Migraine Triggers and Helpful Treatments

Migraines affect an estimated 38 million Americans. They can strike both young and old, but a majority of sufferers are women, and/or between the ages of 35 and 55.

Worldwide, as many as 1 billion people are affected, making migraine the third most prevalent illness in the world. Yet, despite its prevalence, researchers still struggle to understand exactly how and why migraines occur. Adding to the complexity, there are several different types of migraines, including:

✓ Cluster

✓ Chronic

✓ Episodic

✓ Basilar

✓ Hemiplegic

✓ Retinal

✓ Abdominal

✓ Optical

✓ With aura

✓ Without aura

✓ Status migrainous

✓ Transformed

✓ Menstrual

✓ Vestibular


What Sets Migraine Apart From Other Headaches?

Migraine attacks are typically recurring, of moderate to severe intensity, many times occurring only on one side of your head.

Along with throbbing, piercing or "burning" pain, other common symptoms include nausea, visual disturbances, dizziness, numbness in your extremities or face, and extreme sensitivity to light, sound, smell and touch.

An attack may last from a couple of hours to as long as three days, often requiring bed rest in complete darkness and silence.

Generally speaking, migraine is thought to be a disorder of your central nervous system, most likely originating in your brain stem. While most brain regions do not register or transmit pain signals, the trigeminal nerve network does.

Pain is relayed through the trigeminal network to an area in your brain stem called the trigeminal nucleus. From there, it is conveyed to the sensory cortex in your brain that is involved in awareness of pain and other senses. However, what initially activates your trigeminal nerve to set off your migraine is still under debate.

One hypothesis is that a wave of neurotransmitters racing across your cortex can directly stimulate your trigeminal nerve, setting off a chain reaction that ends in the transmitting of pain signals.

In all likelihood, there are several mechanisms at play. We know, for example, that migraine is more common in women than men, and this has been linked to hormonal influences.

What Does a Migraine Feel Like?

A migraine is more than just a bad headache. In a recent Greatist article, migraine sufferers were asked to describe their pain. Here are some of their answers:

"My head feels like it's in a vise." Triggers often include stress, weather changes, physical exertion, lack of sleep and/or eating the wrong foods. Artificial sweeteners such as aspartame are also known to commonly trigger migraine.

Doctors suggest keeping a food diary to track the emergence of symptoms to pin down certain food triggers. You could do the same for weather and stress if you believe such factors may play a role.

It's "like when a light fixture starts to go out." This patient is describing the effects of ocular migraine, the onset of which often starts with flickering or flashing light phenomena, or zigzagging lines in the peripheral vision, which can eventually take over the entire field of vision.

These visual disturbances are referred to as an "aura." Other common auras include blind spots, blurry, wavy or kaleidoscope vision. Auras can also involve other senses.

For example, you may experience paresthesia (tingling or numbness), aphasia (trouble speaking), auditory hallucinations or smelling something that isn't there.

Approximately one-quarter of all migraines are accompanied by aura, which is thought to be caused by a chemical or electrical wave in the brain region that processes sensory signals.

"It's like I've been staring at the sun." Oftentimes, the entire head, from the neck up, can feel overworked, "battered and bruised," or like your brain has been pounded with a hammer. Post-symptoms can also include a stiff neck for up to a day after the headache ends.

"Like I'm on a ship during a storm." Nausea and a feeling of being in motion is also common.

Some Migraines May Indicate a More Serious Blood Vessel Problem

One long-held theory was that a migraine is caused by vascular changes in your brain, from initial blood vessel constriction and a drop in blood flow, followed by dilation and stretching of blood vessels, which activates pain-signaling neurons.

Newer studies have negated this theory, however, as researchers determined migraines are not actually preceded by constriction and decrease in blood flow, but rather by a blood flow increase of nearly 300 percent.

Despite that, circulation appears normal, or even slightly reduced, once the attack is in full swing. The question remains: Why? One small observational study found that migraineurs tend to have a different blood vessel structure in their brains compared to those who do not get migraines.

Using magnetic resonance angiography, the researchers examined the structure of blood vessels and the changes in cerebral blood flow, focusing on a system of arteries that deliver blood to the brain called "circle of Willis."

They found that an incomplete circle of Willis was significantly more common in those who get migraines, with or without aura, compared to the control group (73 percent and 67 percent versus 51 percent, respectively).

As a result, compared to those with a complete circle of Willis, those with an incomplete circle had greater asymmetry in hemispheric cerebral blood flow. According to one of the authors of the study, Dr. John Detre, a professor of neurology and radiology:

"Abnormalities in both the circle of Willis and blood flow were most prominent in the back of the brain, where the visual cortex is located. This may help explain why the most common migraine auras consist of visual symptoms such as seeing distortions, spots or wavy lines."

Interestingly, recent research suggests some migraines — primarily migraines without aura — may even be caused by a tear in your neck artery (arterial dissection), which raises your risk of stroke.

Compared to people who had migraine with aura, those without aura were 1.7 times more likely to have an arterial tear. Arterial dissection and stroke was also more likely in men and those under the age of 39. Overall, your probability of having this problem is very low, but it may be worth getting it checked out if you fall into a high-risk category.