What causes migraine attack?

A migraine is more than simply a headache. It can be very painful and debilitating with a wide variety of symptoms. We will talk through which migraine triggers that may apply to you so you have a better chance of avoiding them.

Understanding migraines

Migraines tend to involve a throbbing pain on 1 side of the head although this can spread to the neighboring side of the brain. A lot of people have additional symptoms including disturbed vision, sensitivity to light, sound and smells as well as feeling and being sick. Migraines are very common affecting 1/5 women and 1/15 men.

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There are 3 main types of a migraine attack

Migraine without aura - This represents the majority (70-90%) of migraines. Attacks last 4 hours to 3 days. There is usually a throbbing pain on one side of the head making it difficult to continue with everyday activities. Sensitivity to light, sound and feeling nauseous are common.
Migraine with aura - This condition is experienced by 10-30% of migraine sufferers. Many/all of the symptoms of migraine without aura are present as well as additional neurological symptoms (commonly visual disturbances) developing within 5-20minutes and lasting less than 1 hour. It is also known as ocular migraines or ophthalmic migraines.
Migraine aura without headache - Auras or other symptoms are present without headaches.

Several theories exist regarding the science behind migraines. Ultimately migraines involve abnormal states of brain activity. There is a change in the chemicals, nerves and blood vessels in the brain. While there is no cure for migraines, there are certain triggers, unique to the individual that can be avoided and a variety of treatment options.

Migraine Causes and Treatment

Triggers of migraines

While genetics plays a role this often combines with triggers to elicit a migraine attack. Keep a diary for at least 8 weeks to help determine the cause of your migraines and distinguish them from simple headaches. Try to record:

date
time
duration
What you were doing before
Symptoms
Any medicines you took

Triggers can be quite diverse and unique to each sufferer. Identifying triggers and avoiding suspected triggers one at a time and seeing the effect can confirm your suspicions. Some common migraine triggers are listed below:

Stress and other extremes of emotion - Stressful life events in some people or in the recovery period from stress migraines can become worse. Shock, excitement, anxiety and depression can spark off a migraine.
Undersleeping or oversleeping - Most healthy adults need 7-9 hours of sleep. Changes in these hours or disturbed sleeping patterns can trigger a migraine so it is important to get into a healthy sleep routine.
Lack of food or water - Eating regularly and avoiding sugary snacks which cause a rise and slump in blood glucose may be key in avoiding a migraine. If you wake up with migraines it may be worth having a snack before you head to bed. Hydration is also important. Aim for 2L a day. This equates to about 8 glasses of water a day.
Food and drink - Potential triggers are tyramine rich substances including wine and soft cheese. Other foods including citrus fruits, chocolate and caffeine rich substances may be a trigger. Craving sugar may be an early sign a migraine is underway rather than being a trigger. Certain diets such as gluten-free diets may help.
Hormone changes in women - Migraines may be linked to a woman’s period occurring a few days before, during or up to a few days after. This is referred to as a menstrual migraine. The menopause can worsen migraines.
Medications - Hormonal contraception, hormone replacement therapy and some sleeping tablets can be triggers of migraines.
Environment - Uncomfortable environments such as loud, stuffy or environments with bright flashing lights may trigger a migraine.

Migraine treatments

In addition to changing to a healthier lifestyle, medication can also help to ease the symptoms of migraines or prevent the likelihood that they occur:

Painkillers - Over-the-counter painkillers such as paracetamol, aspirin or ibuprofen can help if taken early at the first signs a migraine is happening. However avoid taking these medications at high doses for a prolonged period as NSAID overuse can lead to stomach ulcers and can actually make migraines worse. If your migraines cannot be sufficiently managed with painkillers speak to your doctor who can prescribe other medications.
Triptans - This class of medications are believed to work by reversing brain changes that may cause migraine attacks. At the start of a migraine blood vessels dilate and triptans act by causing vessels to narrow.
Antiemetics - These substances prevent you feeling sick and work better in combination with painkillers and triptans.
Propranolol, Topiramate and Amitriptyline - These drugs can be used to prevent the likelihood of migraine attacks occurring. However there are certain contraindications for each of these drugs.
Other - Alternatives to try include acupuncture or botox injections to nerves in the face and neck related to migraine reactions. TMS may be another option.

It may take some weeks before an improvement is seen. Sharing your migraine diary with your doctor can help to gear treatment most appropriate to you.