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The Science Behind Migraines

With over two decades of experience in medicine, Melissa Flagg writes patient education articles, keeping you informed about your health.


Everyone has the occasional headache, but about 10% of the population worldwide suffers from migraines. Migraines are one of those things that most people do not fully understand until they have experienced one. I am one of the unlucky 10% that suffers from them almost daily.

What Is a Migraine?

I am sure everyone reading this knows what a migraine is, but here is a brief definition:

Migraine: a severe headache localized to one side of the head associated with a pulsating pain, nausea, sensitivity to light and sound, which can last anywhere from four to 72 hours and sometimes longer.

Migraine severity can range from a dull throb to excruciating. The excruciating migraines are the ones with the infamous pounding hammer in the head, nausea and vomiting, extreme sensitivity to sound, and the vampire-like aversion to light.

These headaches tend to get worse as they progress, and the sufferer will feel one of two ways. They will either want to bang their head against a wall or crawl into bed and not move. Sometimes even breathing feels like it’s making the pain worse.

Four Stages of a Migraine

While not all migraine sufferers experience them, there are four stages of development associated with migraine headaches.

1. Prodrome

The prodrome is the first stage and occurs hours or days before the actual pain starts. Prodrome symptoms include any or all of the following:

  • Euphoria
  • Scotoma (partial loss of an area in the peripheral vision)
  • Disorientation
  • Aphasia (impairment of language ability, which can vary from not being able to remember words to not being able to speak, read or write.)
  • Photosensitivity (light sensitive)
  • Altered Mood
  • Depression
  • Fatigue
  • Irritability
  • Yawning (excessive)
  • Excessive sleepiness
  • Cravings for certain foods (one of the most common is chocolate)
  • Stiff muscles (especially the neck)
  • Dizziness and/or vertigo
  • Hot ears
  • Constipation or diarrhea
  • Increase or decrease in urination

This is one of the main reasons a migraine diary can be helpful. Knowing what prodrome symptoms you have prior to a migraine can be invaluable in stopping the migraine before it even starts.

The trapezius muscle is the most common neck muscle affected by the prodrome.

The trapezius muscle is the most common neck muscle affected by the prodrome.

My Prodrome Experience

For me, the first stage of a migraine starts with irritability, yawning, aphasia (I typically forget medical information that is normally second nature to me), and stiff neck muscles. You might notice all of these are also PMS symptoms. For women, the monthly menstrual cycle can exacerbate not only the frequency but the severity of these headaches.

2. Migraine Auras

The next phase of the migraine is the aura. The aura only affects about 20 to 30 percent of migraine sufferers and gradually builds in intensity over a period of 5 to 20 minutes.

The aura can sometimes be mistaken for an ocular migraine, a migraine that affects the eye only with no headache. The main difference between the aura and an ocular migraine is that the aura involves both eyes, whereas the ocular migraine affects only one eye.

The headache starts either during the aura or within an hour of the end of the aura. In silent migraines, there is no aura; the prodrome is the only warning.

An example of what an aura might look like

An example of what an aura might look like

3. The Migraine

The third phase is, of course, the migraine itself. The pain is an intense, pounding, or throbbing sensation. In typical migraines, it is located on one side of the head and starts gradually.

The pain will peak and then start to subside. All of this can last from 2 to 72 hours or even longer in adults. In children, migraines typically last 1 to 48 hours.

Atypical migraines can be located anywhere and can be a throbbing sensation or excruciating dull ache.

The pain is exacerbated by any movement at all, including breathing. Sometimes I think my heartbeat makes the pain worse. The only thing that really helps in these situations (aside from awesome medication) is sleep.

Why does sleep help? When we sleep, we essentially hit a reset button. The sodium/potassium pumps that govern cell signaling in our brains are completely reset during sleep. Many times, this is enough to also reset serotonin levels and alleviate the headache.

4. Remnants (Postdrome)

Remnants are the residual leftovers from the migraine. It’s a sore sensation where the pain was located. Some people even experience problems in their thought process—you know, the “that-neuron-just-doesn’t-want-to-fire” feeling, otherwise known as “brain farts.” This phase of the migraine is called the postdrome and can last one to several days.

What Happens During a Migraine?

While there are several schools of thought on this issue, the general consensus is that migraines are neurovascular events starting in the brain and spreading to the blood vessels. They are typically the result of blood vessels in the brain constricting and then dilating too quickly. New scientific evidence has shown this constriction, and subsequent dilation is triggered by a drop in serotonin levels.

Serotonin is the “feel good” neurotransmitter that affects mood, pain sensation in the brain, and sleep. When serotonin levels drop, the blood vessels in the brain constrict and then dilate rapidly. This dilation is what triggers the migraine; however, the fundamental cause of migraines remains a mystery.

Both sleep and exercise are the brain's reset button. Exercise also raises serotonin levels while causing the release of endorphins, the brain's painkillers.

What Triggers a Migraine?

There is much debate over possible migraine triggers. Stress, food (including chocolate and MSG), fatigue, hunger, weather changes, and hormones are just a few of the possible triggers. Menstruation is typically blamed for migraines in women, as is pregnancy and menopause. Scientific research has not been able to consistently prove a connection between these triggers and migraines, however.

What many people don’t know is that muscles in the neck are a common trigger for many headaches, not just migraines. Neck muscles can cause compression in the vertebra just below the skull, specifically C1 (cervical vertebrae one), C2, and C3 (I know this from personal experience).

When compressed, these vertebrae can constrict the flow of the cerebrospinal fluid (the fluid that is supplied to the brain via the spinal cord), which can trigger a drop in serotonin levels, and well you know the rest.

These migraines are considered atypical, and the pain is usually located on one side of the head but near the back of the skull just above the neck. Pushing on one side of the vertebral column near the base of the skull during a migraine can indicate where the migraine was triggered. These headaches have the same symptoms as typical migraines, and they hurt just as bad.

A Brief History of Migraines

Migraines are nothing new. They can actually be traced back to ancient Egypt. In these ancient times, the main treatment for these types of headaches was trepanation.

The skull of a female who survived the trepanning procedure

The skull of a female who survived the trepanning procedure

Trepanning involved drilling holes into the head of the patient in order to allow the evil spirits causing the headache to escape. In the 17th century, William Harvey, and English physician, recommended trepanning as a treatment specifically for migraines.

Egyptian papyrus drawing of a patient with a headache

Egyptian papyrus drawing of a patient with a headache

Some patients did actually survive these “treatments.” However, the majority of those who underwent trepanning died of infection. In 1868, the first vasoconstrictor was used successfully to treat migraines, alleviating the need for the barbaric procedure.


^ Ayata, Cenk; Lauritzen, Martin (2015-07-01). "Spreading Depression, Spreading Depolarizations, and the Cerebral Vasculature". Physiological Reviews. 95 (3): 953–993. ISSN 1522-1210. PMC 4491545 . PMID 26133935. doi:10.1152/physrev.00027.2014.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2013 Mel Flagg COA OSC


Mel Flagg COA OSC (author) from Rural Central Florida on April 01, 2013:

lol I love the science-y stuff!! :D

Zulma Burgos-Dudgeon from United Kingdom on April 01, 2013:

My daughter's a sufferer and I'll definitely be sending her this link.

As usual, full of fun, science-y stuff.