A migraine headache is a form of vascular headache. Migraine headache is caused by a combination of vasodilatation (enlargement of blood vessels) and the release of chemicals from nerve fibers that coil around the blood vessels. During a migraine attack, the temporal artery enlarges. (The temporal artery is an artery that lies on the outside of the skull just under the skin of the temple.) Enlargement of the temporal artery stretches the nerves that coil around the artery and causes the nerves to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the artery magnifies the pain.
Migraine attacks commonly activate the sympathetic nervous system in the body. The sympathetic nervous system is often thought of as the part of the nervous system that controls primitive responses to stress and pain, the so-called “fight or flight” response. The increased sympathetic nervous activity in the intestine causes nausea, vomiting, and diarrhea. Sympathetic activity also delays emptying of the stomach into the small intestine and thereby prevents oral medications from entering the intestine and being absorbed. The impaired absorption of oral medications is a common reason for the ineffectiveness of medications taken to treat migraine headaches. The increased sympathetic activity also decreases the circulation of blood, and this leads to pallor of the skin as well as cold hands and feet. The increased sympathetic activity also contributes to the sensitivity to light and sound sensitivity as well as blurred vision.
What causes migraine headaches?
Migraine headaches seem to be caused in part by changes in the level of a body chemical called serotonin. Serotonin plays many roles in the body, and it can have an effect on the blood vessels. When serotonin levels are high, blood vessels constrict (shrink). When serotonin levels fall, the blood vessels dilate (swell). This swelling can cause pain or other problems.
Many things can affect the level of serotonin in your body, including your level of blood sugar, certain foods and changes in your estrogen level if you’re a woman.
What causes migraines?
Experts are not sure what causes migraines. It may have something to do with the blood vessels in your brain.
Migraines run in families, but it is not clear why some people get migraines and others do not.
Different types of migraine headaches
Common migraine accounts for 80% of migraines. There is no “aura” before a common migraine.
People with classic migraines experience an aura before their headaches. Most often, an aura is a visual disturbance (outlines of lights or jagged light images). Classic migraines are usually much more severe than common migraines.
Status migrainosus is a migraine that does not go away by itself.
Possible symptoms of migraines
Intense throbbing or dull aching pain on one side of your head or both sides.
Nausea or vomiting
Changes in how you see, including blurred vision or blind spots
Being bothered by light, noise or odors
Feeling tired and/or confused
Feeling cold or sweaty
Stiff or tender neck
How migraine can be treated?
You can usually manage your migraines. First try an over-the-counter pain medicine, such as ibuprofen or naproxen. Brand names include Advil, Motrin, and Aleve.
If over-the-counter medicine does not work, your doctor can prescribe stronger medicine that stops the migraine as it is starting. You may not be able to use some medicines if you are pregnant or have other health problems, such as heart problems or high blood pressure.
When you feel a migraine coming on:
- Stop what you are doing, and take your medicine. Do not wait for the migraine to get worse. Take your medicine exactly as your doctor told you to.
- Take it easy. Rest in a quiet, dark room. Close your eyes, and try to relax or go to sleep. Do not watch TV or read. Put a cold pack or cool cloth on the painful area.
If the first treatment you try does not work, try something else. It may take time to find what works best for you.
Some people also use other kinds of treatments, such as acupuncture. These may help reduce the pain or the number of migraines you have. But experts need more research to see if they really work.2
Be careful when you use your migraine medicines. Taking them too often can cause you to get another headache when you stop taking the medicine. This is called a rebound headache. If you find you are taking your medicines very often, talk to your doctor before a problem starts.
Can I reduce how often I have migraines?
You may be able to reduce how often you have migraines by staying away from things that cause them. These are called “triggers.” Common triggers include chocolate, red wine, cheese, MSG, strong odors, not eating, and poor sleep habits. It may be helpful for you to track and write down your triggers. You may be able to avoid the trigger and more migraines.
If you have migraines often, your doctor may prescribe medicine that helps prevent them.