Migraines are complex and involve much more than just a headache. They can include pre-headache and post-headache phases, sensitivities, nausea, fatigue, and even food cravings. For those who experience them, migraines are not only painful but also incredibly frustrating. Although they were misunderstood for many years, we now know that migraines are influenced by genetics and brain function.
To grasp why migraines are more than just headaches, it’s important to first define what headaches are. According to Rashmi Halker Singh, a board-certified headache neurologist at Mayo Clinic, headaches refer to pain above the neck. The International Classification of Headache Disorders lists around 300 different types of headaches. While migraines fall under this category, they involve much more than just head pain.
Migraines are considered a form of brain dysfunction and are recognized as a common genetic disorder. To diagnose migraines, individuals must experience recurrent headaches lasting between 4 to 72 hours without medication. The pain must include at least two of the following symptoms: moderate to severe intensity, more intense on one side of the head, throbbing or pulsating quality, and worsening with activity.
Migraines involve more than just pain; they also include sensitivity to light or sound and nausea. Migraine attacks progress through four stages, with the headache phase being just one of them. Before the headache, about one-fourth of migraine sufferers experience an aura, which can manifest as visual disturbances like light spots or jagged lines, or sensory symptoms such as tingling sensations. This aura typically lasts 5 to 60 minutes and is usually followed by the headache.
The first stage of a migraine attack is called the prodrome, which can last an entire day and may include symptoms such as increased yawning, difficulty concentrating, increased urination, and cravings for specific foods. After the headache phase, many patients report experiencing a “headache hangover,” known as the migraine postdrome. This phase is not fully understood, but it is believed to be a recovery period for the brain, during which individuals may feel fatigued or have trouble concentrating.
Understanding these four phases is crucial to comprehending migraines. Historically, it was thought that migraines were caused by the constriction and dilation of blood vessels in the brain. However, we now know that migraines originate from brain dysfunction and involve abnormalities in pain processing. Various genes have been identified as playing a role in migraines, and researchers continue to explore this genetic predisposition.
A significant focus in migraine research is on the trigeminal nucleus caudalis, a part of the brainstem crucial for pain processing. During a migraine attack, trigeminal nerve endings become activated and release Calcitonin Gene-Related Peptide (CGRP), which contributes to the prolonged pain associated with migraines. While the exact mechanisms are still being studied, the relationship between CGRP and migraines has led to the development of new treatment options.
For the first time, we have preventive treatments designed to address migraines based on our understanding of brain activity during an attack. Research has shown that infusing CGRP in susceptible individuals can trigger a migraine, while blocking CGRP can lead to improvements in migraine symptoms. This represents an exciting advancement in the field of migraine treatment.
Engage in a seminar where you will explore the four stages of a migraine. Work in groups to create a presentation that explains each stage, including prodrome, aura, headache, and postdrome. Use visual aids and real-life examples to illustrate how these phases manifest in individuals.
Participate in a workshop focused on the genetic aspects of migraines. Research and present on specific genes linked to migraines and discuss how genetic predisposition can influence the severity and frequency of migraine attacks. Collaborate with classmates to create a genetic profile of a hypothetical migraine patient.
Analyze a series of case studies that detail different migraine experiences. Identify the symptoms, triggers, and phases experienced by each individual. Discuss in small groups how these cases illustrate the complexity of migraines beyond just headaches, and propose potential treatment plans based on current research.
Engage in a role-playing activity where you simulate various migraine triggers and their effects on individuals. Each student will take on a role, such as a migraine sufferer, a neurologist, or a researcher, to explore how lifestyle, environment, and genetics contribute to migraine onset and management.
Conduct research on the latest advancements in migraine treatments, focusing on CGRP inhibitors. Prepare for a debate where you will argue for or against the effectiveness and accessibility of these treatments. This activity will help you understand the scientific and ethical considerations involved in migraine management.
Migraines are more than just headaches; they encompass pre-headaches, post-headaches, sensitivities, nausea, fatigue, and even food cravings. Most importantly, they are painful and frustrating for those who experience them. For years, migraines were misunderstood, but we now recognize that they are influenced by genetics and brain function.
To understand why migraines are more than just headaches, we first need to define what headaches are. My name is Rashmi Halker Singh, and I am a board-certified headache neurologist at Mayo Clinic, where I also serve as the headache fellowship program director.
There is a comprehensive resource called the International Classification of Headache Disorders, which includes around 300 different diagnoses of headache types. When we refer to headaches, we mean pain above the neck. While migraines are classified as headaches, experiencing a migraine attack involves much more than just head pain.
Migraines are a form of brain dysfunction and are considered a common genetic disorder. According to diagnostic criteria, individuals must experience recurrent headaches, which can occur infrequently or frequently, lasting between 4 to 72 hours without medication. Additionally, the pain must include at least two of the following four symptoms: moderate to severe intensity, more intense on one side of the head, throbbing or pulsating quality, and worsening with activity.
Moreover, a migraine involves more than just pain; it also includes sensitivity to light or sound and nausea. Migraine attacks progress through four stages, with the headache phase being just one of them. Before the headache, some individuals—about one-fourth of migraine sufferers—experience an aura, which can manifest as visual disturbances like light spots or jagged lines, or as sensory symptoms such as tingling sensations. This aura typically lasts 5 to 60 minutes and is usually followed by the headache.
The initial stage of a migraine attack is called the prodrome, which can last an entire day and may include symptoms such as increased yawning, difficulty concentrating, increased urination, and cravings for specific foods. After the headache phase, many patients report experiencing a “headache hangover,” known as the migraine postdrome. This phase is not fully understood, but it is believed to be a recovery period for the brain, during which individuals may feel fatigued or have trouble concentrating.
When we consider migraines, these four phases are essential to understanding the condition. Historically, it was believed that migraines were caused by the constriction and dilation of blood vessels supplying the brain, but we now know that migraines originate from brain dysfunction and involve pain processing abnormalities. Various genes have been identified as playing a role in migraines, and researchers are continuing to learn more about this genetic predisposition.
A significant focus in migraine research is on the trigeminal nucleus caudalis, a part of the brainstem crucial for pain processing. During a migraine attack, trigeminal nerve endings become activated and release Calcitonin Gene-Related Peptide (CGRP), which contributes to the prolonged pain associated with migraines. While the exact mechanisms are still being studied, the relationship between CGRP and migraines has led to the development of new treatment options.
For the first time, we have preventive treatments designed to address migraines based on our understanding of brain activity during an attack. Research has shown that infusing CGRP in susceptible individuals can trigger a migraine, while blocking CGRP can lead to improvements in migraine symptoms. This represents an exciting advancement in the field of migraine treatment.
Migraines – A type of headache characterized by severe pain, often accompanied by nausea, vomiting, and sensitivity to light and sound. – Migraines can significantly impact daily activities, making it essential to identify triggers and manage symptoms effectively.
Headache – A pain or discomfort in the head or face area, which can vary in intensity and duration. – Frequent headaches can be a sign of underlying health issues that require medical attention.
Symptoms – Observable effects or signs of a condition or disease, which help in diagnosis and treatment planning. – The symptoms of a viral infection can include fever, fatigue, and muscle aches.
Genetics – The study of heredity and the variation of inherited characteristics, often playing a role in the predisposition to certain health conditions. – Genetics can influence an individual’s risk of developing chronic diseases such as diabetes or heart disease.
Brain – The organ in the body responsible for processing sensory information, regulating bodily functions, and enabling thought and emotion. – The brain’s ability to adapt and reorganize itself is known as neuroplasticity.
Dysfunction – An abnormality or impairment in the operation of a bodily system or organ. – Cognitive dysfunction can result from various neurological disorders, affecting memory and decision-making abilities.
Sensitivity – The heightened response of an organism or system to stimuli, which can be physical, chemical, or emotional. – Sensitivity to certain allergens can trigger an immune response, leading to symptoms like sneezing and itching.
Research – The systematic investigation into and study of materials and sources to establish facts and reach new conclusions, particularly in scientific fields. – Ongoing research in neuroscience is uncovering new insights into how the brain processes information.
Treatment – The management and care of a patient for the purpose of combating a disease or condition. – Effective treatment of chronic illnesses often requires a combination of medication, lifestyle changes, and therapy.
Processing – The series of actions or steps taken to achieve a particular end, often referring to how the brain interprets and responds to information. – Sensory processing involves the brain’s ability to interpret and organize sensory input from the environment.
