People who have experienced migraines know they’re more than just a headache (and probably get irritated when someone tries to compare a hangover to a migraine’s debilitating pain). But what is a migraine, exactly?
That is something researchers are still trying to determine. Though migraines share a name, their symptoms differ dramatically—which can make them difficult to treat.
“Those of us who treat migraines see common ground among patients, but there’s also huge variability from person to person,” says Jenna Kanter, M.D., a neurologist and headache disorders specialist who practices at the Headache Clinic at University of Washington Medical Center—Roosevelt.
Even more confounding is the fact that migraines are much more common in women, especially young women. This means that, like other medical conditions that affect mostly women, migraines may not get as much attention or research funding, Kanter says.
Migraines aren’t just a bad headache
Though migraines are still somewhat mysterious, one thing is clear: they are not just in someone’s head. A migraine is a full-body problem that can debilitate a person for days.
Migraines are caused by brain hypersensitivity to environmental triggers like bright lights or loud noises. Once a migraine is triggered, the nerves in the brain respond more strongly than normal.
“Normally, pain signals start externally, a signal to the brain that then produces a pain response. In migraines it’s almost the opposite, where pain signals get turned on internally and activates nerves in the head and brain that then create a reinforcing loop,” says Kanter.
This hypersensitivity then leads to an inflammatory response in the tissues of the head and neck. (In contrast, regular headaches are caused by muscle clenching.) Some neurotransmitters, such as serotonin and calcitonin gene-related peptide (CGRP), may also play a role.
Though the pain is intense, sometimes the other symptoms are worse. For example, since there’s a strong connection between the nerves in our brain and the nerves in our gut, migraines are often accompanied by things like nausea and vomiting. Sometimes just being anywhere except a quiet, dark room is unbearable.
Migraines can be preceded by weird visuals, like blind spots or blinding zig-zags, or hearing noises that aren’t there; these are called aura. And after the pain subsides, other symptoms don’t go away immediately. People can feel confused, dizzy and weak for a day or more.