Migraines are an extreme form of headache that affect 36 million people in the U.S., 14 million of whom suffer from daily Migraine pain. In addition to severe pain in various parts of the head (e.g., behind the eyes and ears), migraine sufferers may experience some or all of the following symptoms:
- Increased sensitivity to sounds and smells
- Extreme fatigue
Causes and risk factors for migraines
Early research indicated that migraines are vascular in nature (involving the veins and their constriction in the head), but there are other causes or risk factors associated with migraines.
Women are three times more likely to suffer from migraines than men. They are also more likely to see migraine pain diminish, if not disappear, after menopause, which leads some researchers to conclude that changes in hormones are a factor in migraine in women. Michael A. Moskowitz, MD, professor of neurology at Harvard Medical School at the Massachusetts General Hospital in Boston had this to say about the connection:
“Hormonal changes are a big contributor to the higher female incidence. There are lines of evidence that support this from lab to clinical evidence and a decrease (although not abolished) incidence in post-menopausal females.”
A study published in the November 25, 2013 edition of the online journal Cephalalgia connected allergies and migraine headaches for the first time. Allergies, also called allergic rhinitis, are a condition that causes irritation and inflammation in the body. Because migraines are also associated with inflammation of the blood vessels, it makes sense that one might exacerbate (or trigger) the other.
Vincent Martin, MD is a professor of medicine and a co-director of the University of Cincinnati’s headache and facial pain program. He writes:
“We are not sure whether the rhinitis causes the increased frequency of headaches or whether the migraine attacks themselves produce symptoms of rhinitis in these patients. What we can say is if you have these symptoms, you are more likely to have more frequent and disabling headaches.”
People with family members suffering from migraine are more likely to develop migraine themselves, and scientists at the University of California, San Francisco have found a genetic mutation that is common in those with the most typical type of migraine. The research team, led by a Howard Hughes Medical Institute investigator, found a mutation in the gene casein kinase I delta (CKIdelta). Researchers studied two families in which migraine was common and discovered the genetic mutation, then recreated that mutation in laboratory mice.
Another larger study of 11,000 migraine sufferers found other genetic links to migraine without aura. While the science continues to develop, it is clear that family history is a powerful cause of migraine, with 80% of migraine sufferers having at least one family member who also has migraines.
Nerve fibers are surrounded by a protective coating called the myelin sheath. This prevents nerves from being overly stimulated at any given time, but when this sheath is damaged, migraines could result.
American Society of Plastic Surgeons (ASPS) member surgeon Bahman Guyuron, MD, of Case Western Reserve University, Cleveland found that migraine sufferers showed abnormalities in the myelin sheath surrounding their trigeminal nerve. The trigeminal nerve is a cranial nerve that originates from the brain stem to enervate the face and actions such as chewing and speaking. Dr. Guyuron examined the nerves of 15 patients with migraine and then compared them to 15 patients who were undergoing a cosmetic forehead lift. Of the results, Dr. Guyuron noted that:
“Essentially, the protective layer surrounding and insulating the normal nerves, called myelin, is missing or is defective on the nerves of the patients with migraine headaches…damage to the myelin sheath may make the nerves more prone to irritation by the dynamic structure surrounding them, such as muscle and blood vessels, potentially triggering migraine attacks.”
This is a broad category of causes that could be considered more along the lines of triggers than root causes of migraine. These include any of the following:
- Changes in weather: A falling or rising barometer can affect the pressure in the head, thus triggering a migraine.
- Stress: Stress over a long period of time can trigger a migraine, particularly immediately after a stressful time when the level of cortisol in the body drops.
- Food: Certain food preservatives or additives can trigger migraines, as can alcohol, sugar, and caffeine. Low blood sugar can also act as a trigger.
- Lack of sleep: Not enough sleep or sleep that is not restful is a common cause of migraine, a cycle that is perpetuated as migraines tend to make quality sleep elusive.
Not all of these will trigger a migraine 100% of the time, but when a migraine starts, there are a few treatment options. Prescription pain medications and anti-nausea drugs are often used to control those two symptoms. There is also some evidence that blood pressure medication may help to ease vascular inflammation. Complementary medicine can be very effective as well. Biofeedback training can help migraine sufferers to regulate their body’s response, and acupuncture can work to calm the mind. Staying hydrated and resting in a dark room with a weighted eye pillow can sometimes offer relief.
For migraine patients who do not respond to the above treatments, doctors may consider using temporary nerve blocks to see if that can identify the cause, making the block permanent if pain relief occurs. In some cases, the same techniques used in cosmetic eyelid surgery helped to permanently relieve migraine pain and may be an option.
Do you suffer from migraines? What are your triggers, and what helps you manage the pain?
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