger causes neurons in the brain to fire abnormally. These triggers are vast and varied, and include lack of sleep, increase in stress, dietary choices, strong scents, shift in weather, or hormonal changes during a woman’s menstrual cycle.1

Phase 2: Hypersensitivity

Those abnormally firing neurons cause hyperexcitability in various regions of the brain, leading to symptoms that affect the senses. You may experience nausea, sensitivity to light and sound, or difficulty with motor skills and speech, although symptoms vary for every sufferer. Some sufferers even experience aura—either a visual disturbance that appears as lights or lines, or a temporary loss of vision.2,3 It is important to talk to your doctor if you experience any of the above symptoms, as migraines can become severely debilitating if left untreated.

Phase 3: Attack

Scientists believe that the head pain associated with migraines may begin because of a drop in the body’s levels of the neurotransmitter serotonin, which causes the nervous system to release other chemicals called neuropeptides.4 Low serotonin levels cause the blood vessels surrounding the brain to dilate, and it’s this expansion that can lead to throbbing in your head, often concentrated on one side.4,5

Phase 4: Aftereffect

Most migraines last between 4 and 72 hours. Yet even once they’re gone, your body is still working to recover.6 For the next day or two, it is normal to experience impaired concentration, fatigue, and even weakness.6 Take it easy and get plenty of rest. Consider scaling back on obligations, exercise, and daily activities until you feel back to your usual self.

Fast Track to Relief

It’s important to address a migraine as soon as you feel it coming on; a delay in treatment can make it more difficult for your head pain to respond. (See why “waiting out” a migraine isn’t the best idea.) Making changes in your lifestyle—such as stress management, exercise, and relaxation practices—may be helpful in reducing the number and severity of migraine attacks.3 These techniques, combined with over-the-counter medications like Excedrin® Migraine, can help provide fast relief.

Symptoms and stages of migraine

Introduction

Not everyone will have a ‘typical’ migraine. There are different types of migraine that involve different symptoms.

The most common symptoms of a migraine attack include throbbing headache, sensitivity to light and noise, nausea (feeling sick), vomiting (being sick) and lethargy (lack of energy).

Migraine attack stages or phases

It is often difficult to predict when a migraine attack is going to happen. However, you can often predict the pattern of each attack as there are well defined stages. It is these stages and their symptoms which distinguish a migraine from a headache.

In adults, we can divide a migraine attack into four or five stages that lead on from each other:

  • Premonitory or warning phase
  • Aura (not always present)
  • The headache or main attack stage
  • Resolution
  • Recovery or postdrome stage

Learning to recognise the different phases of a migraine attack can be useful. You might get one, all, or a combination of these stages, and the combination of stages may vary from attack to attack. Each phase can vary in length and severity.

Recognising different symptoms at different times during your headache attack can give a doctor information which may help diagnosis. Also, taking medication before the symptoms have fully developed may reduce the effect of an attack. A child’s migraine attack is often much shorter than an adult’s attack, and it may therefore not be possible to fully make out the different headache phases.

Premonitory stage

This describes certain physical and mental changes such as tiredness, craving sweet foods, mood changes, feeling thirsty and a stiff neck. These feelings can last from 1 to 24 hours.

Aura

The aura of migraine includes a wide range of neurological symptoms. This stage can last from 5 to 60 minutes, and usually happens before the headache. Migraine without aura does not include this stage.

In some people, changes in the cortex area of the brain cause changes in their sight, such as dark spots, coloured spots, sparkles or ‘stars’, and zigzag lines. Numbness or tingling, weakness, and dizziness or vertigo (the feeling of everything spinning) can also happen. Speech and hearing can also be disturbed, and people with migraine have reported memory changes, feelings of fear and confusion, and more rarely, partial paralysis or fainting. These neurological symptoms are called the ‘aura’ of migraine. In adults, they usually happen before the headache itself, but in children, they may happen at the same time as the headache. It is possible to have the aura symptoms without the headache. We have more information about aura here.

The headache or main attack stage

This stage involves head pain which can be severe, even unbearable. The headache is typically throbbing, and made worse by movement. Some people describe a pressing or tightening pain. The headache is usually on one side of the head, especially at the start of an attack. However, it is not uncommon to get pain on both sides, or all over the head. Nausea (sickness) and vomiting (being sick) can happen at this stage, and the person with migraine may feel sensitive to light or sound, or both.

Resolution

Most attacks slowly fade away, but some stop suddenly after the person with migraine is sick, or cries a lot. Sleep seems to help many people, who find that even an hour or two can be enough to end an attack. Many children find that sleeping for just a few minutes can stop their attack.

Recovery or postdrome stage

This is the final stage of an attack, and it can take hours or days for a ‘hangover’ type feeling to disappear. Symptoms can be similar to those of the first stage, and often they are mirrored symptoms. For example, if you lost your appetite at the beginning of the attack, you might be very hungry now. If you were tired, now you might feel full of energy.

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Migraine

There is no specific cure for migraine headaches. The goal is to treat your migraine symptoms right away, and to prevent symptoms by avoiding or changing your triggers.

A key step is learning how to manage your migraines at home. A headache diary can help you identify your headache triggers. Then you and your doctor can plan how to avoid these triggers.

Lifestyle changes include:

  • Better sleep habits, such as getting enough sleep and going to bed at the same time each night
  • Better eating habits, including not skipping meals and avoiding your food triggers
  • Managing stress
  • Losing weight, if you’re overweight

If you have frequent migraines, your provider may prescribe medicine to reduce the number of attacks. You need to take the medicine every day for it to be effective. Medicines may include:

  • Antidepressants
  • Blood pressure medicines, such as beta blockers
  • Seizure medicines
  • Calcitonin gene-related peptide agents

Botulinum toxin type A (Botox) injections may also help reduce migraine attacks if they occur more than 15 days a month.

Some people find relief with minerals and vitamins. Check with your provider to see if riboflavin or magnesium is right for you.

TREATING AN ATTACK

Other medicines are taken at the first sign of a migraine attack. Over-the-counter (OTC) pain medicines, such as acetaminophen, ibuprofen, or aspirin are often helpful when your migraine is mild. Be aware that:

  • Taking medicines more than 3 days a week may lead to rebound headaches. These are headaches that keep coming back due to overuse of pain medicine.
  • Taking too much acetaminophen can damage your liver.
  • Too much ibuprofen or aspirin can irritate your stomach or kidneys.

If these treatments do not help, ask your provider about prescription medicines. These include nasal sprays, suppositories, or injections. The group of medicines most often used is called triptans.

Some migraine medicines narrow the blood vessels. If you are at risk for having a heart attack or have heart disease, talk with your provider before using these medicines. Some migraine medicines should not be used by pregnant women. Talk with your provider about which medicine is right for you if you are pregnant or planning to become pregnant.

Other medicines treat symptoms of migraine, such as nausea and vomiting. They may be used alone or along with the other drugs that treat the migraine itself.

Feverfew is an herb for migraines. It can be effective for some people. Before using feverfew, make sure your provider approves. Herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.

How a Migraine Happens

Theories about migraine pain

Older theories about migraines suggested that symptoms were possibly due to fluctuations in blood flow to the brain. Now many headache researchers realize that changes in blood flow and blood vessels don’t initiate the pain, but may contribute to it.

Current thinking regarding migraine pain has moved more toward the source of the problem, as improved technology and research have paved the way for a better understanding. Today, it is widely understood that chemical compounds and hormones, such as serotonin and estrogen, often play a role in pain sensitivity for migraine sufferers.

One aspect of migraine pain theory explains that migraine pain happens due to waves of activity by groups of excitable brain cells. These trigger chemicals, such as serotonin, to narrow blood vessels. Serotonin is a chemical necessary for communication between nerve cells. It can cause narrowing of blood vessels throughout the body.

When serotonin or estrogen levels change, the result for some is a migraine. Serotonin levels may affect both sexes, while fluctuating estrogen levels affect women only.

For women, estrogen levels naturally vary over the life cycle, with increases during fertile years and decreases afterwards. Women of childbearing age also experience monthly changes in estrogen levels. Migraines in women are often associated with these fluctuating hormone levels and may explain why women are more likely to have migraines than men.

Some research suggests that when estrogen levels rise and then fall, contractions in blood vessels may be set off. This leads to throbbing pain. Other data suggest that lower levels of estrogen make facial and scalp nerves more sensitive to pain.

What commonly triggers a migraine?

People who get migraines may be able to identify triggers that seem to kick off the symptoms. Some possible triggers include the following:

  • Stress and other emotions
  • Biological and environmental conditions, such as hormonal shifts or exposure to light or smells
  • Fatigue and changes in one’s sleep pattern
  • Glaring or flickering lights
  • Weather changes
  • Certain foods and drinks

The American Headache Society suggests documenting triggers in a headache diary. Taking this information with you when you visit your healthcare provider helps him or her to identify headache management strategies.

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:

“The present review suggests that migraine may be a risk factor for structural changes in the brain.

In comparison with non-migraine controls, migraineurs have more WMAs (white matter abnormalities), ILLs (infarct-like lesions), and volumetric changes in GM (grey matter) and WM (white matter) regions.”

A common disorder with long-term effects

According to the Migraine Research Foundation, migraine ranks in the top 20 for the world’s most disabling medical illnesses. Every 10 seconds, a person in the US visits the emergency room as a result of a headache or migraine.

For a disorder that is so common, the researchers stress that it is important to understand the long-term effects a migraine can have on the brain.

They add that guidelines from the American Academy of Neurology and the US Headache Consortium suggest that people with migraines who have normal neurological examinations do not need routine MRI scans.

“Only patients with atypical headache, a recent change in headache pattern, other symptoms (such as seizures), or focal neurologic symptoms or signs are recommended for MRI of the brain,” the researchers say.

“Patients with WMAs can be reassured. Patients with ILLs should be evaluated for stroke risk factors. Volumetric MRI remains a research tool.”

Dr. Messoud Ashina of the University of Copenhagen and lead study author says that further research is needed to fully determine the link between migraine and long-term brain structure.

“Migraine affects about 10 to 15% of the general population and can cause a substantial personal, occupational and social burden,” he adds.

“We hope that through more study, we can clarify the association of brain structure changes to attack frequency and length of the disease. We also want to find out how these lesions may influence brain function.”

This year, a study from italian researchers also found that migraine patients have brain abnormalities, compared with those who do not have the disorder.

Other recent research from the University of Pennsylvania suggests that the cause of migraines could be due to the structure of brain arteries that protect the supply of blood to the brain.

This Is Your Body on a Migraine

Migraine triggers range from environmental to hormonal to behavioral. Here are some common culprits, plus ways to avoid them.

Alcohol

Red wine is a well-known migraine trigger, but other alcoholic drinks can also cause a migraine.

Weather changes

Even small decreases in barometric pressure can cause a migraine, according to a study published in December 2015 in the journal SpringerPlus. If weather is a trigger for you, ask your doctor if you should take medication at the first sign of change in the atmosphere.

Bright light

It’s believed that light “turns on” certain cells that can trigger pain. Wearing sunglasses indoors can increase your eyes’ sensitivity to light, so save your specs for outside. You can also try wearing FL-41 boysenberry-tinted lenses, which have been shown to minimize light’s triggering effect.

Caffeine

Both caffeine itself and caffeine withdrawal can trigger a migraine. Try not to vary your regular coffee routine, even on weekends.

Cheese and processed meats

Some people are sensitive to tyramine, a product of broken-down proteins in aged foods. You may want to limit your intake of these and other foods that are high in tyramine, including soy sauce, red wine, kimchi, smoked fish, caviar, and beer.

Computers

Poor ergonomics and the screen’s bright light can combine to trigger a migraine. Practice good posture and take frequent stretch breaks.

Dehydration

Not consuming enough liquids causes blood volume to drop, decreasing blood flow to the brain; the loss of electrolytes might also be a culprit. Aim to drink at least eight 8-ounce glasses of water a day.

Hormonal changes

Migraines disproportionately affect women, which could be partly due to the fluctuation in estrogen levels. Talk to your doctor about whether you should take NSAIDs a few days before menstruation.

Hotter temperatures

The risk of migraine jumps almost 8 percent for every 9-degree Fahrenheit rise in temperature, according to a study published in March 2009 in the journal Neurology. Stay hydrated and consider avoiding outdoor activities during sudden temperature increases.

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