“What is a migraine headache?” Headache specialist explains diagnosis

Exactly what is a migraine headache?  I get terrible headaches in the front and top part of my head that just kill me sometimes, and no one has been able to help me.  I was thinking that maybe these are migraines and I am causing them somehow by what I do, like what I drink or eat.  Sometimes they seem to come on when I get overly tired.  Do you have any advice?




Greetings Erik,

What is a migraine headache is an important question because not all severe headaches are migraines. The National Headache Foundation estimates that 30 million Americans suffer from migraines on a regular basis, and further that half of people who suffer migraine headaches go undiagnosed.  If so, you might have a lot of company and not know it.

On the other hand, many people say they have migraine headaches simply because they think any severe headache qualifies to be called a migraine.  By not knowing exactly what is a migraine they can undergo the wrong kind of therapy because they are treating the wrong kind of headache.

A migraine is a kind of headache that is usually painful and intensely pounding, that can last from an hour to three days, often accompanied by nausea, vomiting, and visual disturbances such as seeing flashes of light, blind spots or sensitivity to light. The pulsing pain usually begins in the area of the forehead, side of the head or around the eyes, and gradually worsens no matter what is done.  However, any movement, activity, bright light or loud noise can increase the pain and make the headache last longer.  Some people will also note feeling depressed, tense, tired, irritable or restless shortly before the headache develops.  Migraines usually follow a pattern of occurrence that the individual recognizes, as often as every day at a certain time or under a certain set of circumstances, or only once or twice a year.  Men (6%) are less likely to have migraines than women (17%).

The cause of migraine headaches was previously thought to be only related to dilation (widening) of blood vessels.  Now, more current ideas suggest they are caused by a combination of blood vessel enlargement as well as the release of chemicals from nerve fibers that coil around blood vessels. During a migraine headache any of several small arteries that are located on the outside of the skull and just under the skin long the side of the head can enlarge.  This results in the release of a cascade of chemicals that cause inflammation, pain, further enlargement of the artery and worsening of pain for many hours.

Because of these effects on the blood vessels that eventually give rise to a migraine headache some people have found that caffeine (coffee, tea, chocolate) can reduce a migraine headache rather rapidly.  However, if too much caffeine is used or done too often it can lead to a pattern of a daily caffeine headache instead of migraine headaches.

Approximately 15-35% of people who have migraine headaches will see a pattern of lines or shadows in front of their eyes as the headache is beginning; rarely, a person will hear low tones or strange noises, or smell things that are not actually present but originate in the head as a warning sign that a migraine headache is about to begin. This is called an “aura,” and the headache that occurs with an aura is called a “classic migraine.”

An aura can last from a few minutes up to an hour, and seldom longer.  Most often the aura occurs before the headache pain, but it can overlap or even occur after the pain.  Auras usually involve vision; a person might see flashing lights and colors, or might temporarily lose some areas of vision such as your side vision or central vision.  Some auras involve other senses like hearing and smelling sensations that originate from signals generated from within the brain of the individual.

The pain of a classic migraine headache can occur on only one side of the head or both.

However, most people who experience migraines do not have an aura happen to them and their headaches are called a “common migraine.”  The common migraine headache starts more slowly, will only involve one side of the head, lasts longer and tends to be more painful than the classic type.

External factors that set off a migraine headaches

Many people eventually figure out what happens in their external environment to trigger the start of a migraine.  If you can pay close attention to what is going on in your life immediately before your headache starts you might be able to identify the relationship and so you can control, limit, or even avoid these headaches.  Some common migraine headache triggers include:

  • Emotional stress.  Emotional tension is the most common trigger of migraine headaches, either as the sole cause or contributory cause when combined with others listed below.  Stress from a variety of sources, anxiety, excitement, anger, worry, excitement, and fatigue can increase muscle tension and dilated blood vessels throughout the body, but especially in the upper body and head, and can cause or intensify the severity of the migraine.  During any of these strong emotional states certain brain chemicals are released to deal with the stress in a way that is called the “flight or fight response.”  These brain chemical cause changes in the blood vessels of the brain that cause migraines.
  • Sensitivity to certain food, food preservatives and coloring agents or environmental chemicals.  Certain foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), can trigger migraines.   Sometimes food additives such as nitrates (in pepperoni, bacon, hot dogs, luncheon meat) and monosodium glutamate or MSG that is abundantly found in prepared food as well as famously in Chinese food is said to trigger from 25-50% of all migraines.
  • Caffeine.  It appears that some people have a greater or lesser tolerance of caffeine than others.  Hence, some people while having a low caffeine intake will experience a migraine headache, while others who consume a lot of caffeine do not get migraines.   Regardless, excessive caffeine intake or abrupt caffeine withdrawal will cause a headache for sensitive people whose blood vessels are sensitive to caffeine. .
  • Rapid weather changes.  Fast moving storm fronts, rapid changes in barometric pressure, abrupt changes in altitude (as with a descending airplane or riding an elevator), or exposure to strong winds during a storm, can all trigger a migraine.
  • Fatigue.  Both forms of fatigue (lack of sleep and being overly tired from excessive physical activity) can lead to a migraine headache.
  • Hunger.  It has long been known that not eating at regular intervals and skipping meals can allow the blood sugar levels to drop to stressful levels.  This temporary hypoglycemia can cause many abnormal changes in body chemistry such as blood vessel changes in the brain that lead to a migraine headache.
  • Changes in normal sleep pattern.  Different than simple fatigue, this means getting a sufficient amount of rest but having it represent a stressful alteration of internal body chemistry or metabolism from the simple fact that sleep occurs at a different time.

What is a migraine headache diagnosis?

The diagnosis of a migraine headache is made primarily by taking a history, and the signs and symptoms that are commonly found.  For those who experience a sensory aura, typically visual, along with a one-sided headache, the migraine diagnosis is fairly easy to make. However, the International Headache Society recommends what is known as the to diagnose migraines that occur without an aura. This means:

  • 5 or more such headache attacks have occurred in the person’s life.
  • 4 hours to 3 days is the common duration for the headaches.
  • At least 2 of following symptoms are present: one-sided headache location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity is necessary to control the headache.
  • At least 1 additional symptom: sensitivity to light, sensitivity to sound, nausea, vomiting.

Erik, if this “5, 4, 3, 2, 1 criteria” applies to you, or you have an aura before or during your headache, then it is rather safe to say you have a history of migraine headaches.

Using the above triggers, look to see if you can figure out what you are coming in contact with or doing that you can eliminate so that you take control of your migraine headaches.  For example, you mentioned that you think that getting tired seems to bring on your headaches.  Well, you have seen that this is on the list of common migraine triggers so you must be careful about this so you do not have to pay the consequences with a bad migraine headache. There might be other things that are also working against you, so do not be satisfied to think you can help yourself just by attending to one aspect of your problem like getting a little sleep.  You must take care of all the triggers you can find, OK?

Good luck to you.  Let me know if I can help you in any other way.  DL