What causes migraines? Study of 'brain blackout' offers clues

I suffered from migraines for over a decade. They were infrequent at first but, at the peak, I was getting 1-2 a week and felt like I was just "surviving" in life. I saw countless doctors and specialty clinics, none of which offered long term relief other than drugs.

For me, Rizatriptan helped take the edge off pain but I always had more migraines than pills could safely relieve in any given month. In the end, most months I had to choose whether I would get relief in the moment or save the 1-2 remaining pills for the following week(s) before a refill.

I had every blood / allergy test available and none ever showed any issues. I thought there may be a correlation to gluten but there were times where gluten (bread) helped with the nausea side effects.

Ultimately, I gave up gluten, coffee and sugar all at once. Within weeks I felt better and suffered no migraines for over a year until I decided to test the waters with a flour tortilla. Within a few hours I was bed ridden with a migraine for 2-3 days.

I have worked sugar back in to my diet in moderation but gluten and coffee are still out. I have only had that one migraine in 3+ years.

Anyone suffering, the absolute best advice I ever got was to keep a food / pain log. Do it every day no matter what. It may take a week, months or a year but it will uncover something that will help reduce frequency. Also, listen to your body. I had numerous doctors tell me I didn't have any food allergies and to focus on other areas for relief. Every single one was wrong and I could have had a cure years previous.

I have gotten migraines (a visual aura followed by a horrible headache) on and off for years. Some years I’d have a couple, some years I’d have none at all. I have always tried to trace it back to a common theme. For the longest time I thought that common theme was caffeine.. to the point that I quit caffeine for like a year. Unfortunately, I still ended up with a migraine! One day I realized something, maybe my migraines had nothing to do with caffeine but everything to do with electrolyte balance. I recalled the many days I’ve had migraines and besides caffeine, the other common theme was that I had drank a significant amount of water. Sparkling water especially, I can pretty much just guzzle all day because I never get bored or sick of it. Sense then, I’ve made sure that if I drink a lot of water I also throw in some LMNT or similar electrolyte powder in there. I’ve been able to enjoy coffee again without the migraine. YMMV!

It's cool to see some progress on aural migraines.

In the past I tried zolmitriptans for it but they don't do much, same with milder pain killers.

My migraines started at 20, two decades ago. I remember the first one like it was yesterday. I was studying CS and was coding on a dark-mode CRT monitor with a big fat window reflection on the screen.

It always happen the same way, with the characteristic jiggles, some kind of colorful, moving patterns of light that start in the center of my vision, slowly expanding to my entire field of view, making me temporarily blind. Then 30 mns after the onset of that, gone. 30 more minutes and the headache + strong nausea start, and immense fatigue. At that point I'm out of commission for a good 12h. Meaning I better be close to my bed, in total darkness.

It really sucks. I used to have them every 3 months on the dot, like on a timer. As I'm getting older I'm having less and less of them, going about a year without one. And they are a lot milder now. I have a lot less of the jiggles, no nausea and the headache is not so bad. I'm still fatigued but usually recover the same day. I consider myself lucky.

It seems to run in my family.

I've tried finding a trigger for the migraines but I have no clue. I used to associate them with bright lights as there is usually a bright light present when they happen, but it needs some other element. Stress and fatigue appear to be factors, as are tanins contained in red wine and beer. But sometimes none of these elements were present.

I have a personal non-scientific theory that serotonin levels play a role. High levels like I think I had when I was younger tend to trigger migraines. As I'm getting older and grumpier, I probably have low serotonin and less migraines...

I wonder if there are multiple different causes. Because I have had migraines regularly since I was a little kid and sleep was the only cure. (Hours of crying until I'd pass out) But when I got to a teen I tried every pain killer I could find and finally I found that none of them helped unless I took it very early when the pain started. (Within maybe 30-40 min) And even then only ibuprofen worked. (And I have to take quite a bit) But even then the pain doesn't go away for some time. But at least it doesn't get any worse.

So I keep ibuprofen in every car, bag, and a few places around the house.

I semi-regularly get migraines, maybe a handful a year.

Nearly every time it's associated with a night of insomnia - I do everything the same, no coffee or alcohol or anything, no late work or screens. The same bedtime routine, I just.... don't sleep.

I'm not sure how to draw the line of cause/effect between the two. Is the lack of sleep causing a migraine the next morning? Or is the insomnia some symptom of whatever then becomes the symptom of a migraine.

Or even if such a line exists, I think the association is strong enough the two are related, but I know memory and the brain making things fit patterns can be misleading.

I (late 30’s male) grew up with migraine and ultimately discovered that they were triggered by caffeine mixed with dehydration and/or chocolate.

Having discovered this I’ve been able to control them completely, but realize that not everyone’s triggers are the same.

I carry sumatriptan just in case but have never felt as though it’s made a difference. I’m always hopeful for more solutions to migraines for those who suffer

Strange how this has so many different kind of triggers for different people. Makes me wonder if this really one phenomenon, or multiple with similar symptoms.

For me, it took years to identify two triggers: Relieve from stress, and overly exhausting sports or sauna. I used to have a stressful job, and regular intensive training on sunday mornings, and would very often get migraine at exactly 4pm. Since changing the job and doing moderate sports, it became much more infrequent.

Also, I have never had an optical aura. But I have observed yawning, and an increased sensitivity in my nasal passages (basically I feel every breath much more detailed, but not painful) as forewarnings.

I had headaches diagnosed as migraines since I was a kid, for 40+ years. It got to a point where I had scale 9 headaches for most days of some weeks and it was a tough going. Lots of doctors, some pain relief, but ultimately, no help. Then, in desperation, I tried drinking water. Headaches had been accompanied by the feeling of hunger/thirst and I thought to drink until it went away. I brought home a six-liter pack of mineral water and drank it all in 24 hours. And no more headaches. Nowadays I always have a bottle of water at hand consuming at least 1.5 liters a day. Nights are punctuated by visits to the loo, but I can live with that.

Reading other comments, I suppose migraines are a systemic issue, where something in the body is out of balance which manifests itself as an headache. And the medical science is really not very good with systemic issues: heart surgery has made great strides, but where nervous system meets the digestive system meets the limbic system etc, they struggle. Also, I think there’s an interesting aspect of level of detail of sensitivity here. Turns out my bouts of hunger were actually thirst. Since then, endurance sports have introduced me to an even wider gamut of ways the body might ask for different things. So maybe it’s about our ability to recognize and therefore correct imbalances in the body?

My favorite annoying quote from a book is once you have migraines figured out, they change. I had one solution that worked, it stopped, switched, rinse and repeat.

I get lightning shocks in my head at times, it’s not great. Long list of tried and failed medications. Almost everything on the list 0. Seems different for everyone. X drug works for some then causes memory loss for others.

If you have over 15 migraines per month, you can get Botox every 3 months. It lasts 1-3 months for me with an average of 2. Lasts meaning 1-3 per week. Not lasts means near daily migraines. $2-3k without insurance and it’s about 40 painful shots. Supposedly 2/3 people refuse Botox due to side affects (droopy eye 1/50 chance) or injection pain. Migraines are worse than 40 shots.

The new cgrp migraine prevention versions are available and highly advertised. You need to fail 2-3 classes of drugs to get approval depending on insurance and the syringes are currently hard to get but they last one month with a self subcutaneous injection.

Herbs: haven’t had much luck with anything except menthol variants and smelling/rubbing it on temples which is backed by a few papers.

The people I talk to usually say they used to get migraines then got divorced and they went away. Changed jobs to be less stressful led to less migraines.

Getting sick, weather changes, being overheated, pressure changes barometric/altitude, and not sleeping well causes more migraines. Food triggers led me nowhere.

0. https://www.drugs.com/condition/migraine.html?page_all=1

Reading this from the perspective of cluster headache, which gets some hand-me-down treatments from migraine, I just spent half an hour reading about CGRP blockers that have been approved in the last five or six years, including Aimovig and Ajovy for migraine, and Emgality for clusters.

It's been several years since my last cycle (my longest break yet), but it's heartening to know that research continues, leading to more treatment options.

Let me just copy/paste what I commented the last time this article was posted:

> The pain is protective because it’s telling the person to rest and recover and sleep

Try telling that to people who have pain so intense they end up in a cycle of vomiting and sleeping for a period of 72 hours.

> the brain experiences a blackout called a cortical spreading depression (CSD), when neuronal activity shuts down for a short time

Blackout does not sound like a good description. CSD travels across the cortex in a "wave", where the part currently affected by the wave is depolarized. Nothing is shutting down.

There are a lot of people who get migraine headaches without aura, and there are a lot of people who get migraine auras without headaches. The article doesn't seem to take that into account at all, and I can't seem to find a link to the research? The DOI link just points at the same short article?

Edit: I don't mean to sound like a debbie downer. I'm happy with any and all migraine research, and this seems to look at things from a different perspective, which might lead to new discoveries.

I have pain/food logs that uncovered nothing about my migranes. I started keeping a sleep log and discovered that on days I snooze my alarm and go back to sleep I have migranes. It takes some effort, but not "snoozing" my alarms (even 10 minutes) and getting up immediately has cured me of my migranes.

I share this in the event someone suffers this unknowingly.

In the past I had very frequent migraines, I suspect caused by stress and irregular sleep (I worked for years in-call and making lot of night works). Migraines will usually come in the weekend and take sometimes more than 24 hours to end. They started with irritability, light, noise and smell sensitivity, then visual aura and then migraine. I had a consultation with a neurologist and he suggested, before starting the drug therapy, to try agopunture with exactly those words:"For somebody is working and if it's not, you just got some needles in your body and you are not getting hurt". I was very skeptical, but it works: after couple of sessions my migraine are almost gone and very less intense. When migraines increases intensity and frequency, I immediately book a new agopunture session and I am fine for 12/18 months.

I suggest anybody that is struggling with migraine to try agopunture, for me was a game changer.

Have migraines from childhood(semi regularly, few per month). There have been a period where it stopped completely for several months. Had medication prescribed, but did not like side effects much (getting high, blood pressure rising, etc), and since ibuprofen usually helps to mitigate it, I stuck with it(I only get a migraine like once a year that is unbearable, to the point of crying). Few months ago, went on again to "researching" (listening any podcast episodes I could find on migraines) this topic a bit, and what I heard that I missed before - there is a considerable percentage of people who get migraines from fermented foods(or at least a connection they have made). So eliminating such food lowered my migraine count quite a bit (but I still do get them - and I think a handful of them might be stress related).

I've had migraines twice in my life, both preceded by chronic lack of sleep (thesis writing!). Auras preceded painful headaches in both cases. I cannot imagine having chronic migraines. Perhaps research like this will prompt us not search for the cure to migraines per se but the underlying cause.

I get migraines from two situations:

1. Stress. Significant stress can lead to migraines and I can feel them slowly start to build in the upper front of my brain above my left eye (or at least that's what it feels like). This can be stress from work or from kids or whatever.

2. Blips. I don't know how to describe these really. It's like my brain doesn't quite know how to process what's going on. An example: I gave my kids some ice cream for a snack one day after asking my wife if I should and her saying yes. 5 minutes later, she comes into the kitchen and says "Do we have any ice cream for the kids?". I respond with "Yes, I just gave them some, like we discussed." Her response: "We should give the kids some ice cream."

Now, that's a little bit of a weird conversation, and I think she was distracted by someone messaging her on her phone, but my brain just kind of "blipped" and didn't quite know how to handle it and it was instant blurred vision.

In case it helps anyone else, my wife gets migraines immediately from eating anything with milk, onions, corn, green beans, bananas and a few others. However, she can eat all of the above if it is organic. We’re from the US and visited Europe (Germany, Switzerland, The Netherlands) and she could eat anything there, organic or not. Hope it helps someone.

I have suffered migraines for a long time before I knew what migraines were and also a long time after. I was ignorant. But over the years I learned about my triggers. Some may find this helpful so posting them here. Your specific triggers may vary. The ones I have learned over the years are Refined Sugar, Electrolyte Imbalance, Stress, Sleep debt, Acid Reflux, Excessive Hunger, Dehydration (even mild), Excessive Heat, Sun Exposure. This list is not exhaustive but it can help identify triggers that usually go unnoticed for years.

I've had crippling migraines for a few years now. Often 20 or so per month. I rarely get headaches, and usually it's more of a feeling of exhaustion and malaise, following aura that includes facial numbness. The worst part is that it affects my work pretty badly by causing brain fog that lasts for days.

I'm on Ajovy injections which has reduced how many I get, but the only thing that really helps is taking 800mg of ibuprofen. That gives me a few hours of comfort.

It seems like an interesting mechanism, that the brain is somehow signalling by modifying CSF which in turn then then activates nerves.

The question I have is mechanistically, how is the brain actually doing that. If CSF sits on the other side of the blood-brain barrier, it doesn't contact brain cells. So you'd have to introduce some other layer of signalling that does communicate between them.

I've only had probably 3 or so migraines in my life, I sympathize with people who get them often. I can't imagine that level of pain regularly.

One strange thing about migraines for me is that it usually gets worse and worse until eventually I throw up. Immediately after barfing, the migraine loosens its grip and I feel normal again. Always found it super strange.

Just a data point I'd like to throw in... I'll get some horrible headaches if I don't get enough sleep and eat too much salt. It took me a while to figure out the trigger because it take two things, lack of sleep and eating something salty, and then there is a delay of 12 hours or so.

Does anyone else get nasal aural symptoms? My go-to signs were a tingling sensation in the nasal cavities, followed by things smelling horrible.

I've had the classic visual sawtooth pattern exactly once, but the nasal stuff was there maybe 75% of the time. What seems to have helped was blood pressure medication.

Getting up at the same time every day of the week without fail, and reducing overall caffiene intake helped mine

So as to not bury the lede: I'm not giving medical advice, but I wonder how many people's migraines are worsened by the Valsalva maneuver? How many would be prevented with a daily low-dose aspirin?

I had my first migraine (with aura) as a teenager. What a scary thing for you to lose proper vision, get a truly nightmarish headache, then feel nauseous and throw up! On average I'd say I got 1-5 a year for many years. I managed them with Migranal. Triptans didn't help. Migranal was an expensive pain to get, and is a poster child for our crazy pharmaceutical situation, but I digress.

I had a concussion a few years ago after which I could hardly go two weeks without getting at least one scotoma. In contrast to before, sometimes it would be just the aura without headache. For insurance reasons I moved over to Nurtec which wasn't bad, and a lot less unpleasant a taste. But 30+ incidents a year was crippling.

My neurologist was convinced my troubles were due to a PFO (patent foramen ovale): in the womb, we obviously do not breathe. A hole between the left and right sides of the heart allows blood to flow through from the mother. At birth a flap is supposed to cover this hole, but in many people it doesn't close all the way and there's a residual "shunt" which allows the "dirty" blood to flow straight through without going through the lungs (which also filter out junk, like microclots for example). When you strain, such as when bearing down/lifting something heavy/Valsalva maneuver, it really pushes this stuff through. Indeed I seemed to notice migraines came more frequently when I was better about exercising.

I had some other sporadic things over the years. My neurologist said "the brain is a big network. Throw a bunch of crap in there, and you get nonlinear outcomes." He was convinced the PFO was to blame for all of this.

I was referred to an interventional cardiologist, whose research had concluded, basically: "not all migraines are resolved by closing the PFO. But, if blood thinners make the migraines go away, in those cases closure does make them go away." Bayes at work. I was put on blood thinners and indeed they virtually stopped. (Sure enough, one of the two I did have in the year I was on Plavix--again, down from 20-30--was when I was doing the Valsava to pop my ears while a flight was landing).

After a year I did have the PFO closed. I am still on low-dose Aspirin (baby/EC). The neurologist had prescribed it years earlier when he first tested me for the PFO, but I resisted having to take medication daily. My original cardiologist who examined me further for the PFO said it was tiny and thought it was clinically insignificant, and didn't think I needed the aspirin. I've had the PFO closed for a year. I had one migraine during the procedure itself (not unexpected), and one more after about six months when I went off the aspirin. So I went back on the aspirin, and will presumably continue to be on it for life.

There are still unanswered questions: none of this explains the concussion, does it? The theory I've pieced together is that migraine is a probabilistic phenomenon. Things can make it more or less likely, presumably by putting the brain in a more or less resilient state. Bad sleeping habits? Inconsistent timing of food (low blood sugar)? Dehydrated? This is playing with dry kindling, waiting for the spark: perhaps a microembolism crossing through the PFO, or some other vasoactive compound (I've had them from the sun reflecting off of something and catching my eye). It was around puberty time when it all began, so a lot of stuff is going on. My thought is that perhaps the concussion "permanently" lowered my threshold.

My mother had always suffered from migraines. For other reasons (old with heart issues), she went on blood thinners temporarily. Then was off the blood thinners. Then she was back on blood thinners. Sure enough, after my experience we looked at her migraine log, and can you guess what pattern we found?

At present, closure is only indicated after you've had a stroke (I had at least one event that adequately qualified). I'm lucky: a few years before my adventure, my coworker had a stroke (while lifting weights) with permanent consequences, after which his PFO was closed. We already know that migraineurs are frequently at higher risk of stroke. I would bet that PFO closure will become a more routine procedure in the coming decades.