Migraines are more than just headaches.
They’re pre-headaches, post-headaches, sensitivities, nausea, fatigue and can even bring on food
cravings.
But most of all they are painful and frustrating for those who suffer from them.
For years they were misunderstood, but now we know it comes down to two main things,
your genes and your brain.
To really understand why migraines are so much more than headaches, first we have to
know what headaches are.
My name is Rashmi Halker Singh.
I'm a fellowship trained board, certified headache neurologist here at Mayo Clinic.
I'm also the headache fellowship program director here at Mayo Clinic in Arizona.
There's actually a huge book called the International Classification of Headache Disorders, which
has maybe 300 different diagnoses of different types of headache.
So when we say headache, all we mean by that is pain above the neck.
And yes, migraines are pains above the neck so they are headaches, but again, suffering
from a migraine attack is much more than just having a headache.
So migraine is actually a problem of brain dysfunction.
It's a genetic disorder that is very common.
So by diagnostic criteria you need to have recurrent headaches, whether it happened infrequently
or frequently, lasting 4 to 72 hours without medication.
And then in addition to that, the pain has to have at least two of the following four
symptoms.
The pain needs to be moderate or severe in intensity, and more intense on one side of the
head, throbs or pulses, and gets worse with activity.
But to stay on theme, a migraine is more than just experiencing pain.
You also have to have either a sensitivity to light or sound or nausea.
In fact, migraine attacks come in four stages with a painful headache being just one of
them.
Before the headache stage, some people, about one fourth of migraine sufferers, will experience
what is called an aura.
When someone has a visual aura, they will see light spots, jagged lines, things like that
in their vision.
Sometimes people will have a sensory aura as well in which they'll have like pins and
needles, tingling sensation up one limb.
And again, this typically lasts 5 to 60 minutes and is typically followed pretty much
immediately by the headache.
But before that, migraine sufferers will experience a prodrome, the first stage in the migraine
attack.
This stage can last an entire day and includes symptoms like increased yawning, trouble concentrating,
increased urination and even cravings for things like chocolate.
Finally after the headache phase has ended a lot of my patients will tell me,
you know, Doc, I have this like headache hangover.
And that's what we would call a Migraine postdrome.
This is not fully understood exactly just yet, but we think it's probably a recovery
phase within the brain.
And they might feel just really tired or fatigued or still have trouble concentrating.
Just kind of still recovering from the whole episode.
So when we think about Migraine, those would be the four phases.
Most of what we know has to do with the pain phase.
And what we know is not a lot.
It was once thought that migraines were caused by constriction and dilation of the blood
vessels that supply blood to the brain...
But we know that's not the case anymore.
We know that Migraine is actually a problem of brain dysfunction.
It originates from the brain itself.
And it's a problem of pain processing.
And there's a whole host of different components involved in this whole pain processing abnormality.
And because of that, there's lots of different genes involved as well.
A few genes have been identified, but we're still learning more about this.
So we know that genes are a part of migraines, you can be genetically predisposed to have
these painful headaches.
And researchers have identified the part of the brain involved with migraines and the
lingering pain associated with them.
Really a lot of our emphasis on migraine has to do with something called the trigeminal
nucleus Caudalis, which is, something in the brainstem that's really important for pain
processing.
And when a migraine attack occurs, there are what we'd call trigeminal
afferents or nerve endings that also become activated and they will release CGRP.
CGRP stands for Calcitonin Gene-Related Peptide, and when released helps the pain continue,
resulting in the long-drawn out painful migraine headache.
Now, how this exactly works is still unknown, but the correlation between CGRP's and migraine
headaches has actually led to some better treatment options for patients.
For the first time in history, we have preventive treatments designed to treat migraine based
on what we know as to what happens in the brain during a migraine attack.
And a lot of research has shown us that if you, you know, infused CGRP in a patient who's
susceptible to having Migraines, you can trigger a migraine attack.
And if you block CGRP, that reduction in CGRP levels correlates with migraine improvement.
So based on that information, we've been able to develop some new medications.
So you know, this is a really exciting time in the migraine world.