Prevention: The Future of Migraine Therapy
Stopping a migraine headache before it ever begins is the new focus of treatments.
Migraine Headaches Connected to Hormones, Lifestyle
To understand how all this works, it's helpful to know how migraine headaches develop. The tendency to get them is inherited. They plague teen girls and adult women especially, although a small number of young boys and adult men get migraines as well, researchers say.
Female hormones such as estrogen influence migraines, though it's not clear why. The drop in estrogen levels that occurs a few days before a normal menstrual period seems to increase the chances of a migraine, possibly by priming blood vessels in the brain.
If a woman is taking birth control pills, her headaches are most likely to occur during her "off week," when estrogen levels drops. Some women start getting migraines only at menopause, when their period stops. For others, menopause is the first real relief from migraines.
Lifestyle and environment can also trigger migraines. Weather changes, altitude changes, bright lights, sleep problems, stress, smells, cheeses, caffeine, monosodium glutamate (MSG), nitrates, or aspartame are just some of a long list of potential triggers. Every migraine patient has his or her own headache trigger pattern.
The evolution of a migraine starts with this trigger: When your brain perceives the trigger, it begins a cascade of events. The headache will start developing within two hours or two days. In the beginning, blood vessels in your forehead start to swell up. This causes nerve fibers, which are coiled around the blood vessels, to release chemicals causing pain and inflammation.
A vicious cycle develops: The inflammation makes the blood vessels enlarge even more, making the pain only worse. When this chain-reaction process goes on for an hour or two, it achieves a new threshold.
"It's called 'central sensitization,' and it tends to perpetuate the headache," explains Seymour Solomon, MD, director of the Montefiore Headache Unit at Albert Einstein College of Medicine in the Bronx, N.Y. At that point, the chain-reaction of pain begins traveling along nerve pathways throughout the head, to the base of the neck and to the spine.
That's when everything starts hurting, Solomon tells WebMD. The pain-nerve cells are stuck in the "on" position. The slightest touch or movement hurts. Even the pulse of blood in your brain causes pain. Your intestinal system gets thrown out of whack, too, by the onset of nerve chemicals. You feel nauseous, you throw up, you get diarrhea. Your hands and feet grow cold. The color drains from your face.
There's nothing pretty about having a migraine.
Not everyone has this threshold or central sensitization effect, researchers say. Luckily, these patients can take existing painkillers such as Motrin, Advil, Excedrin, or certain prescription pain drugs. These are nearly 100% effective in kicking their headaches, says Solomon.
But most people with migraines need more effective drugs. They must take them before the headache lasts an hour. After that, some relief will come, but usually not enough.