Migraines: The Puzzle Pieces We’re Still Missing

By Inessa Sevantsian

As I prepared to begin my investigation on this neurological condition, I felt a pulsating pain in my left temple and my vision started to blur, immersing me into the reality of this disabling condition. Migraines are a neurological disorder that result in intense headaches that last from four hours to up to three days, affecting about 12% of the population (Burch et. al. 2019). One hypothesis of the cause of migraines is an increase in the levels of cortisol, a stress hormone released by the adrenal gland, which increases stress levels particularly in the morning and affects the body’s metabolism, causing an increase in blood pressure and migraine attacks. There is strong evidence of sleep disruptions and disorders being associated with the frequency and severity of migraines in sufferers. Data shows that migraine-sufferers are three times more likely to have insomnia and sleep-related disorders than a non-migraine sufferer, indicating a bidirectional relationship between the two (Amiri et. al. 2022).

Migraines are typically divided into four distinct phases: premonitory symptoms, aura, headache, and postdrome. The initial phase of premonitory symptoms occur up to 24 hours before a migraine onset and often includes symptoms such as increased fluid retention or output, mood changes, yawning and cravings (National Institute of Neurological Disorders and Stroke). The aura is often described as a sensation of light flashes, dark spots or a feeling of unusual discomfort that signals an oncoming migraine taking place. The headache phase is the gradual build up of the pain of a migraine, which is possible to occur without a headache. Postdrome is the final phase of a migraine, which consists of the feeling of being tired or exhausted following a migraine, lasting up to one day before returning to feeling healthy again (National Institute of Neurological Disorders and Stroke).

The pain level of a migraine can vary based on whether it is with or without an aura, and whether it is a chronic or new onset of a migraine. Migraine with an aura, also known as a classic migraine, includes neurological symptoms and blurred or temporary loss of vision, which is usually accompanied by pain. The pain is often described as a moderate to severe throbbing or pulsating on one side of the temple, caused by the activation of the nerve fibers within the meninges (National Institute of Neurological Disorders and Stroke). A migraine without aura is a more common form of a migraine and is described as pain on one side of the head without warning and is accompanied by nausea, blurred vision, and sensitivity to light (National Institute of Neurological Disorders and Stroke). Migraines are considered the second most disabling condition in the world due to the impact they have on the quality of life of individuals (Burch et. al. 2019).

Figure 1: Frontal Cortex lesions in patient suffering from migraines

Researchers have examined the structural differences in the brains of migraine-sufferers and non migraine-sufferers, revealing that the certain population of subjects studied, individuals who suffered migraines exhibited an increase in white matter lesions in the brain (Negm et. al. 2018). The presence of these lesions may be attributed to the demyelination of the neurons in the brain, similar to the process that occurs in patients who suffer a stroke or have multiple sclerosis (Negm et. al. 2018). More specifically, they are known as white matter hyperintensities, which develop overtime in individuals who suffer migraines with an aura more than those without, and are seen to have a positive correlation with the intensity of the headache pain (Negm et. al. 2018). As seen in Figure 1, the arrows pointing to the white structures in the frontal cortex are lesions that are found in a patient who suffers from migraine without aura for six years and is not responding to any treatment (Negm et. al. 2018). Although these lesions do not pose a serious threat to patients, they are noted outcomes linked to the painful migraine attacks, as a result of the increase in inflammatory response and neuronal activation in white matter brain regions.

Present day research shows that migraines are not likely to occur spontaneously and are usually associated with some common triggers, stress being the most common one (Peroutka 2014). Some studies indicate that an individual with chronic migraines may have a strong association with stress. Stressors in life can include hormonal changes, skipped meals, odors, and light exposure which are possible triggers that are common in the population who suffer migraines (Ruschel and Jesus 2023). While the primary cause and leading trigger of migraines is yet to be discovered, current research points more toward triggers that are within our everyday lives and may be challenging to identify, which adds onto the mystique of migraines. 

Works Cited

Amiri, Parastoo, et al. “Migraine: A Review on Its History, Global Epidemiology, Risk Factors, and Comorbidities.” Frontiers in Neurology, U.S. National Library of Medicine, 23 Feb. 2022,www.ncbi.nlm.nih.gov/pmc/articles/PMC8904749/#:~:text=In%20a%20study%20on%20the,important%20migraine%20trigger%20(87). 

Burch, Rebecca C, et al. “Migraine: Epidemiology, Burden, and Comorbidity.” Neurologic Clinics, U.S. National Library of Medicine, 27 Aug. 2019, pubmed.ncbi.nlm.nih.gov/31563224/.

“Migraine.” National Institute of Neurological Disorders and Stroke, U.S. Department of Health and Human Services, 11 July 2023, www.ninds.nih.gov/health-information/disorders/migraine. 

Negm, Mohamed, et al. “Relation between Migraine Pattern and White Matter Hyperintensities in Brain Magnetic Resonance Imaging.” The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, U.S. National Library of Medicine, 10 Sept. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6133060/. 

“NINDS CRC Chronic Migraine Treatment Trial.” National Institute of Neurological Disorders and Stroke, U.S. Department of Health and Human Services, 25 July 2022, www.ninds.nih.gov/health-information/clinical-trials/ninds-crc-chronic-migraine-treatment-trial. 

Peroutka, Stephen J. “What Turns on a Migraine? A Systematic Review of Migraine Precipitating Factors.” Current Pain and Headache Reports, U.S. National Library of Medicine, 18 Oct. 2014, pubmed.ncbi.nlm.nih.gov/25160711/.