Causes and Treatments of Migraine and Related Headaches
Robert Cowan, MD
Soma Sahai, MD
Joseph Carcione Jr, DO, MBA
Francisco Talavera, PharmD, PhD
James H Halsey, MD
Migraine Headaches Introduction
Headaches are very common; in fact, almost everyone will have a headache at some point. Headaches have been written about since the time of the Babylonians. Migraine headaches are even discussed in the Bible. Some very famous historical figures (for example, Napoleon Bonaparte) suffered from severe headaches.
Experts do not agree about what causes headaches, but they agree that more studies are needed. Headaches are hard to study because of the following reasons:
Although headaches might rarely be due to infections or diseases, most are probably the result of an inborn protective mechanism responding to an external environmental stress. Headaches can be divided into 2 broad categories: primary headaches and secondary headaches. Primary headaches are not caused by problems with a person's internal structure or organs or by bacteria, viruses, or other organisms. Migraine, cluster, tension, and rebound headaches are types of primary headache. Secondary headaches are those caused by an underlying structural or organic disease.
Several observations support this idea. When exposed to very high or low temperatures, people sometimes develop a migrainelike headache. (Migraine headaches are sometimes called vascular headaches. Vascular means having to do with the blood vessels.) These headaches can also suddenly arise in some people when they do not get enough sleep or food.
Common triggers of migraine headaches include heat, stress, and lack of sleep or food. Not every headache sufferer is sensitive to these triggers, but virtually all persons with migraine headaches (called migraineurs) have some environmental trigger. About 70% of migraineurs have a first-degree relative (parent, brother, sister, or child) with a history of migraine. People with an inherited tendency for headaches may respond more easily than others to these external stress factors. Some experts have therefore thought that headache is an adaptive and developed response. Most primary headaches slowly develop over minutes to hours. The pain experienced in headache is transmitted by the slowest of all unmyelinated nerves. Unmyelinated nerves lack a myelin sheath, or covering, and send impulses slowly.
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