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What causes migraine headaches?

Asked on: May 28, 2025, 8:40 pm | Views: 27

Migraine Headaches: An Overview

Migraine headaches are more than just regular headaches; they are a neurological condition characterized by intense throbbing pain or a pulsing sensation, usually on one side of the head. They can be accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraines can significantly interfere with daily activities and can last for hours or even days if left untreated. The exact cause isn't fully understood, but it's believed to involve a complex interplay of genetic and environmental factors.

Symptoms

Migraine symptoms can vary from person to person and even from one migraine attack to another. They are often categorized into four phases, although not everyone experiences all phases:

  • Prodrome (Premonitory Phase): This phase occurs one or two days before the actual headache. Symptoms can include:

    • Constipation
    • Mood changes, from depression to euphoria
    • Food cravings
    • Neck stiffness
    • Increased urination
    • Fluid retention
    • Frequent yawning

  • Aura: This phase occurs before or during the headache. Auras are reversible neurological symptoms. Most people don't experience aura. Symptoms can include:

    • Visual phenomena, such as seeing bright spots, flashing lights, or zigzag patterns
    • Vision loss
    • Pins and needles sensations in an arm or leg
    • Speech or language disturbances
    • Motor weakness

  • Headache Phase (Attack Phase): This is the main phase of a migraine. Symptoms can include:

    • Throbbing or pulsing pain, usually on one side of the head
    • Sensitivity to light (photophobia)
    • Sensitivity to sound (phonophobia)
    • Nausea
    • Vomiting
    • Blurred vision
    • Lightheadedness, sometimes followed by fainting

  • Postdrome: This phase occurs after the headache. Symptoms can include:

    • Feeling drained and exhausted
    • Confusion
    • Mood changes
    • Difficulty concentrating
    • Some people feel elated.

Less common symptoms during any of these phases can include:

  • Vertigo (a sensation of spinning)
  • Cognitive difficulties
  • Nasal congestion
  • Scalp tenderness

Causes

The exact causes of migraine headaches are complex and not fully understood. However, several factors are thought to contribute:

  • Genetics: Migraines tend to run in families, suggesting a genetic component.

  • Brain Chemistry: Imbalances in brain chemicals, including serotonin and calcitonin gene-related peptide (CGRP), are believed to play a role. Serotonin helps regulate pain and mood. CGRP is a protein that causes blood vessels in the brain to dilate.

  • Environmental Factors: Several triggers can set off a migraine in susceptible individuals. These include:

    • Foods and drinks: Aged cheeses, salty and processed foods, alcohol (especially red wine), and caffeine (too much or withdrawal)
    • Food additives: Aspartame and monosodium glutamate (MSG)
    • Stress: Stress is a common migraine trigger.
    • Sensory stimuli: Bright or flashing lights, loud noises, strong smells (perfumes, smoke)
    • Changes in sleep patterns: Missing sleep, sleeping too much, or jet lag
    • Weather changes: Changes in barometric pressure, temperature, or humidity
    • Hormonal changes in women: Fluctuations in estrogen levels, such as before or during menstruation, pregnancy, or menopause
    • Medications: Some medications, such as oral contraceptives and vasodilators, can trigger migraines.
    • Skipping meals: Low blood sugar can trigger migraines.
    • Dehydration: Not drinking enough fluids.

Diagnosis

There isn't a specific test to definitively diagnose migraines. Diagnosis is based on a medical history, a neurological examination, and a detailed description of your symptoms. Your doctor will ask about the frequency, severity, and characteristics of your headaches, as well as any associated symptoms.

In some cases, your doctor may recommend imaging tests, such as:

  • MRI (Magnetic Resonance Imaging): To rule out other conditions, such as tumors, strokes, or infections.
  • CT (Computed Tomography) scan: In emergency situations to assess for acute brain issues.
  • Blood tests: To rule out other underlying medical conditions.

It's important to note that these tests are typically only ordered if there are unusual symptoms or concerns about a secondary headache disorder (a headache caused by another medical condition).

Treatment Options

Migraine treatment aims to relieve symptoms and prevent future attacks. Treatment options include:

  • Pain-relieving Medications: These medications are most effective when taken at the first sign of a migraine.

    • Over-the-counter pain relievers: Aspirin, ibuprofen, naproxen, acetaminophen.
    • Triptans: These drugs block pain pathways in the brain (e.g., sumatriptan, rizatriptan).
    • Ditans: These medications work similarly to triptans but may be suitable for people with certain cardiovascular conditions.
    • Gepants: CGRP receptor antagonists, which block the activity of CGRP (e.g., ubrogepant, rimegepant).
    • Ergotamines: These medications are less commonly used due to potential side effects.

  • Preventive Medications: These medications are taken regularly to reduce the frequency, severity, and duration of migraines.

    • Beta-blockers: Propranolol, metoprolol
    • Antidepressants: Amitriptyline, venlafaxine
    • Anti-seizure medications: Topiramate, valproate
    • CGRP monoclonal antibodies: Erenumab, fremanezumab, galcanezumab
    • Botulinum toxin (Botox): Injected around the head and neck to prevent migraines in adults with chronic migraine (15 or more headache days a month).

  • Other Therapies:

    • Biofeedback: A technique that teaches you to control certain bodily functions, such as muscle tension and heart rate.
    • Acupuncture: A traditional Chinese medicine technique that involves inserting thin needles into specific points on the body.
    • Cognitive Behavioral Therapy (CBT): A type of therapy that helps you identify and change negative thought patterns and behaviors that may be contributing to your migraines.
    • Neuromodulation devices: These devices use electrical or magnetic stimulation to modulate nerve activity and reduce migraine pain. Examples include transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS).

  • Lifestyle Changes:

    • Stress management: Techniques such as yoga, meditation, and deep breathing exercises.
    • Regular sleep schedule: Go to bed and wake up at the same time each day, even on weekends.
    • Healthy diet: Eat regular meals and avoid skipping meals.
    • Hydration: Drink plenty of water throughout the day.
    • Regular exercise: Engage in regular physical activity, such as walking, swimming, or cycling.
    • Avoid known triggers: Keep a headache diary to identify and avoid your personal migraine triggers.

Prevention

Preventing migraines involves identifying and avoiding triggers, adopting healthy lifestyle habits, and, in some cases, taking preventive medications. Key strategies include:

  • Identify and avoid triggers: Keep a headache diary to track your headaches and identify potential triggers, such as foods, drinks, stress, or changes in sleep patterns.
  • Manage stress: Practice relaxation techniques, such as yoga, meditation, or deep breathing exercises.
  • Maintain a regular sleep schedule: Go to bed and wake up at the same time each day, even on weekends.
  • Eat regular meals: Avoid skipping meals and eat a healthy diet.
  • Stay hydrated: Drink plenty of water throughout the day.
  • Exercise regularly: Engage in regular physical activity, such as walking, swimming, or cycling.
  • Consider preventive medications: If you have frequent or severe migraines, talk to your doctor about preventive medications.

When to See a Doctor

It's essential to see a doctor if you experience any of the following:

  • Sudden, severe headache (thunderclap headache): This could be a sign of a serious medical condition, such as a brain aneurysm.
  • Headache with fever, stiff neck, rash, confusion, seizures, double vision, weakness, numbness, or difficulty speaking: These symptoms could indicate meningitis, encephalitis, or another serious infection.
  • Headache after a head injury: This could be a sign of a concussion or other head injury.
  • Chronic headaches that are getting worse or more frequent: This could indicate an underlying medical condition that needs to be addressed.
  • Headaches that interfere with your daily activities: If your headaches are significantly impacting your quality of life, it's important to seek medical help.
  • New headache symptoms: If you experience new or unusual headache symptoms, it's important to see a doctor to rule out any underlying medical conditions.

Complications

While migraines are not typically life-threatening, they can lead to several complications if left untreated or poorly managed:

  • Chronic Migraine: Migraine headaches occurring on 15 or more days per month for more than three months.
  • Status Migrainosus: A migraine attack that lasts longer than 72 hours.
  • Migrainous Infarction: A stroke that occurs during a migraine attack. (Rare)
  • Persistent Aura without Infarction: Aura symptoms that persist for more than a week without evidence of a stroke. (Rare)
  • Depression and Anxiety: People with migraines are at a higher risk of developing depression and anxiety.
  • Medication-Overuse Headache: Headaches caused by overuse of pain-relieving medications.

Medical Disclaimer: The information provided here is for general informational purposes only, and does not constitute medical advice. It is AI-generated and may contain inaccuracies. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.

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