Headaches From Hell

How is a "migraine brain" different from a regular brain?
It's a brain that's hyperexcitable. It's a brain that's more sensitive than the brain of someone who doesn't have migraines. Cells in the brain of a person with migraines tend to get irritated or excited and begin to send off signals when they shouldn't, whereas the brain of someone who doesn't have migraines probably wouldn't react.

There are certain triggers like bright lights or flashing lights. You could be very sensitive to alcohol. If you go to a party and have just a sip of wine, you could get a migraine. The brain of someone who doesn't have those triggers, who doesn't have those hyperexcitable brain cells, would be able to tolerate light or a night with no sleep or hormone changes that begin a menstrual period without having any symptoms like this.

What is going on in the brain that causes pain?
The abnormal discharging of the cells moves forward—to use a medical term, it propagates. And that means it travels through the brain. It can do a couple of things. It can trigger off pain centers, a lot of which run through a part of the brain called the thalamus. Most kinds of pain are modulated through that. What we think now is that the migraine discharges irritate and cause firing in a nerve called the trigeminal nerve. The trigeminal nerve is a nerve that supplies sensation and modulates pain in one side of the face or the other.

These cells that are a little too finicky begin to fire, the impulse moves forward through the brain and then they trigger off a nerve that is very, very irritable. When the nerve begins to fire, that's when the pain starts. There are probably a couple of other pieces of the pain; people disagree about precisely which is the causative factor. My feeling is that it is a little bit different for different people, but one way that the pain may be modulated is by a spasm of blood vessels in the brain. It is validating for people with migraines to hear this because they know there is a reason for what they are feeling.

Why are women more likely to get migraines than men? 
It is probably related to hormones, but there may be something about women's physiological makeup that makes them more likely to have migraines. The most clear-cut reason is hormonal fluctuations. Until the age of about 12, boys and girls have migraines at about the same rate. Then the girls just take off. That's right around the time of puberty. For a lot of women, the headaches go away at menopause. So there are actually not a whole lot of women in my practice over the age of 60. Most of them are between 20 and 50.

If you think about a brain that's very sensitive, you can postulate that if there are changes in hormone levels causing all kinds of physiological changes, some of those are enough to trigger migraines. One component that's well described is menstrual migraines. If you get a migraine at the start of bleeding consistently, that would be consistent with menstrual migraines. There are other women who get hormonal headaches. They get headaches around the time of ovulation as well. There are probably very potent changes that we're just beginning to understand. You have to keep a journal and chart your periods with your headaches and see what correlation you can find.