The anatomy of a migraine attack

Scientists have learned a lot in recent years about what happens in the brain to explain the throbbing pain, nausea, heightened sensitivity to light or sound felt during a migraine headache, and the mysterious ‘aura’ that both doctors and scientists use to describe the telltale period, starting up to an hour before a migraine attack, when a person sees dots, wavy lines, flashing lights, blind spots or difficulty with speech, sensation, or movement.

What triggers a migraine attack? 

Although researchers don’t understand exactly what triggers migraine attacks, they do know that certain foods, lack of sleep, changes in weather, and even stress can trigger a migraine attack in 1 in 200 people.

The anatomy of a migraine attack

Neuroscientists now see migraine as firstly a disturbance in nerve function rather than a disorder of the brain’s blood vessels. It is believed that in most patients, a wave of electrical activity passing through a major nerve that collects and transmits signals to the face – the trigeminal nerve – and stimulates the release of chemicals such as CGRP and other substances that cause inflammation, makes the nerves more sensitive to pain, and causes blood vessels near the brain to expand (dilate). This nerve irritation often progresses as an electrical wave from the skin to nerves located centrally in the brain.

The first 20mins are crucial for treatment

The key to treatment is to act quickly to stop the irritation spreading.  In fact anti-migraine drugs can offer relief only in the earlier stages of the attack, but not later, when the pain neurons in the brain have become sensitized. For this reason patients are advised to take medication within 20 minutes of an attack and while migraine pain is still mild.

The wave that turns into a flood

A migraine attack is triggered when a wave of electrical activity which starts in the trigeminal nerve on the side of the face enters the brain and ripples across the surface of the brain. In fact, researchers have been able to demonstrate a possible link between this wave and the experience of ‘aura’ particularly as it spreads across the visual part of the brain. Several drugs used to prevent migraine attacks work by preventing this wave from spreading.

Click on the National Headache Foundation website (www.headaches.org) for additional information.

In an upcoming post, prominent migraine research scientist  Dr. Chad Beyer will explain how the race is on to discover better and safer drugs to diminish migraine pain and prevent future attacks.

Read Part Two – What happens during a migraine attack