Migraine Headaches

Commonly asked questions regarding possible causes of migraine headaches answered by Dr. Saper

What causes migraine headaches?

For most people migraine is a hereditary medical condition. Some people get migraine headaches after head trauma or a brain injury. Several different brain chemicals (neuro-transmitters) are involved in triggering and perpetuating the migraine attack. Inflammatory changes develop around blood vessels and there are alterations in blood flow to the brain. The usual electrical activity of the brain may change. This complex sequence of events causes the pain and the other symptoms associated with migraine.

Since the same neurochemical transmitters which are involved in migraine are necessary for other body functions such as sleep and mood, it may not be unusual for people with migraine to experience depression, anxiety, panic attacks and sleep disturbances. These associations are important in developing an effective program for preventive migraine treatment.

Could genetics or heredity factors play a part in my headaches?

Yes, over 80% of patients with recurring headaches have a family member who also suffers from headaches. And just as in other illnesses which were once thought to be "psychological," migraine headaches are caused by biochemical abnormalities in the brain. Hereditary factors play a role in that physiological vulnerability.

What is the relationship between fluctuations in my blood sugar and hypoglycemia and occurrence of a headache?

As one's blood sugar drops too rapidly, it can trigger a headache of a migraine type. In addition, a person with an abnormal blood sugar metabolism can trigger a headache by missing even a single meal. So it is better to eat regularly, at the same time in the day, and regulate medications around meal times as well. Headaches that occur after sleeping longer than usual or headaches that occur during the night or upon awakening may reflect hypoglycemia, although many other explanations are possible.

My mother "outgrew" her headaches in older age. Will I?

The lifetime course of chronic recurring head pain is variable. Many people will outgrow their symptoms, while others will experience their first headache later in life. If the person from whom it is likely that headaches have been inherited outgrew the headaches, that represents a good but not absolute indication that the offspring will outgrow the headaches as well.

Are there specific tests which can prove that you have migraines?

No. There are no specific tests which will show if one has a migraine. However, there are a number of tests which will help to rule out certain illnesses and provide information related to circulation, brain wave, and brain anatomy. Tests are performed to eliminate causes of headache other than those which are "built into" your physiology (such as migraine and other primary headaches).

My tests are normal. What, then, causes my headache?

Most of the tests involved in the assessment of headache are done to identify other illnesses which could be causing the head pain. Tests such as CT scan, MRI, EEG, and blood studies are usually normal or near normal in patients with migraine. No tests currently available for routine use can detect the changes that occur in migraine. This should be interpreted as good news, not bad, and should not frustrate headache sufferers.

Can stress cause my headache?

It is complicated.  Stress is not a “cause” but can definitely provoke.  “Let down” after stress can also provoke a headache.  Some patients are “stress-sensitive” which means a certain amount of stress that would otherwise be unimportant in another person may in a “stress-sensitive” patient provoke a headache.  Similarly, the relief from a stressful situation may bring with it a headache attack, so the “shifting of gears” emotionally from a bad spell to a good period may ironically provoke a headache attack.  It is almost as though patient’s with migraine do not do well with changing phenomena, whether it be sleep patterns, time zone changes, stress dynamics, or other changing psychological or physiological parameters

Can my headaches be cured?

Headaches, except if there is a specific treatable identifiable cause, such as an infection or hormonal disturbance, cannot be “cured”, but they can be controlled in over 80% of individuals.  It may take dietary control, medications, changes in lifestyle patterns and so forth, but they can be controlled.