Migraines Are Not Just Headaches

Last year, I was diagnosed with chronic migraines. This was in the middle of my junior year, which led to an extended absence from school for many months. Something as simple as standing or looking at my phone felt impossible. I can still recall my first migraine attack as clear as day, and I cannot describe the head pain I went through. It was so severe that I went to the hospital and was admitted and stayed for a week, getting MRIs and CT scans. I slept for the entire week, until one medication finally worked and I was discharged. I thought it was a freak thing, and I wouldn't get another migraine, but oh boy was I wrong. Little did I know my migraine journey had just begun, and I would suffer from chronic migraines for months to come, and face debilitating complications.

You may be wondering, "What is a migraine? Isn't it like a bad headache?"

Before I had suffered from migraines, I too thought it was just a bad headache. I didn't realize the severity of it, and I didn't know how it could impact someone's day to day life, until I experienced them. Migraines are a neurological condition that are frequently characterized by intense, debilitating headaches. In my case, it was accompanied by nausea, vomiting and extreme sensitivity to light and sound.

This is a visual representation of what it is like to experience double vision, which I frequently experience with migraines. 

The causes of migraines aren't fully understood, but genetics appear to factor in. Migraines typically affect women, and it does run in families (it runs in my family). Familial hemiplegic migraine (FHM) has been linked to showing an autosomal dominant pattern of inheritance, and is usually heterogeneous. There are three main causative genes, CACNA1A, ATP1A2, and SCN1A which have been identified through family pedigrees. These three main genes encode for ion channels or ion transport proteins, which lead to the conclusion that HM is a channelopathy. Also, changes in the brainstem and its interactions with one of the nerves (the trigeminal nerve, a major pain pathway) could also be involved. There are lots of unknowns with migraines, and there are so many triggers that could lead to a migraine attack. Factors like hormonal changes, drinking alcohol, stress, sleep changes, weather changes, foods and food additives could lead to an attack. In my case, migraine attacks aren't triggered by anything in particular, as I would suffer from attacks weekly and for days without any medications.

The trigeminal nerve, which is a pain pathway that leads to the face 

There is one aspect of the migraine pain theory that explains that migraine pain happens due to waves of activity by excitable brain cells. The neurotransmitter serotonin plays a role in communication between nerve cells, which can result in the narrowing of blood vessels throughout the body.

Since migraines commonly affect women, changes in estrogen levels can also theoretically lead to migraines. For women, estrogen levels naturally increase during fertile years, and decrease afterwards. Women of childbearing age also experience monthly changes in hormonal levels, which leads to an assumption that migraines can be associated with fluctuating hormonal levels. Some researchers believe that when estrogen levels rise and fall, contractions in blood vessels may be off, which leads to throbbing pain. However, other data suggests that lower levels of estrogen can make the facial and scalp nerves sensitive to pain.

Estrogen can affect serotonin levels, the trigeminal nerve and cause mood changes 

So you might be wondering how migraines are treated. There are a ton of medications you can take to relieve current migraine symptoms.

Typically, there are two medication types that are used to treat migraines. Treatment choices depend on the frequency and severity of headaches. Usually doctors will try to combat migraines at home with over the counter and prescription pain relievers. Excedrin is also a popular medication used, but it usually only works against mild migraines. In hospitals, you will typically receive an IV and be treated with medications such as IV Tylenol or other pain relievers, anti nausea drugs and possibly opioids. Dihydroergotamine (D.H.E.) is a popular medication given in hospitals, but can have side effects of its own such as high blood pressure and vomiting/nausea.

How DHE helps to relieve migraines

If you suffer from frequent migraines like I do, preventative medications can be used. The goal of these medications is aimed at reducing how often you get a migraine and how severe the attacks are. Medications that do this include blood pressure lowering medications (beta blockers), antidepressants (amitriptyline), anti-seizure medications (topamax), and botox injections. Botox works by being injected around pain fibers that are involved with migraines, and Botox is placed in the nerve endings which blocks the realize of chemicals involved in pain transmission. This prevents pain networks from firing, leading to migraine relief.

With a diagnosis of migraines, it might seem like the end of the world. I promise you it is not, you just need to learn how to do things differently and realize that you might be dealing with this condition your entire life. You may need to change your daily routines and realize your journey might be challenging, but it is important to not let it discourage you. You can make modifications, but it is important to not give up on reaching your goals in life.

June is migraine awareness month