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  • Migraines are more than just headaches.

  • They're pre-headaches, post-headaches, sensitivities, nausea, fatigue and can even bring on food cravings.

  • But most of all they are painful and frustrating for those who suffer from them.

  • For years they were misunderstood, but now we know it comes down to two main things,

  • your genes and your brain.

  • To really understand why migraines are so much more than headaches, first we have to know what headaches are.

  • My name is Rashmi Halker Singh.

  • I'm a fellowship trained board, certified headache neurologist here at Mayo Clinic.

  • I'm also the headache fellowship program director here at Mayo Clinic in Arizona.

  • There's actually a huge book called the International Classification of Headache Disorders, which

  • has maybe 300 different diagnoses of different types of headache.

  • So when we say headache, all we mean by that is pain above the neck.

  • And yes, migraines are pains above the neck so they are headaches, but again, suffering

  • from a migraine attack is much more than just having a headache.

  • So migraine is actually a problem of brain dysfunction.

  • It's a genetic disorder that is very common.

  • So by diagnostic criteria you need to have recurrent headaches, whether it happened infrequently

  • or frequently, lasting 4 to 72 hours without medication.

  • And then in addition to that, the pain has to have at least two of the following four symptoms.

  • The pain needs to be moderate or severe in intensity, and more intense on one side of the

  • head, throbs or pulses, and gets worse with activity.

  • But to stay on theme, a migraine is more than just experiencing pain.

  • You also have to have either a sensitivity to light or sound or nausea.

  • In fact, migraine attacks come in four stages with a painful headache being just one of them.

  • Before the headache stage, some people, about one fourth of migraine sufferers, will experience

  • what is called an aura.

  • When someone has a visual aura, they will see light spots, jagged lines, things like that in their vision.

  • Sometimes people will have a sensory aura as well in which they'll have like pins and

  • needles, tingling sensation up one limb.

  • And again, this typically lasts 5 to 60 minutes and is typically followed pretty much

  • immediately by the headache.

  • But before that, migraine sufferers will experience a prodrome, the first stage in the migraine attack.

  • This stage can last an entire day and includes symptoms like increased yawning, trouble concentrating,

  • increased urination and even cravings for things like chocolate.

  • Finally after the headache phase has ended a lot of my patients will tell me,

  • you know, Doc, I have this like headache hangover.

  • And that's what we would call a Migraine postdrome.

  • This is not fully understood exactly just yet, but we think it's probably a recovery phase within the brain.

  • And they might feel just really tired or fatigued or still have trouble concentrating.

  • Just kind of still recovering from the whole episode.

  • So when we think about Migraine, those would be the four phases.

  • Most of what we know has to do with the pain phase.

  • And what we know is not a lot.

  • It was once thought that migraines were caused by constriction and dilation of the blood

  • vessels that supply blood to the brain...

  • But we know that's not the case anymore.

  • We know that Migraine is actually a problem of brain dysfunction.

  • It originates from the brain itself.

  • And it's a problem of pain processing.

  • And there's a whole host of different components involved in this whole pain processing abnormality.

  • And because of that, there's lots of different genes involved as well.

  • A few genes have been identified, but we're still learning more about this.

  • So we know that genes are a part of migraines, you can be genetically predisposed to have these painful headaches.

  • And researchers have identified the part of the brain involved with migraines and the

  • lingering pain associated with them.

  • Really a lot of our emphasis on migraine has to do with something called the trigeminal

  • nucleus Caudalis, which is, something in the brainstem that's really important for pain processing.

  • And when a migraine attack occurs, there are what we'd call trigeminal

  • afferents or nerve endings that also become activated and they will release CGRP.

  • CGRP stands for Calcitonin Gene-Related Peptide, and when released helps the pain continue,

  • resulting in the long-drawn out painful migraine headache.

  • Now, how this exactly works is still unknown, but the correlation between CGRP's and migraine

  • headaches has actually led to some better treatment options for patients.

  • For the first time in history, we have preventive treatments designed to treat migraine based

  • on what we know as to what happens in the brain during a migraine attack.

  • And a lot of research has shown us that if you, you know, infused CGRP in a patient who's

  • susceptible to having Migraines, you can trigger a migraine attack.

  • And if you block CGRP, that reduction in CGRP levels correlates with migraine improvement.

  • So based on that information, we've been able to develop some new medications.

  • So you know, this is a really exciting time in the migraine world.

Migraines are more than just headaches.

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What Really Causes a Migraine?

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    Jerry Liu posted on 2019/08/01
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