What Causes Migraine Headaches?

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By Mike DuBose with Dr. Surb Guram, MD

Many people don’t realize how serious migraines can be…until they have one! Migraine headaches, whether occasional or regularly endured as a chronic illness, can be detrimental to sufferers’ physical and mental health. They also harm individuals’ work productivity, family lives, and social relationships.

Migraines are a widespread problem. According to the Migraine Research Foundation, they affect 39 million people in the United States. All individuals have the potential to be afflicted with migraines, but women are up to three times more likely than men to experience them. People who are 35-45 years old endure these painful headaches more frequently, according to the World Health Organization, although all ages—including children—are at risk. 

Many sufferers experience migraines several times a month, for multiple days at a time. The illness impacts many aspects of their lives, keeping them from social, physical, or religious activities, school, and work. For those who frequently experience very severe migraines, it’s considered a disability—according to the Migraine Research Foundation, migraines are the sixth most disabling illness in the world! The condition not only causes pain to individuals, but also businesses: one study estimated that work productivity lost due to migraines costs the United States up to $17 billion per year.

Migraine Symptoms and Warning Signs

If you’ve ever had the misfortune of undergoing a migraine, you’re likely familiar with the symptoms: primarily, a throbbing, severe pain on one or several areas of the head, often paired with other troubles like nausea, vomiting, vision problems, and sensitivity to light and sound. Others also report chills, sweating, temporary paralysis, dizziness, and/or weakness. How long the symptoms last varies from person to person, taking anywhere from four hours up to multiple tortuous days.

Before the pulsating headache, sensory overload, and stomach upset begin, many people experience conditions that alert them a migraine is on its way. These warning signs occur in the “premonitory phase,” which takes place hours or even days before the migraine occurs. One of the most recognizable is the visual “aura,” a physical warning sign from the body that a migraine is on the way. Visual auras often take the form of distorted eyesight; brightness, dots, or squiggly lines running across the field of vision; blind spots; and even temporary loss of sight. Auras can also impact the other senses, causing ringing in the ears, changes in taste and smell, or a generally uneasy feeling. Up to 30% of migraine sufferers experience these unique warning signs, but they may not have an aura every time. 

According to the Cleveland Clinic, other warning signs and precursors to migraines include:

  • Constipation
  • Mood changes, from depression to euphoria or vice-versa
  • Food cravings
  • Neck stiffness
  • Increased thirst and urination
  • Frequent yawning

Migraine Risk Factors

Scientists are still unclear on what exactly causes migraines, so the risk factors are not completely understood. The Mayo Clinic reports that “genetics and environmental factors appear to play a role,” and that imbalances in brain chemicals like mood-boosting serotonin (associated with depression) may also contribute to migraines. Researchers have also suggested that blood vessels, nerve pathways, and blood flow to the brain may be involved.

Although a definitive cause for migraines has not yet been discovered, researchershave been able to find correlations between certain risk factors and the painful illness. For example, the higher incidence of severe headaches in women than in men is thought to be caused by hormone fluctuations within the female body. According to the National Institutes of Health, “Young women often have their first migraine once they start having periods. It is also common for migraine attacks to go away during pregnancy and disappear completely after menopause.”

Family history is another factor that seems to be related to migraine risk. The Cleveland Clinic reports, “Four out of five migraine sufferers have a family history of migraines. If one parent has a history of migraines, the child has a 50% chance of developing migraines, and if both parents have a history of migraines, the risk jumps to 75%.”

Unfortunately, there is little that can be done to avoid migraines caused by biological factors like genetics and gender. However, there are circumstances over which sufferers have at least some control that also seem to fuel migraine headaches. These “triggers” are not universal—one migraine-prone person may have a completely different reaction to a substance like coffee or perfume than another—but there are enough trends amongst the migraine-suffering population to show that these items can be potential instigators for many.

Common Triggers

Stress and anxiety. According to the American Migraine Foundation, “Stress is a trigger for almost 70% of people with migraine.” Humans today live in a near-constant state of stress, running from one event to another; cramming our schedules with too many activities; creating unrealistic life goals; and focusing too much on work with little time doing the activities we really enjoy. Many of us fail to set aside time to just pause, relax, and rest on an ongoing basis. Compounding the problem, some sufferers are anxious about when their next migraine will occur, which makes them more likely to generate a migraine!

Caffeine consumption. Caffeine is a drug, and its impact differs amongst migraine sufferers. Some say that it triggers their migraines; others, that it relieves them (in fact, some migraine medications contain caffeine). Caffeine withdrawal—when someone stops consuming caffeine after the body has become used to it—can also be a major migraine trigger.

Changes in weather and barometric pressure. In a National Headache Foundation Survey, three out of every four respondents said the weather was a trigger for their headaches. Specific weather-related triggers include: changes in humidity, extreme temperatures (hot or cold), storms, high winds, and dry or dusty conditions.

Seeing bright lights. Sensitivity to bright light, called photophobia, is one of the major factors used in diagnosing migraines. Both bright natural and artificial light (especially fluorescent bulbs) can be triggers. Sitting in front of a television or computer screen—which, like fluorescent bulbs, often have subtle flickers that cannot be detected with the naked eye—can lead to a migraine!

Consuming alcohol. Drinking alcoholic beverages can raise one’s likelihood of having a migraine attack. Red wine seems to be a particularly common trigger, and it is possible that sulfites (preservatives that are used to maintain wine’s freshness) are the cause. Alcohol also contributes to dehydration, which is a trigger for about one-third of migraine sufferers, according to the American Migraine Foundation. 

Changes in sleep patterns. Migraines have been linked to a variety of sleep problems, such as poor-quality sleep, too much sleep, or not enough sleep (depending on the person).

Smelling certain scents. Paint thinner, gasoline, perfume, air fresheners, detergents, fabric softeners, home cleaning agents, chemicals, bug sprays, and cigarette smoke are top odors named by migraine sufferers as triggers for their headaches. So many people are impacted by these smells that public locations, such as houses of worship, doctor’s offices, and workplaces, often ask attendees not to wear strong perfumes, lotions, or other scents. However, many people ignore these warnings, potentially causing migraines in others. 

Allergies. A wide variety of agents can cause allergic reactions in humans, which can spiral into migraine headaches. Typical allergens include commonly encountered substances like dust, trees, shrubs, weeds, molds, dust mites, pets, feathers, and certain foods.

Hearing loud noises. In addition to setting a migraine attack off, loud sounds can also worsen a headache that is already in progress.

Changes in hormone levels in women. This applies to both natural fluctuations, such as those that happen during menstruation, and to outside factors like hormonal birth control pills.

Dehydration. Drinking inadequate amounts of water throughout the day can lead to dehydration. The human body needs about six eight-ounce glasses of water daily, and getting too little can cause headaches and migraines.

Physical activity. Physical exertion from activities like sexual intimacy and exercise has been identified as a potential cause. While most studies indicate that exercise is good for you, in some individuals, it can actually cause headaches.

Going on vacation or having time off work. Surprisingly, migraines can be triggered by a vacation or a restful weekend, due to different sleep patterns, increased exercise, or meal times that are earlier or later than a person’s typical schedule. People are more likely to make these changes on vacation or on the weekend than when it’s the work week, leading more individuals to experience headaches during these times.

Medical conditions. Rarely, migraines can be caused by medical problems, such as: inflammation; problems with the blood vessels in and around the brain, including stroke; infections like meningitis; intracranial pressure that's either too high or too low; brain tumors; and traumatic brain injuries.

Eating and drinking certain items. While there is debate over whether chocolate causes migraines (many sources say that it’s a common craving people have as a result), there are foods, drinks, and additives that have been linked to these headaches, including:

  • Processed, fermented, pickled, or marinated foods
  • Aspartame, an artificial sugar (most often used in Equal sweetener) that appears in foods and drinks like diet cola and yogurt
  • Food additives such as monosodium glutamate (MSG), which is a common additive in restaurant foods to enhance flavor
  • Nuts and peanut butter
  • Aged cheeses (like blue cheese or brie)
  • Smoked fish
  • Chicken livers
  • Certain beans, like snow peas
  • Fruits (avocados, bananas, citrus fruits, raisins, figs)
  • Meats containing preservatives like nitrates and nitrites (bacon, pepperoni, hot dogs, salami, processed and sliced sandwich meats, cured items)
  • Salty foods such as olives
  • Color dyes
  • Cultured dairy products (yogurt, buttermilk, sour cream)
  • Onions

Skipping meals. Failure to eat a healthy, balanced diet with three or more meals each day can cause low blood sugar and lead to migraines. Rushing or gulping down a meal can also stress the digestive system and cause problems.

Medications. There is a condition called “Medication Overuse Headache” (MOH) that can happen to people who take medicine for acute migraines more than 10 days in a month. For these unfortunate individuals, their migraine medicine causes more migraines! In addition, many supplements, vitamins, over-the-counter drugs, and prescribed medications have side effects that can trigger a headache or migraine. (Read more about the potential side effects of drugs in our article here.) 

The bottom line: Migraines are an extremely painful illness, and they affect more people than you may realize. The pounding headaches, nausea, and other symptoms experienced during a migraine are difficult for any individual to endure. These powerful attacks can harm work productivity and relationships by putting the sufferers “out of commission” for hours or even days! Some potential causes have been identified, but without a definitive answer as to why migraines occur, solutions can be difficult to name. Fortunately, by identifying and avoiding their specific set of triggers, sufferers can minimize the frequency of these agonizing headaches.

Read our next article in this two-part series at https://www.mikedubose.com/blog/preventing-and-treating-migraine-headaches to learn about treatments and ways to avoid common migraine triggers.

About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, research, experiences, successes, and mistakes. You can e-mail us at katie@dubosegroup.com.

Mike DuBose received his graduate degree from the University of South Carolina and is the author of The Art of Building a Great Business. He has been in business since 1981 and is the owner of Research Associates, The Evaluation Group, Columbia Conference Center, and DuBose Fitness Center. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional business, travel, and personal articles, as well as health articles written with Dr. Surb Guram, MD.

Dr. Surb Guram, MD is a board-certified internist and a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.

Katie Beck serves as Director of Communications for the DuBose Family of Companies. She graduated from the USC School of Journalism and Honors College.

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