The path of pain.
Imagery technology has allowed scientists to see a picture of the human brain while it experiences migraine. Even though it still cannot provide complete details in every angle, the available information already provides us with a clear understanding about how migraine occurs.
- Stimuli
Any stimulus can trigger migraine. For most people, however, the triggers come in the form of a combination of many factors gradually occurring together over time to become individualized triggers. These factors can be influenced by internal factors like hormones, stress and lack of sleep and external factors like changes in weather, food allergies, etc.
- Control Center
Migraine triggers gather together at the hypothalamus, which is the part of the brain responsible for regulating the secretion of many types of hormones that regulate sleep and hunger, and the symptoms associated with migraine such as nausea and vomiting are caused by signals sent from the hypothalamus to the nervous system, which leads to migraine.
- Source of Migraine
The hypothalamus sends signals to the upper part of the brain stem where the trigeminal nerve is located. This nerve is a large neuro network that branches out to cover the entire brain in a manner not unlike that of a helmet. When this part of the nervous system is triggered, migraine begins.
- Headache
Headache occurs because the blood vessels of the brain tissues become dilated, and the nerves in the same region receive pain signals. When these nerves are triggered, they release substances that cause pain receptors to function, leading to even more vasodilation.
Aura.
In some patients, part of the nervous system related to sight and other sensory systems might cause electrical signals to move in waves about throughout the entire brain. These waves distort signals that are sent to the vision system. As a result, many patients see flashing light before pain symptoms occur.
Migraine comes from French and has its roots in the ancient Greek word “Hemicrania”, which means “covering half of the head.”
Migraine headache symptoms according to the International Headache Society (1988) include having the headache for 4-72 hours and that, without treatment or sleep, causes nausea, vomiting and inability to withstand bright lights and noises, and pain symptoms must include at least 2 of the following items:
- Throbbing pain.
- Pain on one side of the head on the temple or the back of the neck.
- Pain ranging in severity from moderate to the point of being unable to work.
- Ordinary activities like walking and moving of the head causes migraine pain symptoms to be more severe.
Some patients might experience auras that occur before or at the same time as migraine. Although a clear cause remains unknown, it is hypothesized that it might be caused by spreading of waves from the brain stem to the cerebrum. Usually, they consist of vision-related symptoms like seeing zig-zagging lights or firefly-like lights for about 10 minutes before a headache follows.
What types of headaches are considered to be migraines?
Migraine headache symptoms according to the International Headache Society (1988) include having the headache for 4-72 hours and that, without treatment or sleep, causes nausea, vomiting and inability to withstand bright lights and noises, and pain symptoms must include at least 2 of the following items:
- Throbbing pain.
- Pain on one side of the head on the temple or the back of the neck.
- Pain ranging in severity from moderate to the point of being unable to work.
- Ordinary activities like walking and moving of the head causes migraine pain symptoms to be more severe.
Some patients might experience auras that occur before or at the same time as migraine. Although a clear cause remains unknown, it is hypothesized that it might be caused by spreading of waves from the brain stem to the cerebrum. Usually, they consist of vision-related symptoms like seeing zig-zagging lights or firefly-like lights for about 10 minutes before a headache follows.
What should you do when migraines occur frequently?
First, you have to observe what your migraine triggers are, such as sleep deprivation or excessive sleep (e.g., having migraine on Saturday morning or Sunday morning), being in the sun for too long or being exposed to bright lights for a long time, especially when driving, during hot weather, extreme fatigue, while fasting, while eating certain foods such as sausages (which contain nitrates), drinking wine, or consuming Chinese food (which contain a lot of MSG), and in women, pain usually occurs before or for the first 2-3 days after a period has started (explainable to be due to changes in hormone levels). Once the cause or triggers are identified, avoiding them can significantly reduce the frequency of migraine. In addition, resting and eating on time and avoiding excessively strenuous activity can also do the same.
Next, when migraine symptoms occur, you should rest in a dark room with cool air and a peaceful atmosphere. If symptoms do not improve within 10-20 minutes, you should take a pain medication. Most patients try not to take medications, due to concern that when they take too much medication they will be unable to control worsening migraine pain symptoms by using ordinary pain medication later on and that they will eventually have to go to the hospital. Hence, taking medications early on can help avoid having to take a lot of medications later. Medications that you should take include anti-vomiting medications (motilium, plasi), paracetamol-related drugs or NSAIDS (ponstan, brufen) and direct migraine drugs (cafergot, sumatriptans **New drugs are very effective.) Side effects may include heart palpitations and numbness like when you take coffee. Otherwise, some people might experience muscle aches throughout their body.
Finally, if symptoms occur by more than twice a month or are so severe that they cause work/school absences, you should take preventive medications that help reduce the sensitivity of blood vessels. These drugs include B-blockers (propranolol, sibelium and tryptanol. Keeping a migraine diary can also help patients and doctors learn about pain symptoms, triggers and drug responses to better make co-treatment plans.
