Migraines: Causes and New Treatments

Michael John Coleman remembers the first time he felt the excruciating pain of a migraine. He was 6 years old.

"I was looking out the window at school at a green field and my head really hurt. I was seeing spots and stars," recalls Coleman. "My teacher told me to put my head down and I saw a huge mass of clouds approaching. Then I felt nauseous."

Since that first onset, Coleman, who heads up MAGNUM, a Washington, D.C.-based migraine awareness group, has struggled with migraines his entire life, getting them at least twice a week. He says his migraines feel like "a gang of thugs" are smashing him in the head with baseball bats — over and over again. Like many migraine sufferers, his headaches are also preceded by an aura, a temporary state during which his vision is blurred and he sees spots.

The pain has been so brutal and unrelenting that he has had four surgeries to try and treat his condition. None have worked and instead made him feel worse.

But recently — only recently — he has become more hopeful about his condition. Better scientific understanding of migraine pain has led to drugs that can target specific causes, rather than offering a blanket-like numbing of head pain. Still, researchers admit, there's a lot left to learn.

"The problem with migraines is they seem to be a very heterogeneous disorder," explains Lawrence Newman, a neurologist at St. Luke's Roosevelt and Beth Israel Medical Center in New York City. "We're on the fringe of discovering its causes — we're close, but not yet close enough."

Fuzzy Outline

In the 17th century a physician named Sir Thomas Willis suggested that the intense headaches were caused by a rush of blood to the head. This increased blood flow led to swollen blood vessels that, in turn, placed uncomfortable pressure on the brain's nerve fibers.

That theory held up for centuries. But in the past decade, through the use of new noninvasive technology, such as MRI, PET and CT scans, researchers have learned that migraines may be caused by a series of complicated processes and that swollen blood vessels are likely a result, not a cause of the headaches.

Current research suggests that some migraines begin when nerve-rich arteries at the back of the brain spasm and lead to a reduction in neural activity throughout the brain. This reduction may be linked to the migraine aura, a condition experienced by about one in five people before a migraine.

Researchers at the University of Essen in Germany recently demonstrated that the process causing an aura is likely separate from those leading to the headache of a migraine.

In what the German researchers say may be a parallel process, a trigger in the brain stem causes the release of a cascade of chemicals. These chemicals aggravate the trigeminal nerve, the largest cranial nerve that branches along the jaw line, ear, face and into the sides and front of the brain. The agitated nerve then releases neurotransmittors, including the brain chemical serotonin, which come in contact with the brain's blood vessels and cause them to swell. The swelling is perceived as pain.

"The whole series of events is not entirely worked out. What causes the release of chemicals, for example? And where, exactly, does the process begin?" says Elizabeth Waterhouse, an associate professor of neurology at the Virginia Commonwealth University School of Medicine. "The general outline is there, but not the details."

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