Movement, light, and sound often make symptoms worse, and classic painkillers are of little help. To treat migraines effectively, it is important to know where the migraine is coming from. Find out more about the causes of migraines and the current state of science here.
The forms of migraines
In contrast to the usual tension headache, migraines have many faces. For some people it only occurs once or twice a year. Others suffer from migraine attacks several times a month or even every day.
In addition to the severe, attack-like pain, there are other symptoms such as nausea, sensitivity to light and noise. The body sometimes also reacts to strong smells and movement. Occasionally, there are visual disturbances called a migraine aura. A migraine with aura usually announces itself before the headache, for example with numbness and visual disturbances.
The migraine forces most sufferers to interrupt their daily routine and to wait in the dark and quiet until the painful attack passes.
How to Get Migraines: Causes
There are many situations and circumstances that are considered Migraine Triggers come into question. These so-called triggers can have internal and external causes. Typical external triggers are smoky rooms, alcohol, flickering light, noise, strong smells or weather changes. Foods such as cheese, citrus fruits or chocolate are also often mentioned in connection with a migraine attack, but have not yet been proven by scientists to be the direct trigger of the attack. Internal causes of a migraine attack, on the other hand, are often an irregular sleep-wake rhythm and daily routine, hypoglycaemia, stress, strong emotions or hormonal changes due to the pill, for example. Anyone who suffers from recurring migraine attacks should try to avoid possible triggers. A pain diary can help identify the individual causes of migraines.
Most migraineurs also have close relatives who also suffer from migraines. Therefore, it is very likely that hereditary factors also play an important role in how to get migraines.
Where does the migraine come from: causes in the brain
Since not everyone suffers from migraines, there must be more fundamental causes of migraines in addition to genetic factors and triggers. So where does the migraine come from? In the past, a malfunction of the blood vessels in the brain, a short-term narrowing and subsequent sudden expansion of the blood vessels were thought to be the cause of migraines. In the meantime, however, research assumes that migraines are caused by a disturbance in the equilibrium of pain centers in the brain stem. This particular area in the brain stem (periaqueductal gray), which is called the migraine center, is sensitive to all incoming stimuli. The part of the brainstem in migraineurs has more blood supply and causes overactivity of the nerve cells as soon as a migraine attack begins.
Another important connection for the development of a migraine is the interface between the trigeminal nerve (facial nerve) and the blood vessels in the brain. Fine branches of the nerve are in contact with the blood vessels. If the nerve cells in the brain stem become overactive, the trigeminal nerve reports this to the brain. As a result, the brain releases messenger substances (in this case: vasoactive neuropeptides), the blood vessels expand, become more permeable for fluid and finally a kind of inflammation of the brain tissue occurs. This inflammation is known as neurogenic inflammation. It is responsible for the impulses of pain known as the pulsating migraine pain. The most important messenger substance for migraine research is the protein CGRP (Calcitonin gene related peptide). During a persistent migraine, the CGRP level is significantly increased and decreases again after the attack.
Migraines and CGRP antagonists
The most effective treatment for migraine sufferers starts directly with the overstimulated trigeminal nerve and the protein CGRP. So far, the CGRP for migraines has mainly been treated with certain painkillers, the triptans. They inhibit the release of the CGRP. However, since these have a vasoconstricting effect, they must not be used in patients with circulatory disorders and during pregnancy or breastfeeding. Cases of ineffectiveness and hypersensitivity of triptans also require alternative and equally effective treatment. The use of CGRP antagonists is now being used here. These only act on the CGRP receptors and block them. Migraine treatment can thereby prevent undesirable side effects such as vasoconstriction. Due to the blocked receptors, the CGRP can no longer dock when a migraine attack begins. As a result, no inflammation occurs in the brain and existing inflammatory processes subside.
As stressful as migraine attacks are – with the right treatment, many sufferers can deal with the symptoms well. Anyone who changes their everyday life and tries to avoid possible triggers can already contribute a lot to migraine prophylaxis. In the case of recurring attacks and greater stress, treatment by a family doctor or neurologist is possible.