June 12, 2025 • 18 mins
Migraines: What causes them? How long do they last? What are the stages? In this episode, we will discuss the history of migraines, the symptoms that are often seen and some of the current treatment options. Tune in to learn more!
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Resources:
National Headache Foundation (US): https://headaches.org/
Migraine Trust (UK): https://migrainetrust.org/
Migraine Australia: https://www.migraine.org.au/
References:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8904749/#s3
https://www.mayoclinic.org/diseases-conditions/migraine-headache/diagnosis-treatment/drc-20360207
https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201
https://www.webmd.com/migraines-headaches/ss/slideshow-celebrity-migraines
https://www.migraineagain.com/6-migraine-books-worth-reading-this-season/
https://headacheaustralia.org.au/what-is-headache/history-of-headache/
https://brainfoundation.org.au/disorders/migraine/
*This podcast is for entertainment purposes only. If you suspect you have a medical condition, please seek out an opinion of a medical professional.*
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
You've been feeling off for the past hour,
(00:02):
struggling to even get a sentence out
and jumbling up words.
You feel pins and needles in your hands,
distracting you as you tried to work,
but you pushed through.
The project was already behind schedule
without you ending the day early.
You start to feel an awful throbbing pain in your head.
The light coming from your computer is too bright.
You start to feel nauseous and run to the bathroom.
(00:22):
You decide to call a friend
and ask them to drive you to the hospital.
(upbeat music)
(upbeat music continues)
Hello and Welcome to Anatomy Of Illness.
Today's episode is about migraines.
(00:44):
Before we get into the condition,
we are going to start with the history.
So why do we know migraines exist?
To start, we are going to begin around 7,000 BC.
This is where we would find evidence of trepanning.
This is the removal of a very small circular part
of the skull.
One of the many reasons suggested for the skulls found
with trepanation holes was because of issues
(01:04):
like migraines and epilepsy,
which we previously discussed in episode 14.
One of the theories behind the reason for the trepanning
is that they believed the pain or other issues
were caused by evil spirits in the head.
Trepanning would be a treatment that would stick around
for quite some time when it came to the treatment
for migraines.
Moving into ancient Mesopotamia around 3000 BC.
(01:25):
This is where migraines would be linked with superstitions.
Migraines were believed to be caused by the evil spirit,
Ti’e, attacking their victims,
which was believed to be the cause
of these migraine symptoms.
Also around this time, we would have the anonymous writing
from an ancient Sumerian poet.
This poet would describe an illness so severe
and a headache so severe that the person suffering from it
(01:46):
wished to be relieved from the pain through death.
Moving on to ancient Egypt.
This is from around 1200 BC with the Ebers papyrus.
This is where we would have the description of migraine pain
and nerve pain as well as severe pain coming on suddenly.
The way they would attempt to cure these migraines
was through the use of a clay crocodile
holding a grain in its mouth.
This would be tied to the scalp with a piece of linen.
(02:08):
The piece of linen had a God's name written on it
as they believed the God could cure the head pain.
What was most likely the reason it helped
was the compression from this procedure.
Moving on to Hippocrates in ancient Greece.
Hippocrates would be the first to comment
on migraines scientifically.
Hippocrates would describe people experiencing bright light
in the right eye after this severe pain
(02:29):
would occur in the head.
This would extend to the entire head area.
Hippocrates would also discuss some of the activities
that could lead to migraines.
He found that they would in some people
occur after exercise or sexual intercourse.
Now we move on to Aretaeus of Cappadocia.
He would be the first to provide a classification
on the different types of headaches.
(02:49):
He classified them as three main types.
Cephalalgia, which with this type,
they were mild and short-term headaches.
Cephalea, this type is more chronic and severe.
And finally Heterocrania.
This was a headache on one side of the head
that occurred suddenly.
These headaches often came with nausea and vomiting,
sweating, sensitivity to light, symptoms in the eyes,
(03:09):
and changes to how fragrances were perceived.
Let's move on to Galen who lived between 129 to 216 AD.
He would write about severe pain
affecting half of the head.
He believed that these were caused by vapors
rising from the stomach and into the head.
This was an idea originally suggested by Hippocrates.
Galen's beliefs are noted with this statement.
(03:30):
“How often do we see the head attacked with pain
when yellow bile is contained in the stomach?
As also the pain forthwith ceasing
when the bile has been vomited.”
This is where we get the name bilious attacks
for the childhood feature of vomiting attacks,
which does happen to have a migraine type nature.
Moving on to the Iranian physician, Razi,
who lived between 854 to 925 AD.
(03:53):
He would write an entire chapter
about migraines and other headaches.
He would also be the first to suggest
that headaches with a sudden and severe onset
were actually likely to be signs of strokes.
Speaking of famous Iranian physicians,
we are moving on to Avicenna.
He is another talented and famous Iranian physician.
He lived between 980 and 1,037.
(04:14):
He would write a chapter on headaches
in his book "Canon of Medicine".
In this, he would describe a kind of headache
that covered the entire head.
The pain was so severe and it came with photophobia,
which is a fear of light or sensitivity to light,
and noise phobia.
This form of headache was made worse by physical activity.
Moving on, we are going to visit with Hildegard of Bingen.
(04:35):
She lived between 1098 and 1180.
She was a nun, a mystic, and an intellectual
in the Middle Ages.
Because who says ladies can't do it all?
She was considered to have exceptional literary
and intellectual powers that would come from her visions.
With these, she left detailed drawings and descriptions
of these visions.
Some have even survived to this day.
With all of the extremely detailed evidence she left,
(04:57):
it gives clear evidence that these visions
were actually caused by migraines.
To be honest, I am stealing that next time I get a migraine,
because vision sounds so much cooler.
During this time, we would also have
some interesting treatments for migraines.
It was the Middle Ages, after all.
These treatments were often drug-soaked poultices
used on the head and scalp.
These were often a mixture of vinegar and opium.
(05:18):
The vinegar was likely to open up
the pores, which allowed for the opium to soak in.
We are going to jump forward all the way to the 17th century.
With Thomas Willis, he would describe his theory
of magrim, which is another word for migraine, back then.
He suggested that they were caused
by the dilation of blood vessels,
stating that the headache symptoms came
from the ascending spasms of the peripheral ends of the nerves.
(05:41):
This is the origins of the vascular theory of migraines.
He would also introduce several other terms and ideas,
like the term neurology.
He would also describe potential causes and triggers
for migraines, these being that migraines were often
hellaraditary, could be triggered
by changes in the weather through season
or atmospheric changes, and diet.
(06:01):
In the late 1770s, we would have Erasmus Darwin,
who happens to be the grandfather of Charles Darwin.
He would make his own comments on migraines.
He believed in the vascular theory of migraines
and would suggest his own treatment.
Centrifuge people who had migraines.
Yes, I really do mean spinning someone very fast,
the idea being that this would get the blood
from someone's head down to their feet.
(06:23):
Personally, I think I would be tasting my lunch
for the second time if I did that during a migraine,
but anyway, moving on to 1873.
This is when Edward Liveing would publish
on megrim, sick headache,
and some allied health disorders,
a contribution to the pathology of nerve storms.
In this, he suggested that there was a clear link
between epilepsy and migraines,
(06:44):
that they were caused by the same thing.
Dysfunctional central nervous system discharges
known as nerve storms.
Moving on to 1888 with William Gowers.
He believed in Liveing's neurogenic theory of migraines
and would suggest for the treatment of migraine,
a healthy diet is important
and would even invent his own treatment
known as Gowers mixture.
This was a mixture of nitroglycerin and alcohol
(07:05):
with a few other interesting ingredients.
He would also recommend the use of marijuana
for the treatment of acute headaches.
He was actually the first person to split treatment
into episodic and prophylactic.
If you have been enjoying this episode,
then make sure to share it with a friend.
So what actually causes migraines?
Well, the cause behind migraines aren't fully understood.
However, there are several theories
behind what could cause them.
It is believed that there are changes in the brainstem
(07:28):
and its interactions between the trigeminal nerve,
which is a major pain pathway.
It is also thought that various chemicals in the brain,
such as serotonin, may be involved.
Serotonin actually helps to regulate pain
in the nervous system.
It is also believed that various environmental factors
as well as genetics contribute to migraines.
So what are the risk factors for being prone to migraines?
There are several risk factors
(07:49):
that make you more prone to having migraines.
These include a family history.
If you have family members who have migraines,
then you are more likely to have them yourself.
Sex, women are three times more likely
to experience migraines than men.
I know, lucky us.
Age, migraines can happen at any age,
occurring most often in adolescents.
Migraine activity normally peaks most often
(08:10):
in the thirties and slows down in the decades afterward.
Hormonal changes.
Migraines are more likely to occur right before
or shortly after you have started menstruating
due to the hormonal changes in your cycle.
Migraines can also change in pregnancy or menopause,
but are generally less likely to happen
after you hit menopause.
But what can trigger a migraine?
(08:30):
When it comes to migraine triggers,
what will cause a migraine will be different for everyone.
However, there are some triggers that are common.
These include hormonal changes in women.
Examples of hormonal changes that can trigger a migraine
include fluctuations in estrogen.
These are at times like before or during periods,
pregnancy, and even in menopause.
Other triggers include various drinks,
like caffeinated beverages.
(08:51):
This is for people who are sensitive to caffeine
or are drinking too many caffeinated beverages.
There is also alcohol, especially wine.
That can be a migraine trigger for some.
Food.
For some people, aged cheeses, salty, or processed food
can trigger migraine symptoms.
Food additives.
Some people will also get migraines from various
food additives, including the sweetener known as aspartame
(09:12):
or even monosodium glutamate.
You may know it as MSG.
Stress.
Having a stressful work or home life
can cause a migraine or several.
Sleep.
Getting either too much or too little sleep
can also trigger a migraine.
So it is good to have a healthy sleep schedule.
Having a set time to go to bed and a set time to wake up
helps to avoid migraines triggered by sleep.
(09:33):
Maybe I'll learn that one day.
Weather changes.
A change in the weather or barometric pressure
can cause a migraine.
So some people get a migraine around storms.
Sensory stimuli.
Bright or flashing lights.
Loud sounds, strong smells.
This can be various things like perfume,
secondhand smoke, paint thinners.
All of these have the ability to trigger migraines.
Physical exertion.
This can be intense physical activity.
(09:54):
So think running a marathon, HIIT exercises,
or even sexual activities.
Yes, sex can give you a migraine.
Don't shoot the messenger.
Medications.
So vasodilators like nitroglycerin and even
oral contraceptives can cause or even aggravate migraines.
How do we diagnose migraines?
When it comes to diagnosing migraines
from other similar conditions,
doctors will ask you about several things,
(10:16):
including your symptoms, your family's medical history.
So does anyone else in your family have migraines?
And also your medical history.
They will also perform a neurological examination
and a physical examination.
If there is anything that has caused the doctor
to be concerned, they will order more tests to be run.
These may include a CT scan or an MRI scan.
This will be done to rule out anything that may,
(10:37):
for example, have caused changes in symptoms,
irregular symptoms, or if it is more severe or complex
than what would generally be considered
when it comes to migraine cases.
It also can rule out things that may be causing migraines.
For example, brain tumors.
An example of a brain tumor is a glioblastoma,
which we covered in episode 53.
Yes, brain tumors can actually cause migraine symptoms.
(10:58):
We'll get right into the symptoms and presentation
right after this little break.
(upbeat music)
This podcast is supported by listeners like you
on Buy Me a Coffee.
What symptoms might you have if you had migraines?
(11:20):
When it comes to migraines, they have stages.
So the symptoms you may have can indicate the stage,
the type of migraine, or even warn you
that a migraine may be about to come on.
So let's break the symptoms down stage by stage,
starting with the first stage.
This is the prodrome stage.
This happens one to two days before the migraine occurs.
With the prodrome stage,
this is where you have subtle changes.
It's a little warning that a migraine
(11:42):
is in your near future.
The symptoms of this may include frequent yawning,
mood changes, one minute you are on top of the world,
the next you are hitting rock bottom
and you are crying for no reason,
or you are angry for no reason.
These happen frequently for some people
without any real reason for them.
Next stiffness, constipation, fluid retention,
increased urination, I know those are kind of opposites,
but sometimes they go together, and food cravings.
(12:04):
Moving on to the next stage,
which is called the aura stage.
Sounds cool, is awful.
This can happen a few minutes up to an hour
before you get the migraine attack symptoms.
In this stage, it is a warning before the pain comes.
The symptoms in this stage are often visual,
but can also be other symptoms.
These include vision loss
or seeing various visual phenomena.
(12:25):
These can include shapes, bright flashes,
or spots of light.
Difficulty speaking, pins and needles.
These sensations are often in one arm or leg,
weakness or numbness in the face
or on one side of the body.
This can make you look like you're having a stroke
considering your difficulty speaking, weakness or numbness.
But if you are having these symptoms,
you'd definitely be concerned
because if it seems like a stroke fast, act fast.
(12:46):
Moving on to the migraine attack.
This is the next stage.
This can last between four to 72 hours,
especially when you do not treat it.
The symptoms that you may have for this
include nausea and vomiting.
Pain, this is normally on one side of the head,
but can be both.
It may also throb or feel like it is pulsating.
You can also have sensitivity to light,
smells, sounds, or even touch.
(13:07):
After the attack, we enter the postdrome stage.
This is where we have a variety of symptoms for about a day.
Most people feel drained, foggy, exhausted,
or even confused.
Some people can feel elated or excited.
And pain can occur with sudden head movement,
but it is normally brief.
And it's not normally as bad
as the migraine that just occurred.
What should a doctor be aware of
(13:27):
when it comes to migraines?
A doctor should be aware of medication overuse headaches
or rebound migraines.
These happen when painkillers are overused
and trigger a headache.
For example, if someone is using over-the-counter
medications like aspirin, ibuprofen, and paracetamol,
which is also known as acetaminophen,
the caffeine and paracetamol, or acetaminophen,
(13:48):
combination medications can also cause this as well.
So using any of these for more than 14 days in a month,
you are likely to experience rebound headaches,
so headaches caused by their overuse.
When it comes to prescription medications like triptans,
these only take about nine days in a month
before they can cause rebound headache symptoms.
There's also opiates and opioids.
They are also able to do these.
(14:09):
So being careful with these as well.
So being careful with the use and prescription of medications
is a must when it comes to pain prevention in migraines.
Another thing doctors should be aware of
is migraines can mimic strokes.
So someone who has migraines
may not even recognise a stroke,
always being aware of the FAST acronym.
Face drooping, arm weakness, speech difficulty,
and time to call for help.
(14:30):
So the faster you act with time,
the less brain death occurs.
If you're suspicious, just go to the hospital.
How do we treat migraines?
When it comes to migraines,
there are two types of treatment.
These are treatments to prevent migraines
and pain-relieving medications
for when the migraine does come.
We're going to start with preventative medications.
Most preventative medications when it comes to migraines
(14:50):
were not actually originally for migraines.
They were just found to do that job as well.
The medications often used to prevent migraines
that weren't originally for migraines
include blood pressure lowering medications.
These can be medications like beta blockers
and calcium channel blockers.
These are often used in those who have migraines
with an aura as a form of preventing them.
So again, these are the visual effects
(15:11):
that you see before a migraine.
Not everyone gets them.
Antidepressants, tricyclic antidepressants
may be used as a form of migraine prevention.
However, due to drowsiness,
it's one of those things
where you have to take it at the right time
and these aren't always used due to that side effect.
Anti-Seizure medications, these are also helpful
but not recommended to be used in women who are pregnant
or trying to get pregnant due to the unwanted side effects
(15:33):
and possibility of causing birth defects.
Botox injections, these are done every 12 weeks
in certain parts of the head and neck.
These can actually prevent migraines for some.
There are also newer preventative medications
that were developed specifically for migraines.
These include calcitonin gene-related peptides
monoclonal antibodies.
These are a monthly or quarterly injection
(15:53):
that help to prevent migraines
you might have heard of Aimovig or Ajovy.
This is what those are.
Moving on to pain relievers.
These are medications used if a migraine attack occurs
as migraines cannot always be prevented.
Some of the pain relieving medications used
when it comes to the treatment of migraines include
over-the-counter painkillers.
These include aspirin, ibuprofen, paracetamol
(16:14):
or medications that combine painkillers with caffeine.
These can help with a mild migraine
but when used too often again can lead to future headaches,
literally.
Triptans, these are medications
that block the pain pathways in the brain.
Opioid medications, these are used
when people cannot take other medications.
These are often not used due
to the addictive nature of opioids.
Anti-nausea medications, also known as antiemetics.
(16:36):
These are used to help with the nausea and vomiting
that some people experience with their aura
and also throughout their migraine.
Are there any famous people with migraines?
Yes, there are several famous people with migraines.
These include Serena Williams.
Yes, I am talking about the incredible tennis star.
She found out she had migraines linked to her menstrual cycle
after losing a tennis match because of one.
(16:57):
There's also Ben Affleck.
He is one of the few men that get them too.
Back in 2006, he was actually hospitalized
while directing "Gone Baby Gone"
due to the severity of his migraines.
If you would like to check out a book
featuring a character with migraines,
you should check out "Apples Never Fall"
by Liane Moriarty.
This book is a family drama
where one of the characters experiences chronic migraines,
(17:18):
although it's not the main focus of the story,
that's not what it's about.
The book actually explores a complex mystery
involving a missing family member.
It has also been turned into a TV show
if you would like something to watch.
If you want to check out a foundation then,
for those in the US,
there is the National Headache Foundation.
They aim to raise awareness about migraines,
providing education about the condition.
For those in the UK, there is the Migraine Trust.
(17:40):
They support research into migraines
and they support those who are experiencing migraines,
providing them tailored help and options.
And for those in Australia, there is Migraine Australia.
They are a patient advocate organization
that provides support to people
experiencing migraines and their families.
They provide up-to-date information
about treatment and migraines as well.
If you want to check out the sources,
social media links or any other links,
you can head to anatomyofillness.com.
(18:02):
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subscribe to be notified about our latest episodes.
If you would like to join our community,
you can join us on Discord or Instagram.
Otherwise, stick around for the next episode.
(upbeat music)
(upbeat music continues)
(upbeat music continues)
(upbeat music continues)
(18:25):
What continues to work even after it's been fired? A Neuron
You've been feeling off for the past hour,
(00:02):
struggling to even get a sentence out
and jumbling up words.
You feel pins and needles in your hands,
distracting you as you tried to work,
but you pushed through.
The project was already behind schedule
without you ending the day early.
You start to feel an awful throbbing pain in your head.
The light coming from your computer is too bright.
You start to feel nauseous and run to the bathroom.
(00:22):
You decide to call a friend
and ask them to drive you to the hospital.
(upbeat music)
(upbeat music continues)
Hello and Welcome to Anatomy Of Illness.
Today's episode is about migraines.
(00:44):
Before we get into the condition,
we are going to start with the history.
So why do we know migraines exist?
To start, we are going to begin around 7,000 BC.
This is where we would find evidence of trepanning.
This is the removal of a very small circular part
of the skull.
One of the many reasons suggested for the skulls found
with trepanation holes was because of issues
(01:04):
like migraines and epilepsy,
which we previously discussed in episode 14.
One of the theories behind the reason for the trepanning
is that they believed the pain or other issues
were caused by evil spirits in the head.
Trepanning would be a treatment that would stick around
for quite some time when it came to the treatment
for migraines.
Moving into ancient Mesopotamia around 3000 BC.
(01:25):
This is where migraines would be linked with superstitions.
Migraines were believed to be caused by the evil spirit,
Ti’e, attacking their victims,
which was believed to be the cause
of these migraine symptoms.
Also around this time, we would have the anonymous writing
from an ancient Sumerian poet.
This poet would describe an illness so severe
and a headache so severe that the person suffering from it
(01:46):
wished to be relieved from the pain through death.
Moving on to ancient Egypt.
This is from around 1200 BC with the Ebers papyrus.
This is where we would have the description of migraine pain
and nerve pain as well as severe pain coming on suddenly.
The way they would attempt to cure these migraines
was through the use of a clay crocodile
holding a grain in its mouth.
This would be tied to the scalp with a piece of linen.
(02:08):
The piece of linen had a God's name written on it
as they believed the God could cure the head pain.
What was most likely the reason it helped
was the compression from this procedure.
Moving on to Hippocrates in ancient Greece.
Hippocrates would be the first to comment
on migraines scientifically.
Hippocrates would describe people experiencing bright light
in the right eye after this severe pain
(02:29):
would occur in the head.
This would extend to the entire head area.
Hippocrates would also discuss some of the activities
that could lead to migraines.
He found that they would in some people
occur after exercise or sexual intercourse.
Now we move on to Aretaeus of Cappadocia.
He would be the first to provide a classification
on the different types of headaches.
(02:49):
He classified them as three main types.
Cephalalgia, which with this type,
they were mild and short-term headaches.
Cephalea, this type is more chronic and severe.
And finally Heterocrania.
This was a headache on one side of the head
that occurred suddenly.
These headaches often came with nausea and vomiting,
sweating, sensitivity to light, symptoms in the eyes,
(03:09):
and changes to how fragrances were perceived.
Let's move on to Galen who lived between 129 to 216 AD.
He would write about severe pain
affecting half of the head.
He believed that these were caused by vapors
rising from the stomach and into the head.
This was an idea originally suggested by Hippocrates.
Galen's beliefs are noted with this statement.
(03:30):
“How often do we see the head attacked with pain
when yellow bile is contained in the stomach?
As also the pain forthwith ceasing
when the bile has been vomited.”
This is where we get the name bilious attacks
for the childhood feature of vomiting attacks,
which does happen to have a migraine type nature.
Moving on to the Iranian physician, Razi,
who lived between 854 to 925 AD.
(03:53):
He would write an entire chapter
about migraines and other headaches.
He would also be the first to suggest
that headaches with a sudden and severe onset
were actually likely to be signs of strokes.
Speaking of famous Iranian physicians,
we are moving on to Avicenna.
He is another talented and famous Iranian physician.
He lived between 980 and 1,037.
(04:14):
He would write a chapter on headaches
in his book "Canon of Medicine".
In this, he would describe a kind of headache
that covered the entire head.
The pain was so severe and it came with photophobia,
which is a fear of light or sensitivity to light,
and noise phobia.
This form of headache was made worse by physical activity.
Moving on, we are going to visit with Hildegard of Bingen.
(04:35):
She lived between 1098 and 1180.
She was a nun, a mystic, and an intellectual
in the Middle Ages.
Because who says ladies can't do it all?
She was considered to have exceptional literary
and intellectual powers that would come from her visions.
With these, she left detailed drawings and descriptions
of these visions.
Some have even survived to this day.
With all of the extremely detailed evidence she left,
(04:57):
it gives clear evidence that these visions
were actually caused by migraines.
To be honest, I am stealing that next time I get a migraine,
because vision sounds so much cooler.
During this time, we would also have
some interesting treatments for migraines.
It was the Middle Ages, after all.
These treatments were often drug-soaked poultices
used on the head and scalp.
These were often a mixture of vinegar and opium.
(05:18):
The vinegar was likely to open up
the pores, which allowed for the opium to soak in.
We are going to jump forward all the way to the 17th century.
With Thomas Willis, he would describe his theory
of magrim, which is another word for migraine, back then.
He suggested that they were caused
by the dilation of blood vessels,
stating that the headache symptoms came
from the ascending spasms of the peripheral ends of the nerves.
(05:41):
This is the origins of the vascular theory of migraines.
He would also introduce several other terms and ideas,
like the term neurology.
He would also describe potential causes and triggers
for migraines, these being that migraines were often
hellaraditary, could be triggered
by changes in the weather through season
or atmospheric changes, and diet.
(06:01):
In the late 1770s, we would have Erasmus Darwin,
who happens to be the grandfather of Charles Darwin.
He would make his own comments on migraines.
He believed in the vascular theory of migraines
and would suggest his own treatment.
Centrifuge people who had migraines.
Yes, I really do mean spinning someone very fast,
the idea being that this would get the blood
from someone's head down to their feet.
(06:23):
Personally, I think I would be tasting my lunch
for the second time if I did that during a migraine,
but anyway, moving on to 1873.
This is when Edward Liveing would publish
on megrim, sick headache,
and some allied health disorders,
a contribution to the pathology of nerve storms.
In this, he suggested that there was a clear link
between epilepsy and migraines,
(06:44):
that they were caused by the same thing.
Dysfunctional central nervous system discharges
known as nerve storms.
Moving on to 1888 with William Gowers.
He believed in Liveing's neurogenic theory of migraines
and would suggest for the treatment of migraine,
a healthy diet is important
and would even invent his own treatment
known as Gowers mixture.
This was a mixture of nitroglycerin and alcohol
(07:05):
with a few other interesting ingredients.
He would also recommend the use of marijuana
for the treatment of acute headaches.
He was actually the first person to split treatment
into episodic and prophylactic.
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So what actually causes migraines?
Well, the cause behind migraines aren't fully understood.
However, there are several theories
behind what could cause them.
It is believed that there are changes in the brainstem
(07:28):
and its interactions between the trigeminal nerve,
which is a major pain pathway.
It is also thought that various chemicals in the brain,
such as serotonin, may be involved.
Serotonin actually helps to regulate pain
in the nervous system.
It is also believed that various environmental factors
as well as genetics contribute to migraines.
So what are the risk factors for being prone to migraines?
There are several risk factors
(07:49):
that make you more prone to having migraines.
These include a family history.
If you have family members who have migraines,
then you are more likely to have them yourself.
Sex, women are three times more likely
to experience migraines than men.
I know, lucky us.
Age, migraines can happen at any age,
occurring most often in adolescents.
Migraine activity normally peaks most often
(08:10):
in the thirties and slows down in the decades afterward.
Hormonal changes.
Migraines are more likely to occur right before
or shortly after you have started menstruating
due to the hormonal changes in your cycle.
Migraines can also change in pregnancy or menopause,
but are generally less likely to happen
after you hit menopause.
But what can trigger a migraine?
(08:30):
When it comes to migraine triggers,
what will cause a migraine will be different for everyone.
However, there are some triggers that are common.
These include hormonal changes in women.
Examples of hormonal changes that can trigger a migraine
include fluctuations in estrogen.
These are at times like before or during periods,
pregnancy, and even in menopause.
Other triggers include various drinks,
like caffeinated beverages.
(08:51):
This is for people who are sensitive to caffeine
or are drinking too many caffeinated beverages.
There is also alcohol, especially wine.
That can be a migraine trigger for some.
Food.
For some people, aged cheeses, salty, or processed food
can trigger migraine symptoms.
Food additives.
Some people will also get migraines from various
food additives, including the sweetener known as aspartame
(09:12):
or even monosodium glutamate.
You may know it as MSG.
Stress.
Having a stressful work or home life
can cause a migraine or several.
Sleep.
Getting either too much or too little sleep
can also trigger a migraine.
So it is good to have a healthy sleep schedule.
Having a set time to go to bed and a set time to wake up
helps to avoid migraines triggered by sleep.
(09:33):
Maybe I'll learn that one day.
Weather changes.
A change in the weather or barometric pressure
can cause a migraine.
So some people get a migraine around storms.
Sensory stimuli.
Bright or flashing lights.
Loud sounds, strong smells.
This can be various things like perfume,
secondhand smoke, paint thinners.
All of these have the ability to trigger migraines.
Physical exertion.
This can be intense physical activity.
(09:54):
So think running a marathon, HIIT exercises,
or even sexual activities.
Yes, sex can give you a migraine.
Don't shoot the messenger.
Medications.
So vasodilators like nitroglycerin and even
oral contraceptives can cause or even aggravate migraines.
How do we diagnose migraines?
When it comes to diagnosing migraines
from other similar conditions,
doctors will ask you about several things,
(10:16):
including your symptoms, your family's medical history.
So does anyone else in your family have migraines?
And also your medical history.
They will also perform a neurological examination
and a physical examination.
If there is anything that has caused the doctor
to be concerned, they will order more tests to be run.
These may include a CT scan or an MRI scan.
This will be done to rule out anything that may,
(10:37):
for example, have caused changes in symptoms,
irregular symptoms, or if it is more severe or complex
than what would generally be considered
when it comes to migraine cases.
It also can rule out things that may be causing migraines.
For example, brain tumors.
An example of a brain tumor is a glioblastoma,
which we covered in episode 53.
Yes, brain tumors can actually cause migraine symptoms.
(10:58):
We'll get right into the symptoms and presentation
right after this little break.
(upbeat music)
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What symptoms might you have if you had migraines?
(11:20):
When it comes to migraines, they have stages.
So the symptoms you may have can indicate the stage,
the type of migraine, or even warn you
that a migraine may be about to come on.
So let's break the symptoms down stage by stage,
starting with the first stage.
This is the prodrome stage.
This happens one to two days before the migraine occurs.
With the prodrome stage,
this is where you have subtle changes.
It's a little warning that a migraine
(11:42):
is in your near future.
The symptoms of this may include frequent yawning,
mood changes, one minute you are on top of the world,
the next you are hitting rock bottom
and you are crying for no reason,
or you are angry for no reason.
These happen frequently for some people
without any real reason for them.
Next stiffness, constipation, fluid retention,
increased urination, I know those are kind of opposites,
but sometimes they go together, and food cravings.
(12:04):
Moving on to the next stage,
which is called the aura stage.
Sounds cool, is awful.
This can happen a few minutes up to an hour
before you get the migraine attack symptoms.
In this stage, it is a warning before the pain comes.
The symptoms in this stage are often visual,
but can also be other symptoms.
These include vision loss
or seeing various visual phenomena.
(12:25):
These can include shapes, bright flashes,
or spots of light.
Difficulty speaking, pins and needles.
These sensations are often in one arm or leg,
weakness or numbness in the face
or on one side of the body.
This can make you look like you're having a stroke
considering your difficulty speaking, weakness or numbness.
But if you are having these symptoms,
you'd definitely be concerned
because if it seems like a stroke fast, act fast.
(12:46):
Moving on to the migraine attack.
This is the next stage.
This can last between four to 72 hours,
especially when you do not treat it.
The symptoms that you may have for this
include nausea and vomiting.
Pain, this is normally on one side of the head,
but can be both.
It may also throb or feel like it is pulsating.
You can also have sensitivity to light,
smells, sounds, or even touch.
(13:07):
After the attack, we enter the postdrome stage.
This is where we have a variety of symptoms for about a day.
Most people feel drained, foggy, exhausted,
or even confused.
Some people can feel elated or excited.
And pain can occur with sudden head movement,
but it is normally brief.
And it's not normally as bad
as the migraine that just occurred.
What should a doctor be aware of
(13:27):
when it comes to migraines?
A doctor should be aware of medication overuse headaches
or rebound migraines.
These happen when painkillers are overused
and trigger a headache.
For example, if someone is using over-the-counter
medications like aspirin, ibuprofen, and paracetamol,
which is also known as acetaminophen,
the caffeine and paracetamol, or acetaminophen,
(13:48):
combination medications can also cause this as well.
So using any of these for more than 14 days in a month,
you are likely to experience rebound headaches,
so headaches caused by their overuse.
When it comes to prescription medications like triptans,
these only take about nine days in a month
before they can cause rebound headache symptoms.
There's also opiates and opioids.
They are also able to do these.
(14:09):
So being careful with these as well.
So being careful with the use and prescription of medications
is a must when it comes to pain prevention in migraines.
Another thing doctors should be aware of
is migraines can mimic strokes.
So someone who has migraines
may not even recognise a stroke,
always being aware of the FAST acronym.
Face drooping, arm weakness, speech difficulty,
and time to call for help.
(14:30):
So the faster you act with time,
the less brain death occurs.
If you're suspicious, just go to the hospital.
How do we treat migraines?
When it comes to migraines,
there are two types of treatment.
These are treatments to prevent migraines
and pain-relieving medications
for when the migraine does come.
We're going to start with preventative medications.
Most preventative medications when it comes to migraines
(14:50):
were not actually originally for migraines.
They were just found to do that job as well.
The medications often used to prevent migraines
that weren't originally for migraines
include blood pressure lowering medications.
These can be medications like beta blockers
and calcium channel blockers.
These are often used in those who have migraines
with an aura as a form of preventing them.
So again, these are the visual effects
(15:11):
that you see before a migraine.
Not everyone gets them.
Antidepressants, tricyclic antidepressants
may be used as a form of migraine prevention.
However, due to drowsiness,
it's one of those things
where you have to take it at the right time
and these aren't always used due to that side effect.
Anti-Seizure medications, these are also helpful
but not recommended to be used in women who are pregnant
or trying to get pregnant due to the unwanted side effects
(15:33):
and possibility of causing birth defects.
Botox injections, these are done every 12 weeks
in certain parts of the head and neck.
These can actually prevent migraines for some.
There are also newer preventative medications
that were developed specifically for migraines.
These include calcitonin gene-related peptides
monoclonal antibodies.
These are a monthly or quarterly injection
(15:53):
that help to prevent migraines
you might have heard of Aimovig or Ajovy.
This is what those are.
Moving on to pain relievers.
These are medications used if a migraine attack occurs
as migraines cannot always be prevented.
Some of the pain relieving medications used
when it comes to the treatment of migraines include
over-the-counter painkillers.
These include aspirin, ibuprofen, paracetamol
(16:14):
or medications that combine painkillers with caffeine.
These can help with a mild migraine
but when used too often again can lead to future headaches,
literally.
Triptans, these are medications
that block the pain pathways in the brain.
Opioid medications, these are used
when people cannot take other medications.
These are often not used due
to the addictive nature of opioids.
Anti-nausea medications, also known as antiemetics.
(16:36):
These are used to help with the nausea and vomiting
that some people experience with their aura
and also throughout their migraine.
Are there any famous people with migraines?
Yes, there are several famous people with migraines.
These include Serena Williams.
Yes, I am talking about the incredible tennis star.
She found out she had migraines linked to her menstrual cycle
after losing a tennis match because of one.
(16:57):
There's also Ben Affleck.
He is one of the few men that get them too.
Back in 2006, he was actually hospitalized
while directing "Gone Baby Gone"
due to the severity of his migraines.
If you would like to check out a book
featuring a character with migraines,
you should check out "Apples Never Fall"
by Liane Moriarty.
This book is a family drama
where one of the characters experiences chronic migraines,
(17:18):
although it's not the main focus of the story,
that's not what it's about.
The book actually explores a complex mystery
involving a missing family member.
It has also been turned into a TV show
if you would like something to watch.
If you want to check out a foundation then,
for those in the US,
there is the National Headache Foundation.
They aim to raise awareness about migraines,
providing education about the condition.
For those in the UK, there is the Migraine Trust.
(17:40):
They support research into migraines
and they support those who are experiencing migraines,
providing them tailored help and options.
And for those in Australia, there is Migraine Australia.
They are a patient advocate organization
that provides support to people
experiencing migraines and their families.
They provide up-to-date information
about treatment and migraines as well.
If you want to check out the sources,
social media links or any other links,
you can head to anatomyofillness.com.
(18:02):
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subscribe to be notified about our latest episodes.
If you would like to join our community,
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Otherwise, stick around for the next episode.
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(18:25):
What continues to work even after it's been fired? A Neuron
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