As I’m sure you probably deduced from the title, headaches and migraines, while seemingly similar, are actually incredibly different. It is a common misconception that migraines are just severe headaches, in actuality it is much more complicated than that. Migraines come with additional symptoms when compared to tension and allergy headaches. These symptoms include unilateral (1-sided) throbbing pain in the head, photophobia (sensitivity to light), phonophobia (sensitivity to sounds), nausea, and vomiting (Goadsby, 2012).
The exact mechanism by which migraines occur is up to debate. Like many other neurological conditions, migraines are thought to be somewhat heterogeneous, meaning it can be caused by different things in different people. That being said, functional imaging analysis suggests that most migraines occur due to hyperexcitability of the cerebral cortex. This means that the outer layer of brain cells require less stimulation to generate a response. It is hypothesized that this increased sensitivity causes dumps of serotonin to flood the brain. While we may view serotonin to be the “happiness chemical” it also plays a role in muscle contractions. These contractions, coupled with altering firing patterns in the brain and brainstem lead to the aura-like sensory experiences and severe headache symptoms of a migraine (Aurora & Brin, 2016).
Migraines are generally thought to occur in 4 stages: prodrome phase, aura phase, headache phase, and postdromal phase (Penn Medicine, 2019). The prodrome phase usually begins a couple of days before a migraine. During this time period an individual can experience an array of symptoms including photophobia, excessive yawning, muscle soreness, changes in mood, and food cravings (Dodick, 2018; Mayo Clinic, 2020). The prodrome phase is followed by the aura phase. Around ⅓ of people who suffer from migraines experience “auras,” physical sensations that signal the imminent onset of a migraine (Penn Medicine, 2019). During the aura phase, the individual will experience sensations such as numbness in extremities, flashes of light, loss of vision, and/or trouble speaking (Mayo Clinic, 2020). The headache phase is relatively self-explanatory. It usually involves throbbing pain on 1 side of the head. However, I would like to note that not all migraines have this explicit headache phase. Crazy, right? You can have a migraine without a headache, often referred to as a “silent migraine” by neurologists (Penn Medicine, 2019). The last phase of a migraine is the postdromal phase. I think of it as the “exhaustion phase.” At this point the aches and pains of the migraine are replaced by feelings of fatigue, disorientation and a general feeling of malaise (Mayo Clinic, 2020; Penn Medicine, 2019).
Experiencing chronic migraines can be incredibly draining and interfere with important activities of daily living. As a condition that cannot be physically seen, many individuals who suffer from this debilitating condition are often ignored. This is further exacerbated by the fact that women, who are often written off as “sensitive” or “hormonal” are 3 times more likely to suffer migraines than men. I want you, the reader, to know that your pain, your experience, is real and if a physician tells you that you are imagining things or being overdramatic, find a new one! You are valuable and do not deserve to go through life with chronic pain.
