headache & migraine center

What Happens in the Brain During a Migraine?

Reviewed on 6/7/2022
Neurologist looking at a brain scan of a migraine sufferer
It is believed that migraine pain occurs when waves of activity by groups of excitable brain cells trigger chemicals, such as serotonin, to narrow blood vessels throughout the body. For some people, when serotonin or estrogen levels change, it can result in a migraine.

A migraine headache is a neurological disorder that causes severe head pain along with sensitivity to light, sound, or smells.

It was previously believed that symptoms of migraine were due to fluctuations in blood flow to the brain. It is now known that changes in blood flow and blood vessels don't trigger migraine pain, but they may contribute to it.

Chemical compounds and hormones, such as serotonin and estrogen, play a role in pain sensitivity for migraine sufferers.

It is believed that migraine pain occurs when waves of activity by groups of excitable brain cells trigger chemicals, such as serotonin, to narrow blood vessels throughout the body.

  • For some people, when serotonin or estrogen levels change, it can result in a migraine. Fluctuating serotonin levels can affect anyone but changes in estrogen levels only affect females, which may explain why women are more likely to have migraines than men.
  • Some research suggests when estrogen levels fluctuate, it may set off contractions in blood vessels that can lead to throbbing pain. Other research suggests lower levels of estrogen cause increased sensitivity to pain in facial and scalp nerves.

What Are Symptoms of Migraines?

Migraine symptoms usually occur in five phases: 

  • Prodrome: warnings before a migraine
    • Fatigue
    • Subtle changes in sensations such as an unusual taste or smell
    • Mood changes
    • Muscle tension 
  • Aura: visual disturbances that precede the headache phase
    • Blind spots (scotomas)
    • Geometric patterns or flashing, colorful lights
    • Loss of vision on one side (hemianopsia)
  • Headache
    • May last 4-72 hours
    • Usually occurs on one side of the head, but may occur on both sides
    • Throbbing pain 
    • Nausea
    • Vomiting
    • Sensitivity to sound (phonophobia)
    • Sensitivity to light (photophobia) 
  • Headache termination
    • Pain usually goes away with sleep, even if the migraine is not treated
  • Postdrome: other signs can linger after the pain goes away
    • Fatigue
    • Inability to eat
    • Difficulty concentrating

What Is the Treatment for Migraines?

Treatment for migraine headaches includes: 

  • Non-medical treatments
    • Ice 
    • Heat
    • Getting adequate hydration
    • Deep breathing
    • Darkened room/covering your eyes
    • Rest
    • Massage
    • Biofeedback
  • Pain relievers
  • Other medications
    • Triptans
    • Trigger point injections
    • OnabotulinumtoxinA (Botox)
  • Anti-nausea medications (antiemetics)
  • Selective serotonin 1F receptor agonist
  • Calcitonin-gene related peptide (CGRP) antagonists
  • Ergotamine preparations
  • Neuromodulation
  • Peripheral nerve blocks

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Reviewed on 6/7/2022
References
Image Source: iStock Images

https://americanmigrainefoundation.org/

https://www.uptodate.com/contents/migraines-in-adults-beyond-the-basics?search=migraine&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3

https://www.uptodate.com/contents/acute-treatment-of-migraine-in-adults?search=headache%20treatment&source=search_result&selectedTitle=7~150&usage_type=default&display_rank=7

https://www.migraineagain.com/how-to-get-rid-of-a-migraine-fast/

https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/how-a-migraine-happens