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Causes
By Mayo Clinic staffAlthough much about the cause of migraines isn't understood, genetics and environmental factors seem to both play a role.
Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway. Imbalances in brain chemicals, including serotonin — which helps regulate pain in your nervous system — also may be involved.
Serotonin levels drop during migraine attacks. This may trigger your trigeminal system to release substances called neuropeptides, which travel to your brain's outer covering (meninges). The result is headache pain.
Migraine headache triggers
Whatever the exact mechanism of the headaches, a number of things may trigger them. Common migraine triggers include:
- Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen. Others have an increased tendency to develop migraines during pregnancy or menopause. Hormonal medications — such as oral contraceptives and hormone replacement therapy — also may worsen migraines, though some women find it's beneficial to take them.
- Foods. Some migraines appear to be triggered by certain foods. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; aspartame; overuse of caffeine; monosodium glutamate — a key ingredient in some Asian foods; salty foods; and processed foods. Skipping meals or fasting also can trigger migraine attacks.
- Stress. Stress at work or home can instigate migraines.
- Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Unusual smells — including pleasant scents, such as perfume, and unpleasant odors, such as paint thinner and secondhand smoke — can also trigger migraines.
- Changes in wake-sleep pattern. Either missing sleep or getting too much sleep may serve as a trigger for migraines in some individuals, as can jet lag.
- Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
- Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
- Medications. Certain medications can aggravate migraines, especially oral contraceptives and vasodilators, such as nitroglycerin.
References
- NINDS Migraine information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/migraine/migraine.htm. Accessed March 28, 2011.
- Cutrer FM, et al. Pathophysiology, clinical manifestations, and diagnosis of migraine in adults. http://www.uptodate.com/home/index.html. Accessed March 28, 2011.
- Boes CJ, et al. Headache and other craniofacial pain. In: Bradley WG, et al. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008. http://www.mdconsult.com/books/page.do?sid=1155758096&eid=4-u1.0-B978-0-7506-7525-3..50111-4&isbn=978-0-7506-7525-3&uniqId=240648610-3. Accessed May 1, 2011.
- Migraine. National Headache Foundation. http://www.headaches.org/education/Headache_Topic_Sheets/Migraine. Accessed March 30, 2011.
- Headache diagnosis and testing. American Headache Society. http://www.americanheadachesociety.org/assets/NAP_for_Web_-_Headache_Diagnosis_&_Testing.pdf. Accessed April 1, 2011.
- Headache: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/headache/headachehope.pdf. Accessed April 1, 2011.
- Migraine. Journal of the American Medical Association. 2009;301:2608.
- Calhoun AH. Estrogen-associated migraine. http://www.uptodate.com/home/index.html. Accessed March 28, 2011.
- Hormones and migraines. National Headache Foundation. http://www.headaches.org/education/Headache_Topic_Sheets/Hormones_and_Migraine. Accessed March 30, 2011.
- Bajwa ZH, et al. Acute treatment of migraine in adults. .http://www.uptodate.com/home/index.html. Accessed March 28, 2011.
- SSRIs, triptans and serotonin syndrome: What is the risk of serotonin syndrome in migraine? American Headache Society. http://www.achenet.org/education/patients/SSRIsTriptansandSerotoninSyndrome.asp?print=y. Accessed April 1, 2011.
- Keeping a headache diary can help your doctor help you. National Headache Foundation. http://www.headaches.org/pdf/How_Keep_Headache_Diary.pdf. Accessed April 1, 2011.
- Gilmore B, et al. Treatment of acute migraine headache. American Family Physician. 2011;83:271.
- Migraine prevention: A guide to the latest methods and treatments. National Headache Foundation. http://www.headaches.org/educational_modules/migraine_module/page_home.htm. Accessed March 31, 2011.
- Fenstermacher N, et al. Pharmacological prevention of migraine. British Medical Journal. 2011;342:540.
- Bajwa ZH, et al. Preventive treatment of migraine in adults. http://www.uptodate.com/home/index.html. Accessed March 28, 2011.
- Cruse RP. Management of migraine headache in children. http://www.uptodate.com/home/index.html. Accessed March 28, 2011.
- Chaibi A, et al. Manual therapies for migraine: A systematic review. Journal of Headache and Pain. 2011; epub Feb. 5.
- Exertional headaches. National Headache Foundation. http://www.headaches.org/education/Headache_Topic_Sheets/Exertional_Headaches. Accessed March 31, 2011.
- FDA approves Botox to treat chronic migraine. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm229782.htm. Accessed April 14, 2011.
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