Anatomy Of A Headache

A migraine is like an electrical storm in your brain. Here's what happens when one hits.

The causes of migraine headaches remain as elusive as a cure. In all likelihood, says David M. Biondi, DO, headache division director at the Michigan Head-Pain & Neurological Institute in Ann Arbor, "there's a whole series of events that take place" to cause this monster headache.

We do know that, during a migraine, a signal from the brain activates the trigeminal nerve, the main sensory nerve of the head and face and a major conduit for pain. Trigeminal nerve endings respond to the signal by releasing neuropeptides, inflammatory chemicals that dilate blood vessels and irritate nerves, starting a pain cycle that can last from several hours to several days, explains Dr. Biondi.

"There are changes in the electrical activity of the brain that might contribute to some of the associated effects that some people have, such as dizziness, inability to concentrate, and fatigue so severe that they can feel as wiped out as if they have the flu," he says. "That's because their whole brain is in turmoil during a migraine.

"Studies have shown that there are changes in bloodflow to the brain's cortex and brain stem when a migraine occurs, and the activity remains high in the brain stem even after the migraine is relieved by drugs. One area of the brain stem in particular contains large amounts of the neurotransmitter serotonin, which is widely thought to play a role in migraine. 

There's also decreased bloodflow in the occipital part of the brain—where visual symptoms of migraine originate—that coincides with the beginning of the headache and the aura that some migraineurs experience. The reduced bloodflow lasts for a few hours—along with changes in the electrical activity in that part of the brain—then gradually increases. 

This complex process is one reason that it may take some time for you to find the right medication or treatment to ease your symptoms, and why you may need to take more than one drug combined with various lifestyle changes. 

As scientists learn even more about migraines, more treatments are likely to be identified. And there is the very real possibility that migraines may become a thing of the past.

More from Prevention: 8 Ways To Mitigate Migraine Misery

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