Migraine Headache FAQs (cont.)

1. A Visual Guide to Migraine Headaches Slideshow
2. Surprising Migraine Triggers Slideshow
3. Take the Migraines Quiz

No one fully understands the exact cause(s) of migraine headaches. Many experts think that a migraine begins with abnormal brainstem (a part of the brain) activity that leads to spasm (rapid contraction) of blood vessels in the cerebrum (main part of the brain) and dura (the covering of the brain). The first wave of spasm decreases blood supply, which causes the aura that some people experience. After the first spasm, the same arteries become abnormally relaxed, which increases blood flow and gives rise to migraine headache pain.

Certain chemicals normally found in the brain (namely, dopamine and serotonin) may be involved in causing migraines. These chemicals are called neurotransmitters because they transmit signals within the brain. Neurotransmitters can cause blood vessels to act in unusual ways if they are present in abnormal amounts or if the blood vessels are particularly sensitive to them.

Various triggers are thought to bring about migraine in people who have a natural tendency for having migraine headaches. Different people may have different triggers.

• Certain foods, especially chocolate, cheese, nuts, alcohol, and monosodium glutamate (MSG) can trigger migraines. (MSG is a food enhancer used in many foods, including Chinese food.)
• Missing a meal may bring on a headache.
• Stress and tension are also risk factors. People often have migraines during times of increased emotional or physical stress.
• Birth control pills are a common trigger. Women may have migraines at the end of the pill cycle as the estrogen component of the pill is stopped. This is called an estrogen-withdrawal headache.

Symptoms are different for different people and are sometimes different from migraine to migraine. The following 5 phases have been noted:

• Prodrome (a period of warning symptoms): Many symptoms can precede a migraine headache. These include changes in mood (happiness, irritability, sadness) or sensation (funny tastes or smells). Many people experience fatigue and muscle tension before a migraine headache.
• Visual or auditory disturbances (auras): Some people develop scotomas (blind spots), see geometric patterns, experience hemianopsia (vision on only one side), or, less commonly, have auditory (hearing) hallucinations.
• Headache: Although migraine pain usually appears on one side of the head, some migraineurs have them on both sides. Throbbing pain may occur. Many migraineurs feel nauseated, and many vomit. Many people become photophobic (sensitive to light) and phonophobic (sensitive to sound). This phase may last 4-72 hours.
• Headache termination: Even if untreated, the pain usually goes away with sleep.
• Postdrome: Migraineurs may not feel well for some time after the migraine stops. They might not be able to eat right away. Problems with thinking and tiredness are common.

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