What You Should Know About Migraine

adenosine aspartame auras brain caffeine cgrp elimination diet estrogen headache hormones migraine migraine triggers monosodium glutamate nervous system nitrates nitric oxide serotonin stress trigeminovascular system tyramine Sep 23, 2023

Migraine is more than just a headache. It’s a complex brain disorder that’s often inherited in families.¹

Migraine is the world’s third most common disease. It’s also one of the 10 most disabling illnesses globally. In the U.S. alone, it affects more than 37 million men, women, and children. It’s estimated that migraine costs over 20 million dollars in medical expenses and productivity losses in the country every year.^2,3

Multiple factors can trigger migraines. They include hormones, stress, irregular sleep, bright lights, strong smells, loud sounds, and weather changes. Certain foods cause migraine attacks too.⁴

In this article, we’ll tackle the following aspects of migraine:

Phases and symptoms of migraine
Why migraine happens
Common dietary triggers
Other environmental triggers

So, how do you know if you’re having a migraine and not another type of headache? Keep reading to find out!

Phases and symptoms of migraine

One or two days before a migraine attack, many patients experience non-specific symptoms like frequent yawning, neck stiffness, food cravings, mood changes, and a lack of energy.^1,5 Such symptoms are more common in women than in men; this higher prevalence is likely due to regular variations in sex hormones in females.⁶

Sensory disturbances called auras may occur before or during a migraine attack. They take place gradually and last for up to an hour. They mostly include visual changes, such as flashes of light, blind spots, floating zigzag lines, and even vision loss. Auras can involve the other senses too, as in the case of ringing in the ears. Or they could be motor disruptions — for instance, tingling or numbness in the face, in one hand, or on one side of the body. Language problems, such as mumbling or slurred speech, may arise as well (but less often than other aura types do).^5,7

The core symptom of a migraine attack is a moderate to severe headache lasting for hours to days. Usually, the pain is described as either throbbing or stabbing. In addition, it affects only one side of the head; the attack always affects the same side for many patients. The pain also tends to worsen with head movement. What’s more, the headache typically comes with nausea, vomiting, and increased sensitivity to light and sound.^1,5,7

In most cases, a migraine attack ends in deep sleep. But even after sleeping, the pain can return in the same part of the head. Patients tend to feel the pain again for a few seconds or minutes when they cough or move their head suddenly. Further, they can suffer from fatigue, get dizzy, have trouble focusing, or feel euphoric for up to 24 hours after a migraine attack.^1,5,7

Why migraine happens

In the past, it was believed that migraine resulted from changes in blood flow to the brain. Today, it is understood that such changes do not cause migraine per se, although they may contribute to it.⁸

Instead, current theories suggest that people with migraine have a hypersensitive nervous system. As they overreact to stimuli, they experience waves of brain activity that lead to headache and other migraine symptoms.⁹

The trigeminovascular system (TVS) plays a key role in migraine. This system includes nerves and blood vessels that relay head pain signals to the brain. When TVS nerve cells are activated, pro-inflammatory proteins are released. These proteins spread through the TVS, causing inflammation in pain-sensitive areas of the brain. In turn, the inflammation leads to leaky blood vessel walls, increased blood flow, and ultimately, headaches. Also, when the TVS is repeatedly activated over time, the inflammation makes nerve cells even more responsive to stimuli. This process called sensitization leads to the sustained pain and sensory disruptions that migraine is known for.¹⁰

Certain substances are linked to migraine-related events. They include calcitonin gene-related peptide (CGRP), nitric oxide (NO), serotonin, and estrogen.

CGRP is a protein that causes inflammation and widening of blood vessels in the TVS. It is involved in sensitizing nerve cells as well. High levels of CGRP have been found in the blood of migraine patients.¹¹

NO is an important molecular trigger of migraines. Like CGRP, NO causes blood vessel widening, along with TVS inflammation and sensitization. Plus, NO can increase the production and release of CGRP.¹²

Serotonin, a chemical messenger, narrows TVS nerve endings and blood vessels. It also seems to prevent the release of CGRP. As a result, low levels of serotonin make people more likely to have migraines.^12,13

The sex hormone estrogen influences serotonin production and metabolism. A drop in estrogen causes a decrease in serotonin, which can then lead to migraine. But high estrogen levels in the long term can result in migraine too, by increasing NO production. For women, estrogen levels naturally change monthly and throughout their lives. Such fluctuations may explain why women tend to have migraines more often than men do.^13,14

Common dietary triggers

Studies show that diet plays a role in migraine through several mechanisms. For instance, certain foods can affect inflammation, blood vessels, or the amounts of migraine-related chemicals in the TVS. It’s also important to note that people can have migraines not just by consuming, but also by withdrawing from foods.^15,16

Many people complain about migraines after drinking even small amounts of alcohol, especially red wine. Alcoholic beverages contain histamine. This chemical boosts inflammation all over the body, including the brain. What's more, the ethanol in alcoholic drinks stimulates the release of CGRP.^17,18

Aged cheeses, along with pickled and fermented foods, are known to trigger migraines as well. These foods are high in tyramine, an amino acid that first narrows blood vessels in the brain, and then widens them later.^19,20

Cured meats, such as ham, sausages, and hot dogs, may cause migraine because of their nitrate content. Small quantities of nitrates are found naturally in certain vegetables and drinking water. Synthetic versions of these chemicals are often added to processed meats to preserve their flavor and color. Both natural and synthetic nitrates can lead to the release of NO into the blood and thus widen blood vessels in the brain.^19,21

Fast foods and processed ones (e.g, frozen meals, canned goods, seasoning blends, etc.) are high in monosodium glutamate (MSG), a flavor enhancer. But MSG has been linked to various health hazards, including hypersensitivity and mood disorders. Moreover, it seems that the binding of MSG to receptors in the brain leads to NO release, triggering migraines.^19,22,23

Many sugar-free candies, desserts, and beverages contain aspartame. This artificial sweetener can trigger inflammation, which can worsen pain in the joints and other parts of the body. Aspartame is also believed to cause migraine, most likely by blocking the production and release of chemicals like serotonin.^19,24,25

Finally, another well-known migraine trigger is caffeine, which is found in coffee, tea and chocolate. Caffeine withdrawal can lead to migraines because caffeine blocks the action of adenosine, a brain chemical that widens blood vessels. This means that when regular consumers of caffeine suddenly stop their intake, they may get migraines through a large increase in blood flow to their brain.^19,26

Other environmental triggers

Light triggers migraine for over a third of patients. Among the top sources of migraine-inducing light are sunlight, fluorescent lights, and computer and smartphone screens. There’s some evidence that certain nerve pathways from the eye to the brain get activated at the start of an attack, causing light sensitivity and headaches. It’s also been suggested that special eye cells are highly sensitive to specific light wavelengths, including blue light.^4,27

More than 40 percent of patients report smells as a migraine trigger. Perfumes, pesticides, cigarette smoke, vehicle exhaust, and cleaning products are examples of common odors that cause migraine. These strong smells may trigger attacks by activating brain areas that are also linked to painful stimuli.²⁸

Loud sounds that bring about migraines include traffic noises (road, railway, aircraft, and parking cars). Neighborhood noises like voices, staircase sounds, and footsteps may also lead to attacks. Research shows that people who have headaches from noise also have increased pressure in blood vessels in their temples. These swollen vessels may then activate nerve cells in the TVS, causing the release of proteins like CGRP.^29,30

Weather-related triggers involve temperature and humidity changes. Atmospheric pressure plays a role too: a slight pressure decrease widens brain blood vessels, causing the release of serotonin. Raised levels of blood serotonin then leads to vessel narrowing and the onset of aura. Once serotonin drops, the blood vessels widen quickly, triggering migraine.^29,31

Conclusion

Migraine disables people of all genders and ages worldwide. It comes in phases, and its symptoms vary widely from person to person. A complex disease, migraine results from an oversensitive nervous system. It involves brain inflammation, blood-vessel changes, and the release of certain chemicals. Various factors can trigger these events, leading to migraine.

If you suffer from migraines, you can minimize attacks by avoiding your triggers, especially food culprits. In fact, you can manage not just migraine, but many other illnesses of the body and mind, by paying attention to what you eat. Click here to discover how an elimination diet can optimize your health and daily performance.

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