Spotlight On: Migraine

This month, in celebration of the 100th anniversary of the American Physiological Society journal Physiological Reviews, we are highlighting recent research published in the journal. Interested in reading more in celebration of Physiological Reviews’ birthday? Read about bariatric surgery’s effect on hunger, targeting the immune system to treat cancer and new thoughts on why you can’t sleep.

The word “migraine” may not mean much to people who’ve never had one. But for those who regularly experience them, the word may conjure painful memories. Symptoms of this extreme and sometimes prolonged type of headache include severe throbbing pain or pulsing on one side of the head, along with nausea, vomiting and/or sensitivity to light. 

According to a review published in Physiological Reviews, scientists have had trouble classifying migraines and understanding what’s going on in the body when a migraine attack occurs. In the 1800s, it was known simply as a brain disorder. By the 1940s, doctors thought a blood vessel disorder caused symptoms of migraine. More recently, researchers have identified four phases of a migraine, potential factors that trigger migraine attacks and new ways to treat them.

Phases of a migraine

Many people know a migraine is coming before the pain starts. The four phases of a migraine usually progress in order, but sometimes overlap. They are:

• The premonitory phase includes non-headache symptoms such as irritability, fatigue, food cravings, yawning, neck pain and light sensitivity. Symptoms can start as many as three days before the pain hits.
• The aura affects about one-third of people who get migraines. Visual auras include temporary blind spots or repeating patterns of flashing or zigzagging lights in the vision. Auras can last anywhere from five minutes to an hour. Usually the sight disturbances go away before the headache starts. Some people with a severe form of migraine called hemiplegic migraine also have trouble speaking and walking and other symptoms that can mimic a stroke.
• The headache phase is a throbbing pain on one side of the head and sometimes behind the eye that can last from four hours to three days. Nausea and sensitivity to light and sound may occur at the same time.
• The postdrome is after the pain goes away. People who regularly get migraines might not feel like their normal selves even as the pain subsides. Symptoms can include feeling tired or sluggish and having a stiff neck or trouble concentrating.

Migraine triggers

The triggers for migraines vary but can include:

• changes in eating or sleeping patterns,
• stress,
• certain foods (chocolate and MSG are two common triggers), and
• hormonal changes.

Biology and genetics also play a large role. Women are more likely to get migraines than men, and the headaches tend to run in families.

Treating migraines

Avoiding known triggers and staying well-hydrated may help prevent migraines in some cases. But often, medication is needed, either to prevent a migraine from starting (for people with chronic migraines) or to treat symptoms as early as possible. Some drugs reduce inflammation of the nervous system. Others change pain signaling in the brain. People who have migraines often develop a treatment plan in collaboration with a neurologist, trying different medications until one works.

“Migraine pathophysiology has come a long way in the last two millennia,” the Physiological Review article states. The article adds that more research may give people with migraines “even more benefits in the coming decades.”