Migraine Headaches Overview

According to the International Headache Society, there are 129 different types of headache, but the three most common are migraine, (accounting for 31 percent of headache visits to doctors); tension headache, caused by stress (47 percent) and sinus headache, related to sinus infection or hayfever-type allergies (6 percent).

Migraines cause severe pounding, throbbing pain usually on one side of your head, and often nausea and vomiting. Frequently, they strike in the morning, and last from a few hours to two days. Some poor souls get migraines almost daily. Others experience them every few weeks or months. Most migraine sufferers get two to five a month. From 20 minutes to an hour before migraines hit, about 20 percent of people experience strange symptoms (auras) such as flashing lights, blurred vision, blind spots, or peculiar smells.

If you have migraines, you’re probably a woman. Women account for about 75 percent of all migraine sufferers. You also probably get migraines around the time of your menstrual period. Some two-thirds of women with migraines report menstrual headaches, according to endocrinologist Ivy Fettes, M.D., Ph.D., an assistant professor of medicine at the University of Toronto Health Science Center.

In addition, chances are that someone else in your family also has migraines. No clear genetic link has been discovered, but migraines tend to run in families. Finally, you probably had your first migraine as a child or teen (often after years of motion sickness). Migraines typically peak by age 35, and gradually decline after that, one of the great benefits of aging.

It’s still not entirely clear what causes migraines, but here’s what scientists now know: One culprit is the blood vessels in your head. They constrict and expand (dilate) in response to foods, moods, hormones, drugs—all sorts of things. If your nearby pain nerves are sensitive to these changes, you get migraines. The blood-vessel connection explains why so many women get menstrual migraines. Dr. Fettes explains that estrogen dilates the blood vessels in your head. As estrogen levels fluctuate during the menstrual cycle, you get the constriction and expansion that triggers migraines.

In addition, you can also blame your platelets, the blood cells involved in clotting. If you get migraines, your platelets are more likely than average to clump together, a process that releases the brain chemical (neurotransmitter), serotonin. Serotonin, in turn, is involved in triggering migraines.

As if your migraines don’t cause you enough grief, they also increase your stroke risk somewhat. Those overactive platelets might cause a blood clot in your brain. Recently, Yale epidemiologist Kathleen Reis Merikanagas, Ph.D., analyzed data from an ongoing study that has followed 12,000 men and women since the early 1970’s. Among migraine-free women. 2.6 had strokes during the study’s 10-year follow-up period. For women with migraines, the figure was 3.7 percent. For men, the stroke risk was more pronounced: 4.5 percent among men who did not have migraines, 7 percent among those who did. A recent Italian study of 308 people with strokes agreed: Compared with stroke-free controls, those who’d had strokes were almost twice as likely to suffer migraines.