Migraine is a complex neurological disease that affects over 37 million people in the United States alone. A migraine attack can last anywhere from 4 to 72 hours and is often accompanied by intense throbbing head pain, nausea, vomiting, and extreme sensitivity to light and sound. Even after a migraine attack ends, you may experience lingering symptoms known as a “migraine hangover”.
What are the phases of a migraine attack?
A migraine attack has four distinct phases:
- Prodrome – The earliest signs of an oncoming migraine attack, starting hours or days before head pain begins. Symptoms can include appetite changes, mood changes, neck stiffness, yawning, and increased urination.
- Aura – Up to an hour before migraine pain starts, about 25% of those with migraine experience sensory disturbances called aura. Common auras include visual disturbances like flashing lights, zigzag lines, or temporary vision loss.
- Headache – Throbbing head pain on one or both sides of the head is the main event of a migraine attack. The pain can be mild to completely debilitating.
- Post-drome – After the headache phase, you may feel drained, confused, dizzy and tired for up to 24 hours. This is known as the migraine “hangover”.
What triggers a migraine attack?
Migraine attacks can be set off or triggered by a number of internal and external factors including:
- Hormonal changes – Fluctuations in estrogen during the menstrual cycle or with the use of birth control can trigger migraines in women.
- Stress – Physical or emotional stress causes chemical changes in the brain that can ignite migraines.
- Sensory stimuli – Bright lights, loud sounds, strong smells and more can overload the senses and initiate a migraine.
- Sleep changes – Too much or too little sleep can disrupt the brain and lead to migraines.
- Caffeine – Excessive caffeine intake or caffeine withdrawal can trigger migraine headaches.
- Alcohol – Alcohol, especially red wine, and hangovers are common migraine triggers.
- Foods – Aged cheeses, processed meats, chocolate, MSG, artificial sweeteners and more can trigger migraines.
- Weather changes – Changes in weather patterns like drops in barometric pressure can spark a migraine.
What happens in the brain during a migraine?
Research shows there are several neurological processes occurring in the brain during migraine:
- Excitation of the trigeminal nerve – This major pain pathway conveys head pain signals.
- Cortical spreading depression – A wave of excitation then inhibition spreads across the brain.
- Inflammation of the meninges – The membranes surrounding the brain become inflamed.
- Altered brain blood flow – Initially decreased blood flow is seen, followed by dilation of blood vessels.
- Release of inflammatory substances – Chemicals like CGRP and substance P are released, sensitizing pain nerves.
These brain mechanisms are thought to collaborate to initiate the pain and symptoms of migraine.
What physical symptoms can you experience during and after a migraine attack?
In addition to severe head pain, migraine attacks can cause a number of whole-body symptoms including:
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Many people continue experiencing migraine symptoms like fatigue, mental fogginess, nausea, sensitivity to light and sound, and neck pain in the days following a migraine attack. This collection of symptoms is known as the “migraine hangover”.
How do migraines affect the nervous system?
Research indicates migraines impact both the central and peripheral nervous systems:
- Central nervous system – During migraine, hyper-excitability of neurons in the brain leads to cortical spreading depression and activation of the trigeminal nerve pain pathway.
- Autonomic nervous system – Migraine leads to imbalances in the parasympathetic and sympathetic nervous systems. This causes symptoms like nausea, vomiting, and diarrhea.
- Peripheral nervous system – Inflammation of the trigeminal nerve and release of inflammatory substances sensitizes peripheral pain nerves in the head and neck, causing increased pain sensitivity.
In essence, migraines create dysfunction in the communication between nerves in the brain and body, leading to systemic neurological symptoms.
What structural changes occur in the brain with chronic migraine?
Research utilizing brain imaging technology shows people living with chronic migraine can develop several structural brain changes over time including:
- Cortical thinning – Thinning of the outer layer of the brain or cortex in regions related to pain processing.
- Lesions – Development of lesions, or damaged spots, in the white and gray matter brain tissue.
- Brain volume changes – Alterations in volume of certain brain regions and the whole brain.
These structural brain changes may predispose people to developing chronic migraine or could result from the cumulative effects of recurring migraine attacks. More research is needed to fully understand the relationship.
Can migraines cause damage to the brain?
There is no clear evidence that intermittent migraine attacks themselves cause cumulative damage or degeneration of the brain. However, findings show migraines, especially chronic migraine, can lead to the following changes with implications for brain health:
- Chronic inflammation – Associated with neurodegeneration over time.
- Ischemic lesions – Repeated instances of hypoxia from severe attacks could cause brain lesions.
- Altered brain structure – Regions related to pain processing are impacted.
- Cognitive decline – Difficulties with memory, attention and processing speed can occur.
More high-quality longitudinal research is needed to determine if migraine directly causes progressive brain damage or degeneration.
How do migraines impact cognition and mental function?
Many people with migraine report cognitive difficulties including:
- Impaired concentration
- Mental fogginess
- Difficulty finding words
- Short-term memory issues
- Decreased attention span
- Slower information processing
These cognitive symptoms can occur before, during and after migraine attacks. Research indicates migraines can impact functioning in frontal lobe brain regions involved in attention, memory, language, and executive function. Frequent migraines may also increase risk for vascular dementia.
Can migraines cause depression or anxiety?
Studies demonstrate patients with migraine have a 2 to 5 times higher risk of depression compared to the general population. Frequent migraine attacks can lead to depression and anxiety through:
- Chronic head pain and disability
- Reduced social, work and school activities
- Disruption of important life events
- Side effects of medications
- Brain changes that affect mood regulation
On the other hand, depression and anxiety can also predispose people to migraine attacks by increasing sensitivity to triggers and reducing pain thresholds. Migraine and mood disorders appear to have a bidirectional relationship.
How do migraines impact sleep?
Migraine and sleep disturbances often go hand-in-hand. Migraine impacts sleep in the following ways:
- Migraine attacks can disrupt sleep at night.
- Poor sleep is a trigger for migraine attacks.
- Excessive sleep can trigger an attack.
- Migraine causes conditions like insomnia through anxiety and depression.
- Chemical changes during migraine disrupt sleep-wake cycles.
Improving sleep quality and staying well-rested is an important part of migraine management and prevention.
Can migraines become more frequent or severe over time?
For many migraine sufferers, attack frequency and severity can worsen over the course of their condition. Factors that contribute to this “migraine progression” include:
- Increased sensitivity to triggers from repeated attacks.
- Development of medication overuse headache from overtreating attacks.
- Poor management of comorbid conditions like depression, anxiety, insomnia.
- Hormonal changes with puberty, menstruation, perimenopause.
- Structural and chemical changes in the brain.
Close follow up with a headache specialist and lifestyle adjustments can help prevent progression and reduce migraine frequency and severity long-term.
Conclusion
In summary, migraine attacks have wide-ranging effects throughout the body and brain that can persist even after the severe head pain subsides. From impacts on cognition, sleep, mood and more, understanding these post-migraine symptoms provides insight into the true chronic disease burden of migraine. Increased research and awareness of the complex systemic nature of migraine will hopefully lead to better treatments and outcomes for sufferers.
