- 3 Biological Causes of Vascular Migraines
- The Main Cause of Migraines and Headaches: Inflammation
- Migraines vs Headaches
- The 3 Main Causes of Vascular Instability That Contribute to Migraines
- 1) Inflammation
- 2) Endocrine Dysregulation
- 3) Neurotransmitter Dysregulation
- Which Category of Vascular Migraines Are You In?
- Vasodilatory headaches
- Vasoconstriction headaches
- What Are the Kinds of Headaches?
- What Causes Headaches?
- Who Gets Headaches?
- When Should I Call the Doctor?
- How Can I Feel Better?
- Cluster Headaches: Symptoms, Causes, Treatments
- What Is Causing My Headache?
- Migraines: Causes, Symptoms & Relief
- Causes & triggers
3 Biological Causes of Vascular Migraines
Learn how vascular restriction and dilation cause migraines and headaches. Discover how to identify the cause of your own migraines or headaches.
This article focuses on identifying the cause of migraines and headaches. If you want to see complementary strategies for migraines, read this article describing 31 natural, science-backed remedies.
The Main Cause of Migraines and Headaches: Inflammation
It’s still controversial in the scientific arena whether migraines are primarily a vascular (blood vessels) or a neurological dysfunction (dysfunction of neurons), but it’s ly that both have a significant role to play.
Whether vascular or neurological, the source is ly brought on by inflammation. Inflammation directly affects the vascular system and can damage neurons by causing ROS.
This post will focus on the role of “vascular instability” and how it’s affected in various ways. Vascular instability can be due to vasodilation (dilation of blood vessels and a decrease of blood pressure) and vasoconstriction (constriction of blood vessels and an increase in blood pressure).
Nevertheless, remember to consult your doctor if you have migraines or other types of headaches. He or she will try to identify their underlying cause and prescribe a treatment to relieve and prevent them.
Migraines vs Headaches
Chronic migraine is a disease which has headaches as the main symptom.
Isolated headaches are usually not caused by the same processes as migraines. Chronic migraines are usually caused by too much vasodilation.
Headaches can be caused by either too much vasodilation or vasoconstriction.
If someone has a tendency for either state, certain triggers can be tipping points which lead to a headache.
Migraines are more consistent and chronic, while vasoconstriction headaches are more sporadic and much more ly to be induced by environmental triggers such as stress or tyramines (both of which cause vasoconstriction).
Migraines, cluster headaches, and exercise headaches are generally caused by vasodilation. Tension headaches are caused by vasoconstriction.
The 3 Main Causes of Vascular Instability That Contribute to Migraines
These three causes are highly connected to one another and one cause can contribute to another. There are many interactions taking place.
Inflammation influences our endocrine and neurotransmitter levels and these can, in turn, modulate inflammation. Any hormone could lead to an increase or decrease in another hormone.
Inflammation is a natural and healthy response to injury, but chronically high levels are problematic.
Specifically, a cytokine called IL-1b increases COX-2, which causes the trigeminal nerve (a pain mediator) to release calcitonin gene-related peptide (CGRP) .
CGRP release is perhaps the most significant cause of migraines. During some migraine attacks, increased concentrations of CGRP can be found in both saliva and plasma drawn from the external jugular vein .
Furthermore, intravenous administration of alpha-CGRP is able to induce a headache in individuals susceptible to migraines .
Tumor necrosis factor alpha (TNF), another cytokine, can also increase the expression of the CGRP gene .
iNOS, which is induced by TNF and NF-kb (a transcription factor), also increases the expression of the CGRP gene .
MAPK also has a significant role in the inflammatory process that releases CGRP . MAPK is caused by AGEs, which is caused by sugar, especially fructose.
iNOS produces nitric oxide, which causes vasodilation. People with migraines with aura have an increased sensitivity to endothelial nitric oxide. The result is more vessel dilation than is warranted when there is increased blood flow .
Further supporting the role of inflammation, studies have found people with migraines are more ly to have a variation of the gene that makes TNF-alpha. These people have the “TNF-α -308G/A polymorphism”, which is associated with migraine incidence . This variation makes these people have a larger spike of TNF in response to an injury, infection or inflammatory agent .
This released CGRP then binds to and activates CGRP receptors located around meningeal vessels, causing vasodilation, mast cell degranulation and ‘leaky’ blood vessels (extravasation) .
Acute bouts of inflammation from injuries can, therefore, exacerbate these migraines.
In general, acute inflammation is characterized by marked vascular changes, including vasodilation, increased permeability, and increased blood flow, which is induced by the actions of various inflammatory mediators .
Inflammation can also damage our mitochondria. Mitochondrial dysfunction can amplify inflammation through ROS production and NF-κB activation .
Inflammation causes glutamate excitotoxicity and the cytokine IL-1b plays an important role in this, too .
Excitotoxicity causes a cascade of events such as an increase in free radicals and phospholipases, which break down the neuronal membrane, allowing harmful chemicals and ions to enter and ultimately degrading the cell’s mitochondria.
Inflammation also contributes to migraines because it causes changes in the trigeminal nerve, one of the main facial nerves that also houses a major pain pathway .
Migraine sufferers also are more ly than other people to have an incomplete network of arteries that supply blood to the brain. This structural difference may cause frequent headaches or occur as a result of the headaches.
2) Endocrine Dysregulation
This is a dysfunction in the endocrine/hormonal system, sometimes of the HPA axis leading to unbalanced levels of:
This hormonal list is not comprehensive, but these are large players.
Since every one of these hormones plays a role in modulating the vascular system, it seems apparent to me that dysregulation of the endocrine system will result in either vasodilation or vasoconstriction.
When hormonal signaling is whack and too little or too much of one or more hormones is excreted at the wrong time, you get excess vasodilation or vasoconstriction.
There also may be a role played by substance P and pain perception. Substance P is released along with glutamate, so if too much glutamate is released then there may be an increase in pain perception. Substance P also causes neurogenic inflammation.
3) Neurotransmitter Dysregulation
Glutamate (and aspartate), serotonin, acetylcholine, and GABA play the following role in vasodilation and vasoconstriction:
- Glutamate causes vasodilation.
- GABA causes vasodilation.
- Serotonin is a vasoconstrictor – Serotonin deficiency causes vasodilation.
- Acetylcholine is a vasoconstrictor. Acetylcholine deficiency causes vasodilation.
A study in pigs found that glutamate, a major neurotransmitter, is vasoactive in the cerebral circulation. Glutamate vasodilation is mediated by nitric oxide through NMDA receptors .
The levels of serotonin, a vasoconstrictor, seem to decrease during a migraine whereas an I.V. infusion of serotonin can abort a migraine. In fact, serotonin as well as ergotamine, dihydroergotamine, and other antimigraine agents invariably produce vasoconstriction in the external carotid circulation .
Acetylcholine is a vasoconstrictor .
According to one study in goats, administration of GABA (1-100 micrograms) directly into the cerebral circulation produced dose-dependent increases in cerebral blood flow .
Substance P is released along with glutamate, so if too much glutamate is released then there may be an increase in pain perception.
Which Category of Vascular Migraines Are You In?
Below is a list of the symptoms that may help you identify your type of vascular migraine. Talk to your doctor if you experience several of them so that he or she can properly diagnose it and prescribe medications to treat and prevent the attacks.
Your headaches may be caused by vasodilation if it occurs as a result of:
- Sex and masturbation (both vasodilators)
- Exercise (during or post)
- An infection or sickness
- An injury
- Ingestion any food or chemical that they are sensitive to (gluten, casein, etc..)
- Hot flushes by perimenopausal women (increases vasodilation from estrogen) Estrogen also fluctuates in pregnancy and menarche
- After menstruation – estrogen levels peak ~11-13 days after
Exercise, infection, injury and food intolerances may cause inflammation, which leads to vasodilation.
People will usually, but not always, have lower than average blood pressure because vasodilation lowers blood pressure.
MSG or excess glutamine/glutamic acid consumption can worsen vasodilatory migraines because glutamate excess causes vasodilation. The degree of harm caused by MSG is probably minimal.
Instead, glutamate excess is more ly caused by a host of other factors not related to dietary consumption of glutamates such as hypoglycemia caused by eating high glycemic index foods, hyperinsulinemia, fasting/skipping meals or really low carb dieting.
Also, low oxygen can cause glutamate excitotoxicity, such as when we are so stressed we forget to breathe, but more ly as a result of sleep apnea (if you get a headache in the morning check for sleep apnea).
Vasodilatory headaches are least responsive to nonsteroidal anti-inflammatory drugs (NSAIDs) aspirin because while aspirin will block the pain to a certain extent and bring down inflammation, it is a vasodilator itself.
So in one way, it makes it better (by decreasing inflammation) and in another, it exacerbates the problem (by increasing vasodilation).
If your headaches don’t improve with aspirin, that’s another indicator that it’s caused by vasodilation.
NSAIDs have been shown not to work for vasodilatory headaches cluster or exercise headaches because NSAIDs vasodilatory actions will only help for vasoconstrictive headaches.
Allergies and allergic reactions cause an inflammatory response which will trigger or make this headache worse.
People with vasoconstriction headaches will usually have higher blood pressure and experience episodes during times of stress. Tension headaches are a good example of this.
Stress and tyramines, for example, can trigger vasoconstriction. Stress triggers vasoconstriction through cortisol, epinephrine, and norepinephrine.
Any stimulus that causes the body to release stress hormones such as fasting or skipping meals, emotional stress, cold, bright lights, and loud noise can aggravate these headaches.
Tyramines, found in aged cheeses and other foods, displace norepinephrine from neuronal storage vesicles, which leads to vasoconstriction. These headaches can come often but they aren’t as consistent as vasodilatory headaches.
These headaches are most responsive to NSAIDs aspirin because aspirin is both a painkiller and vasodilator. And indeed, the research demonstrates its effectiveness for tension headaches.
People with vasoconstricting headaches are more ly to have:
- High blood pressure, which is caused by angiotensin II
- High choline dosage
Serotonergic SSRI’s and tryptophan or foods which contain high levels of tryptophan may increase serotonin levels and possibly exacerbate vasoconstriction headaches
Although it may feel it, a headache is not actually a pain in your brain. The brain tells you when other parts of your body hurt, but it can't feel pain itself.
Most headaches happen in the nerves, blood vessels, and muscles that cover a person's head and neck. Sometimes the muscles or blood vessels swell, tighten, or go through other changes that stimulate the surrounding nerves or put pressure on them. These nerves send a rush of pain messages to the brain, and this brings on a headache.
What Are the Kinds of Headaches?
The most common type of headache is a tension headache (also called a muscle-contraction headache). Tension headaches happen when stressed-out head or neck muscles squeeze too hard. This causes pain often described as:
- feeling as though someone is pressing or squeezing on the front, back, or both sides of the head
Pain that's especially sharp and throbbing can be a sign of a migraine headache. Migraine headaches aren't as common as tension headaches. But for teens who do get them, the pain can be strong enough to make them miss school or other activities if the headaches aren't treated.
One big difference between tension headaches and migraines is that migraines sometimes cause people to feel sick or even to throw up. Tension headaches typically don't cause nausea or vomiting.
Most migraines last anywhere from 30 minutes to 6 hours. Some can last as long as a couple of days. They can feel worse when someone is doing physical activity or is around light, smells, or loud sounds.
What Causes Headaches?
Lots of different things can bring on headaches. Most headaches are related to:
- infections (such as ear infections, viruses the flu or a cold, strep throat, meningitis, or sinus infections)
- computer or TV watching
- loud music
- caffeine (people who drink a lot of caffeinated drinks might get caffeine-withdrawal headaches)
- skipping meals
- lack of sleep or sudden changes in sleep patterns
- having a head injury
- taking a long trip in a car or bus
- some medicines (headaches can be a side effect)
- vision problems
- smelling strong odors such as perfume, smoke, fumes, or a new car or carpet
- some foods (such as alcohol, cheese, nuts, pizza, chocolate, ice cream, fatty or fried food, lunchmeats and hot dogs, yogurt, aspartame, and MSG)
For some teens, hormonal changes can also cause headaches. For example, some girls get headaches just before their periods or at other regular times during their monthly cycle.
Who Gets Headaches?
Headaches are common in people of all ages.
Migraine headaches often run in the family. So if a parent, grandparent, or other family member gets them, there's a chance you could get them too. Some people are sensitive to things that can bring on migraine headaches (called triggers), such as some foods, stress, changes in sleep patterns, or even the weather.
When Should I Call the Doctor?
If you think your headaches may be migraines, you'll want to see a doctor to treat them and learn ways to try to avoid getting the headaches in the first place. Sometimes relaxation exercises or changes in diet or sleeping habits are all that's needed. But if needed, a doctor also can prescribe medicine to help control the headaches.
You'll also want to see a doctor if you have any of these symptoms as well as a headache:
- changes in vision, such as blurriness or seeing spots
- tingling sensations (for example, in the arms or legs)
- skin rash
- weakness, dizziness, or difficulty walking or standing
- neck pain or stiffness
If you do see a doctor for headaches, he or she will probably want to do an exam and get your to help figure out what might be causing them.
The doctor may ask you:
- how severe and frequent your headaches are
- when they happen (to see if the headaches have a pattern or are connected to any specific foods or events)
- about any medicine you take
- about any allergies you have
- if you're feeling stressed
- about your diet, habits, sleeping patterns, and what seems to help or worsen the headaches
The doctor may also do blood tests or imaging tests, such as a CAT scan or MRI of the brain, to rule out medical problems.
Sometimes doctors will refer people with headaches they think might be migraines or a symptom of a more serious problem to a specialist a , a doctor who specializes in the brain and nervous system.
It's very rare that headaches are a sign of something serious. But see a doctor if you get headaches a lot or have a headache that:
- is particularly painful and different from the kinds of headaches you've had before
- doesn't go away easily
- follows an injury, such as hitting your head
- causes you to miss school
- happens along with any of these symptoms:
- changes in vision, such as blurriness or seeing spots
- tingling sensations (such as in the arms or legs)
- skin rash
- weakness, dizziness, or trouble walking or standing
- neck pain or stiffness
How Can I Feel Better?
Most headaches will go away if a person rests or sleeps. When you get a headache, lie down in a cool, dark, quiet room and close your eyes. It may help to put a cool, moist cloth across your forehead or eyes. Relax. Breathe easily and deeply.
If a headache doesn't go away or it's really bad, you may want to take an over-the-counter pain reliever acetaminophen or ibuprofen. You can buy these in drugstores under various brand names, and your drugstore may carry its own generic brand. It's a good idea to avoid taking aspirin for a headache because it may cause a rare but dangerous disease called Reye syndrome.
If you are taking over-the-counter pain medicines more than twice a week for headaches, or if you find these medicines are not working for you, talk to your doctor.
Most headaches are not a sign that something more is wrong. But if your headaches are intense and happen often, there are lots of things a doctor can do, from recommending changes in your diet to prescribing medicine. You don't have to put up with the pain!
Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: September 2018
Cluster Headaches: Symptoms, Causes, Treatments
Dr. Papay & Dr. Tepper headache research.
Cluster headaches are the most severe headaches. A cluster headache can be many times more intense than a migraine attack. It has been called the “suicide headache” because some people have taken their lives either during an attack or in anticipation of an attack.
The term “cluster headache” refers to headaches that have a characteristic grouping of attacks. Cluster headaches occur up to eight times per day during a cluster period, which may last 2 weeks to 3 months, or longer.
The headaches may disappear completely (go into “remission”) for months or years, only to recur at a later date. A cluster headache typically awakens a person from sleep 1 to 2 hours after going to bed.
These nocturnal attacks can be more severe than the daytime attacks.
Cluster headaches are an uncommon type of primary headaches (i.e., a headache that has no structural cause), affecting less than 1 in 1,000 people.
Cluster headaches are a young person's disease, and the headaches typically start before age 30. Cluster headaches are more common in men, but more women are starting to be diagnosed with this disorder.
The male-to-female gender headaches appear to be six times more common in men than women, especially men in their 20s or 30s.
The true biochemical cause of cluster headaches is unknown. However, the headaches occur when a trigeminal-autonomic reflex pathway in the brainstem is activated. The trigeminal nerve is the chief sensory nerve of the face. When activated, the trigeminal nerve leads to the eye pain associated with cluster headaches.
The trigeminal nerve also stimulates the parasympathetic autonomic system, which causes the eye tearing and redness, nasal congestion and discharge with cluster attacks. Cluster headaches appear to be generated by the hypothalamus (the part of the brain that is home to the suprachiasmatic nucleus or circadian clock).
Recent imaging studies have shown activation or stimulation of the hypothalamus during a cluster attack.
Cluster headaches usually are not caused by an underlying condition such as a tumor or aneurysm. Thus, they are considered to be a form of ‘primary' headache.
The season is the most common trigger for cluster headaches, which often occur in the spring or autumn. Due to their seasonal nature, cluster headaches are often mistakenly associated with allergies or sinusitis. The seasonal nature of cluster headaches most ly results from stimulation or activation of the hypothalamus.
Cluster headaches are also common in people who smoke and drink alcohol frequently and a large proportion of the patients have sleep apnea.
During a cluster period, the sufferer is more sensitive to the action of alcohol and nicotine, and minimal amounts of alcohol can trigger the headaches. During headache-free periods, the patient can consume alcohol without provoking a headache.
Smoking can also increase the severity of cluster headaches during a cluster period.
Cluster headaches generally reach their full force within five or ten minutes after onset. The attacks are usually very similar, varying only slightly from one attack to another.
Type of pain
The pain of cluster headache is one-sided, and during a headache period, the pain remains on the same side. When a new headache period starts, it rarely occurs on the opposite side.
Severity/intensity of pain
The pain of cluster headache is generally very intense and severe and is often described as having a burning or piercing quality. It may be throbbing or constant. The pain is so intense that most cluster headache sufferers cannot sit still and will often pace during an attack.
Location of pain
The pain is located behind one eye or in the eye region, without changing sides. It may radiate to the forehead, temple, nose, cheek, or upper gum on the affected side.
The scalp may be tender, and the pulsing in the arteries often can be felt.
Duration of pain
The pain of a cluster headache can last anywhere from 15 minutes to three hours. In general, the headaches last for 30 to 90 minutes. The headache will disappear only to recur later that day. Typically, in between attacks, people with cluster headaches are headache free but the pain can sometimes linger.
Frequency of headaches
Most sufferers get one to three headaches per day during a cluster period (the time when the headache sufferer is experiencing daily attacks). They occur very regularly, generally at the same time each day, and they often awaken the person at the same time during the night.
The cluster periods can last from two weeks to three months and then disappear completely for months or years. The episodic cluster headache sufferer has variable pain-free intervals between headache attacks.
Attacks appear to be linked to the circadian (or “biological”) clock. Most people with cluster headaches will develop cluster periods at the same time each year — either in the spring or fall or the winter or summer.
Most cluster sufferers (80% to 90%) have episodic cluster headaches that occur in periods lasting seven days to one year, separated by pain-free episodes lasting 30 days or more.
In about 20% of people with cluster headaches, the attacks may be chronic. Some patients will note that the series of headaches are not separated by periods of remission lasting longer than a month. These cases are chronic.
Although the pain of a cluster headache starts suddenly, a minimal type of warning of the oncoming headache may occur, including a feeling of discomfort or a mild one-sided burning sensation.
The affected eye may become swollen or droop. The pupil of the eye may get smaller and the conjunctiva (the tissue that lines the inside of the eyelid) will redden. There may be nasal discharge or congestion and tearing of the eye during an attack, which occur on the same side as the pain.
Excessive sweating may occur, and the face may become flushed on the affected side. Cluster headaches are not typically associated with the nausea or vomiting. People with cluster headaches appear to develop as much sensitivity to light that are found in other types of headaches, such as migraine and sound as people who have migraines.
It is possible for someone with cluster headaches to also suffer from migraines.
People who suffer from cluster headaches–especially people who have tooth or cheek pain with the cluster attacks–have an increased risk of developing a stomach ulcer.
Researchers believe that histamines, which dilate or expand blood vessels, influence the onset of a cluster headache because during a cluster headache, the level of histamine increases in a person's blood and urine.
Last reviewed by a Cleveland Clinic medical professional on 07/22/2014.
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What Is Causing My Headache?
The cause of headaches, or why headaches develop, is complex, often involving an intricate web of pain receptors, abnormal brain processes, genetics, and a neurological phenomenon called sensitization. Outside or environmental factors are also commonly involved, serving as headache triggers—the factors that unmindfully activate pain signals within the brain.
By understanding the biology behind your headaches (at least what experts know so far), you can hopefully tease out what parts of your head pain you can perhaps control ( various environmental triggers), and which ones you cannot ( your genetic makeup).
Headaches are unpleasant experiences, so treating them promptly is key. But in order to effectively treat your headaches, you must understand them.
The vast majority of headaches fall into three categories:
- Tension-type headache
- Cluster headache
These three headache types are primary headache disorders, meaning they exist on their own and are not due to some other condition (called secondary headaches).
Migraine may be the most complicated headache disorder and feels a moderate to severe throbbing sensation on one or both sides of the head. Nausea, vomiting, sensitivity to light (photophobia), and/or sound (phonophobia) commonly co-occur with a migraine headache.
Research suggests that migraine headaches develop as a result of the activation of the trigeminovascular system—a complex pathway that links trigeminal nerve fibers to blood vessels of the brain.
Once the trigeminal nerve fibers are activated, they release various peptides, calcitonin gene-related peptide (CGRP) and substance P. These peptides induce a phenomenon called neurogenic inflammation, which is connected to the prolongation and intensification of pain in migraine.
Eventually, neurogenic inflammation may lead to a process called sensitization, whereby your nerve cells become more and more responsive to stimulation.
Other variables linked to migraine development include structural brain changes and serotonin release. Lastly, a phenomenon called cortical spreading depression—where waves of electrical activity spread across the brain—is believed to be the culprit behind migraine aura.
Tension-type headache is the most common headache type and is often described as a squeezing or tight sensation around the head. Along with this pressure or “rubberband-around-the-head” sensation, tension-type headaches may be associated with muscle tenderness in the muscles of the head, neck, or shoulders.
Experts believe that tension-type headaches result from the activation of myofascial (the tissue that covers muscles) pain receptors. Once activated, pain signals are transmitted to the brain.
As with migraines, experts also believe that the sensitization of pain pathways in the brain occur with tension-type headaches. This sensitization is thought to play a pivotal role in the transformation from episodic to chronic tension-type headache.
Cluster headaches are uncommon and often begin without warning. These headache attacks are often short-lived, lasting between 15 and 180 minutes, and they are excruciating—causing a burning, piercing, or stabbing pain located in or around the eye or temple.
The pathogenesis, or the “why” behind cluster headache development, is not fully understood. Experts suspect that the cause is ly linked to the hypothalamus—a gland located within your brain that helps regulate sleep and circadian rhythm.
In addition to the hypothalamus, trigeminal nerve stimulation, histamine release, genetics, and activation of the autonomic nervous system may contribute to the development of cluster headaches.
Head injuries or trauma or an acute illness, ranging from a run-of-the-mill viral or sinus infection to more serious infections, meningitis, may cause headaches.
In addition, serious underlying (non-infectious) health conditions may cause headaches.
Headaches, especially migraine headaches, tend to run in families. In fact, according to the American Migraine Foundation, if one or both of your parents suffer from migraine, there is a 50% to 75% chance that you will too.
That said, the genetic basis for migraines is complicated. For most migraine types, in order for a person to develop migraines, they must have inherited one or more genetic mutations.
But having a certain genetic mutation(s) is not necessarily a slam dunk case for developing migraines. Rather, that genetic mutation may make you more vulnerable to getting migraines, but other environmental factors, stress, hormone changes, etc, need to be present for the migraine disorder to manifest.
The good news is that researchers are working tirelessly to identify genetic mutations that increase migraine risk. So far, 38 single nucleotide gene mutations have been discovered, although how these discovered mutations can translate into migraine therapies remains unclear.
When linking migraines and genes, it's important to mention a rare but severe type of migraine called familial hemiplegic migraine. With this migraine type, a person experiences temporary weakness on one side of their body during the aura phase.
Mutations in four specific genes have been linked to familial hemiplegic migraine. These four genes include:
- CACNA1A gene
- ATP1A2 gene
- SCN1A gene
- PRRT2 gene
In addition to migraines, keep in mind genetics ly plays a role (albeit more minor) in the pathogenesis of cluster headaches and tension-type headaches. Overall, the research into these specific genetic patterns is less robust than with migraines.
Numerous lifestyle-related and environmental factors have been found to trigger primary headache disorders, especially migraines. It's believed that these triggers are the factors that signal the brain, nerve, muscle, and/or blood vessels to go through changes that ultimately create head pain.
Some common triggers for migraines include:
- Hormone fluctuations, that seen just prior to menstruation (called menstrual migraine)
- Weather changes
- Certain foods or beverages (e.g., nitrates, alcohol, caffeine, aspartame, to name a few)
- Sleep disturbances
- Skipping meals
The two most common triggers are:
Some common triggers for tension-type headaches (of which there is a large overlap with migraines) include:
- Intense emotions
- Abnormal neck movement/position
- Lack of sleep and fatigue
- Fasting or not eating on time
Various lifestyle and environmental factors have been linked to other types of headaches. For example, missing your morning coffee can precipitate a caffeine withdrawal headache, which is located on both sides of the head, worsens with physical activity, and can be quite painful.
Some daily activities strenuous exercise, sex, or coughing can trigger headaches; although these primary headache disorders are uncommon and warrant investigation by a headache specialist.
Lastly, while alcohol can trigger a person's underlying primary headache disorder, it can also cause its own headache, either as a cocktail headache or as a hangover headache. A hangover headache is throbbing, a migraine, but is usually located on both sides of the forehead and/or temples, a tension-type headache.
If your headaches are new or becoming more severe or frequent, a diagnosis by a healthcare professional is important.
In the end, remain dedicated and empowered in your journey to learning more about headaches—but also, be good to yourself and seek out guidance from your primary care physician or headache specialist.
Migraines: Causes, Symptoms & Relief
A migraine is a neurological disorder characterized by over-excitability of specific areas of the brain, which usually results in an intense pulsing or throbbing pain in one area of the head. Migraines are not merely severe headaches, however; in fact, sometimes there is no head pain. Other symptoms include nausea, vomiting and sensitivity to light and sound.
More than 37 million Americans, mostly between the ages of 15 to 55, suffer from migraines, according to the National Headache Foundation. Migraines are three times more common in women than in men, according to the U.S. National Library of Medicine (NLM).
Causes & triggers
Though no one is completely certain on the origin of migraines, some researchers think migraines may be inherited and related to genes that control the activity of some brain cells. Most migraine sufferers — 70 to 80 percent of them — have a family history of migraines, according to the National Headache Foundation. [Related: Genetic Link to Migraines Identified]
Migraine pain occurs when excited brain cells trigger the trigeminal nerve, one of five nerves located in the brain, to release chemicals that irritate and cause blood vessels on the surface of the brain to swell, according to the National Headache Foundation.
The swollen blood vessels send pain signals to the brainstem, which processes pain information. The pain is typically felt around the eyes or temples. Pain can also occur in the face, sinus, jaw or neck area. During a full-blown attack, many people are sensitive to anything touching their head.
Combing their hair or shaving may be painful or unpleasant.
It is important to note that there is a difference in the cause of migraines and the triggers for migraines. A cause is what makes a person susceptible to migraines, while a trigger is what may bring on a migraine.
“Many patients know what will trigger a migraine in them,” said Dr. Niket Sonpal, an assistant professor of clinical medicine in the department of biomedical sciences at the Touro College of Medicine in Harlem, New York.
“Common triggers include certain foods, drinks, bright lights, some odors and stress, to name a few.”
The National Headache Foundation lists these factors that can trigger migraine attacks:
- alteration of sleep-wake cycle
- missing or delaying a meal
- medications that cause a swelling of the blood vessels
- daily or near daily use of medications designed for relieving headache attacks
- bright lights, sunlight, fluorescent lights, TV and movie viewing
- certain foods
- excessive noise
Many people will experience certain symptoms that indicate they will soon have a migraine. These warning signs can happen minutes or hours before an actual migraine. Some of these symptoms include blurred vision, tingling in the arms or face, difficulty speaking or loss of peripheral vision.
Roughly one-third of those who get migraines can predict an oncoming migraine by seeing an “aura” or visual disturbances such as flashing lights, zig-zag lines in front of the eyes or a temporary loss of vision, according to the National Institute of Neurological Disorders and Stroke.
The pain associated with migraines, as well as the nausea, vomiting, extreme sensitivity to light and sound, and other accompanying symptoms can last hours to days before subsiding, according to the Mayo Clinic.
The most common time for a migraine pain to begin is 6 a.m., according to the American Migraine Foundation.
There are many different types of migraines. The type of migraine often corresponds with the accompanying symptoms.
Silent migraines are the exception, since they are classified by a symptom that is missing. Silent migraines are migraines that occur without head pain while including many of the other symptoms associated with a migraine.
Migraines that affect the eyes are often called ocular, optical or ophthalmic migraines. “The terms are pretty interchangeable,” said Sonpal.
“Ocular migraines cause vision loss or blindness lasting less than an hour, along with a migraine headache. Physicians will sometimes call these headaches 'retinal,' or 'ophthalmic' but essentially they are the same thing.
These headaches, through rare, are very serious as they should be investigated by a physician right away.”
Complex migraines or atypical migraines are associated with extended or exaggerated visual auras.
Sporadic hemiplegic migraines are rare and can cause symptoms such as fever, prolonged weakness, seizures and coma.
Neurological symptoms such as memory loss and problems paying attention can last for weeks or months after the person has recovered from the migraine.
Some may even develop permanent difficulty coordinating movements, rapid, involuntary eye movements called nystagmus and mild to severe intellectual disability, according to NLM.
Vestibular migraines are those that are associated with vertigo. The person may experience dizziness or loss of balance during a migraine. Nausea and vomiting are common symptoms of this type of migraine.
Abdominal migraines are unique because they have nothing to do with the head.
Some believe that children who have sporadic abdominal pain may be experiencing abdominal migraines because the symptoms, social and demographic patterns and triggers of the pain is very similar to a migraine, according to research by the University of Aberdeen. Though rare, some adults may also experience abdominal migraines.
Some people may opt to seek medical attention if their migraines are frequent or particularly severe; however, migraines typically can be helped with at-home treatments.
At-home treatments can include going to a dark, quiet room to rest, applying cold packs to the painful area of the head and taking over-the counter pain medication such as ibuprofen or aspirin. Avoiding triggers has also been helpful for many.
A medical professional may order tests to rule out tumors, infections, clots in the brain or other conditions that may cause a migraine. Once any other health concerns are ruled out, a medical professional may prescribe medications. Some medications work well in some patients and not in others, so finding a medication that works takes trial and error.
Typically, treatments include acute medications to resolve the pain as quickly as possible and preventative or prophylactic daily medications to prevent future migraines.
Acute medications fall into three classes, according to the American Headache Society: analgesics, ergotamines and triptans. Analgesics are non-specific pain relievers, such as aspirin and ibuprofen.
Ergotamines and triptans are more migraine-specific medications.
Sonpal explained that triptan migraine medications are structurally similar to serotonin, a neural hormone.
These medications target one of the underlying causes of migraines and help reduce the vascular inflammation associated with migraines. These cannot be taken, however, in patients who are pregnant or have coronary artery disease.
If these medications don’t work, then ergotamine, certain anti-emetic medications and even steroids may be prescribed.
“Preventive medications are aimed are preventing migraines, and have been shown to reduce frequency of migraines by 50 percent,” said Sonpal.
Beta blockers such as propranolol can help to stabilize the blood vessels in the brain and are used when the patient has three but less than or equal to 14 migraines a month.
When a person has more than 15 migraines per month, the physician may consider topirimate as a treatment option. It targets several receptors in the brain to help with the pain and prevent migraines.