In 1948, the publication of Dr. Harold Wolff’s 710-page, 1100-reference Headache and Other Head Pain set a new standard for migraine research. And one of his own 77 research papers included in the textbook took on the question of what can cause migraines.
It stated unequivocally that the cause of migraines is “the distention of cerebral arteries.”
With that statement, the paper, which Dr.Wolff co-authored and published in 1940, announced that internal pressure can swell and distend the vessels in our brains enough to cause excruciatingly pounding migraines. Could that be right?
For anyone experiencing the pounding, it certainly feels that way!
Unfortunately, the answer to what can cause migraines isn’t so simple. While research suggests that blood vessels play a role in them, Dr. Wolff was incorrect in his assessment that a vascular disorder in the brain is completely responsible.
The Current Thinking on What Can Cause Migraines
The current thinking is that migraines are primarily a neurological disorder originating in the brain’s nerve pathways. Surprisingly, however, someone was already thinking that way over 50 years before Dr. Wolff presented his erroneous answer.
In 1888, Sir William Richard Gowers published the landmark A Manual of Diseases of the Nervous System, in which he asserted that what causes migraines is “… aderangement of the nerve cells of the brain.”
Flash forward 133 years, and we’ve narrowed the migraine-causing mechanism down to nerves, just as Dr. Gowers suspected. But researchers have yet to follow the nerves in a straight line.
Phase-by-Phase Migraine Nerve Activity
Yesterday, I described how the first, or prodrome, phase of a migraine stimulates the hypothalamus.
Directly above the hypothalamus is our sleep-regulating thalamus. It’s also known as the brain’s pain center, and there’s some indication that it’s the second step along the path to a migraine.
A migraine progresses from the thalamus/hypothalamus region to the ascending trigeminothalamic pathway. The trigeminal nerve creates sensations in the face and the front part of the head.
But at this point, our tracking of what can cause migraines breaks down. Researchers are still trying to understand how “hypothalamic dysfunction may lead to activation of the ascending trigeminothalamic pathway.”
Around this time, a tsunami of activity described as a “spreading cortical depression” can spread throughout the brain. It’s thought to be aura-related, corresponding to the second migraine phase.
In response to such intense activity, the brain releases neuropeptides into its meninges, or protective outer layer. The neuropeptide release coincides with inflammation and irritation of the cerebral blood vessels, lending credence to Dr. Wolff’s blood vessel research.
As inflamed blood vessels and the accompanying peripheral sensations lead to central sensitization, the migraine is now in full swing. This third phase may continue from four hours to three days.
But even worse, the inflammation may also be related to chronic migraine, which never really goes away.
Migraineurs finally reaching the fourth stage, or postdrome, are pretty exhausted from the overwhelming nerve and blood vessel activity.
Brain imaging shows a “widespread reduction” in cerebral blood flow and the migraine is wrapping up with a final persistent blood flow to the occipital cortex.
Still Seeking Answers about What Can Cause Migraines
Understanding these mechanisms is critical to developing medications and other solutions to help the world’s one billion migraine sufferers.
Dr. Wolff was a migraineur whose agony led him to spend his life trying to understand his pain. He lacked modern technology, so the complete picture remained elusive.
However, even the advances of the past 70 years leave what’s happening in our heads during migraines a partial mystery. Yet, we needn’t depend on science to flesh out every detail.
Migraine sufferers can identify and avoid the specific triggers that launch the migraine process. A future post will cover some well-known triggers.
And we’ll return to Sir William Gower’s prophetic wisdom, as expressed in A Manual of Diseases of the Nervous System. In the chapter devoted exclusively to migraines, he writes of treatments:
“… of especial importance are increased rest, regularity in meals, [and] attention to diet.”
Please read my story of how paying attention to diet dramatically lowered my migraine intensity and frequency!
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