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Here's What's Happening In Your Brain When You Get A Migraine

For example, how and why they're such life ruiners.

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1. Migraines are more than just bad headaches.

The word "migraine" has come to be synonymous with a really bad headache, but it's actually a genetic disorder. If you're diagnosed with migraines, it means you're genetically predisposed to have a lower threshold for migraine-causing stimuli (called triggers), says Dr. Merle Diamond, president of the Diamond Headache Clinic in Chicago.

About 45–48 million Americans suffer from migraines, and the average person gets three attacks per month, each one lasting an average of about 10 hours, she says. Migraines do mean really bad headaches, but they also mean an assortment of other symptoms like nausea, vomiting, dizziness, and sensitivity to light and sound.

2. Some migraines have a built-in warning called an aura.

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An aura is basically a warning sign that a migraine is coming, explains Dr. Jaydeep Bhatt, assistant clinical professor of neurology at NYU Langone Medical Center. Auras can be visual, with bright or flashing lights or dark zigzag lines in your field of vision. They can be something you feel, like pins and needles or numbness somewhere in your body. They can also affect language processing, causing the migraineur to temporarily lose the ability to speak, read, and write.

Auras last anywhere from a few minutes to a half hour, says Bhatt, and for most people a throbbing headache (usually on one side of the head) follows the aura, bringing with it a host of other symptoms.

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3. But the most common kind have no warning sign at all.

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Bhatt says that the majority of migraine sufferers get migraines without aura, where the migraine kicks off with the headache itself. Migraines with aura are the next most common kind. There are two other kinds of migraine that are relatively uncommon: aura without migraine and basilar migraine (which doesn't come with a headache, but instead causes vertigo-like symptoms of dizziness, lightheadedness, etc.).

4. For some people, the first phase of a migraine is days before the actual headache hits.

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The prodrome is considered the very first phase of a migraine and it begins a couple days before the aura or headache hits, says Diamond. During the prodrome, migraineurs experience a repetitive or sustained symptom, like constant yawning, a persistently sore neck, or even an intense craving for starchy food. Not everyone experiences prodrome, though, and their migraines begin with an aura or headache.

Next comes the aura (for people who get them. Others go straight to the next phase — the headache). As mentioned above, an aura lasts up to a half hour and lets the migraineur know that a headache is imminent. The attack phase is next. This is when the headache sets in, and brings with it some or all of the following: nausea, sensitivity to sound and light, dizziness, vomiting, and neck pain, says Diamond. The headache itself can last anywhere from four hours to a couple days.

5. During the attack phase, the pain is very bad.

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While tension headaches and caffeine headaches can be painful, nothing puts the hurt on you headache-wise like a migraine. In fact, Diamond says that one thing that distinguishes migraines from other headaches is the extent to which they are "disabling."

She says that more than 50% of sufferers end up missing work or life for some portion of their migraines, often waiting out their headaches in darkened, silent bedrooms. "Most people don't see a doctor [about their headaches] until they start losing time from work. If you took 100 people who come to my office to talk about their migraines, about 99 would have a diagnosis of migraine," says Diamond.

6. After the headache pain subsides, most people are left with a migraine hangover.

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The last phase, called the postdrome, is when recovery begins. For the couple days it lasts, migraineurs feel foggy and slow to process information, achy all over, and might even have some gaps in memory, says Diamond.

7. Migraines happen when someone with a genetic predisposition to migraines is exposed to a trigger (or triggers).

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To understand how migraine triggers work, think of a door that, when closed, keeps the migraine from getting in. This closed door is the migraine brain when it's not exposed to any triggers. But each time a migraineur is exposed to a trigger, the door opens a bit, eventually allowing a migraine to set in.

Because people who get migraines have what Bhatt says is a "reduced threshold for any biochemical abnormality," some people get migraines in response to some change to their daily routine, like an irregular sleep pattern or disruption to their diet (like going too long without eating), getting dehydrated, or experiencing an uncommon amount of stress.

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8. Triggers can also include food, hormonal changes, and even the weather.

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Cheese, chocolate, and wine are some common ones. Fluctuations in hormones (like your period) or even changes in the weather can bring on a migraine if that's what sets you off.

For some people, skipping a meal would be enough to open that door all the way up and bring on a migraine, says Diamond. For others, they might need a combination of factors to open the door little by little — like a few days when you're super busy at work so your stress peaks, you're sleeping less than usual, you're forgetting to eat, and you're dehydrated.

9. WTF is happening in a migraineur's brain to wreak all this havoc? Two neurological events.

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Bhatt explains that brain cells work by sending electric signals to one another. When a migraine is triggered, a wave of electrical activity — called a cortical spreading depression (CSD) — spreads over the surface of the brain, suppressing the brain's normal electrical activity. If this suppression occurs in the part of the brain dedicated to vision, a visual aura will occur. If it happens in the part of the brain that controls tactile sense, a pins and needles type aura will occur. If it happens in the part of the brain that controls speech, an aphasic (language-related) aura will occur.

If the aura-causing CSD is the opening act of a play, the main event is sensitization of the nerve that controls pain in the face and head, the trigeminal nerve. "When this nerve and its tributaries and neurons get chemically primed, they start firing signals causing you to feel horrible pain," says Bhatt.

The thing is that these nerves are sending out pain signals even though no physically painful stimulus (say, getting hit in the head with a hammer) is present, but rather because migraineurs have that lowered threshold for abnormal biochemistry. In other words, these nerves get sensitized as a result of exposure to a trigger or some combination of triggers, says Bhatt.

10. When it comes to treatment, you can take rescue meds when you feel a migraine coming on.

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In order for medication to be effective in stopping migraine headache pain, it has to be taken before the pain has a chance to move from where it begins in your brain stem to where it wants to go in your cerebral cortex, says Diamond. For some people that window is just five minutes, and for others it's up to an hour, says Diamond.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen provide some people with migraine pain relief, says Bhatt, by blocking the release of chemicals that cause inflammation (and in turn, pain). Once you get a diagnosis of migraine, you might be prescribed something from the triptan family of drugs, which stops migraines by blocking a type of serotonin receptor and aiding the process of stopping pain in the trigeminal nerve.

11. You can take preventive meds, too.

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There are four classes of preventive medications for migraines, says Bhatt. Some blood pressure meds are prescribed for migraine prevention because they keep the blood vessels in the brain covering (the meninges) stable. These blood vessels run alongside the trigeminal nerve, so the less they expand and contract, the less likely they are to "chemically trigger a pain response in nerves that are its neighbors," says Bhatt. Epilepsy drugs (like Topomax) stabilize the nerves in the brain and prevent them from sending chemical signals that provoke migraines.

Botox and Cefaly are newer (but FDA-approved) treatments for migraine prevention. Botox is injected strategically into the tiny muscles around the head, neck, and sinuses, to paralyze the muscles in those areas, thereby preventing migraine pain from occurring, says Bhatt. Cefaly looks like a medical tiara. It's worn on the head and it sends "intelligent signals" to block the electricity of nerves that transmit pain, says Bhatt.

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12. Keeping your daily routine as regular, calm, and balanced as possible also helps.

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"Every migraine has triggers that can be controlled for, but I don't want patients to be phobic about life because sometimes you get a migraine and you don't know why," says Diamond. So you can't avoid everything, but the trick is to try to maintain regularity in your personal habits as much as possible.

"Migraine brains like to get up at the same time every day and need six to eight hours of sleep," Diamond says. She recommends not skipping meals, which can mean carrying snacks at all times, avoiding excess caffeine, exercising regularly, staying hydrated, and having a way to reduce stress and rest (yoga, meditation, cardiovascular exercise; whatever gets the job done). Basically, the evener the keel, the better, when it comes to migraines.

Apps like Migraine Buddy and Migraine Coach can help you track your migraines, identify triggers, and understand more about any important patterns.

13. If you think those terrible headaches you've been missing work for might be migraines, see your doctor.

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Diamond says that it's important for people who get migraines to actually be diagnosed with them so that they can get their hands on treatment — whether that means rescue meds, preventive treatment, or some combination. It's also necessary to see a doctor so they can examine you (and maybe order an MRI) to make sure that your headaches aren't caused by something more serious.

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