Published on June 20, 2023
Authored by Pfizer Medical Team
If you're among the more than 4.9 million Australians living with migraine headaches, you fully understand how debilitating migraines can be.1 The pain, nausea, and sensitivity to light and sound1 can make it impossible to work or care for your family. Migraines are the world’s second leading cause of disability and the first amongst young women aged 15-49 years old. 2
Understanding the science behind migraines and headaches can help to explain why migraines are different to other headaches.
Headaches are characterised by pain and discomfort located in the head. The pain can range in severity from mild to severe, and may be throbbing, pounding, or stabbing.1 Headaches can result from:
Infection, injury, or another problem in the body.
Illnesses such as influenza, meningitis (inflammation of membranes surrounding the brain and spinal cord), and bacterial or viral sinus infections can all cause headaches.
Head injuries, including concussions.
Hunger and dehydration can even trigger headaches.3
On the other hand, a migraine is considered in part a blood vessel disorder that affects the brain but can also impact other parts of the body. Importantly, pain signalling pathways in the brain are sensitised and strongly activated during migraine.3 Symptoms are not restricted to the head, and the functioning of the digestive system (nausea and/or vomiting), eyes (blurred vision), and neck (stiffness/pain), can be affected.3
For some people, the first sign of migraine is a visual “aura”, or visual changes, such as blurred vision, flashing lights, blind spots, or wavy images that are only visible to the person with the migraine. Later, the individual may experience severe head pain, sound and light sensitivity, nausea (feeling sick), or vomiting. Movement can make symptoms worse, so someone experiencing a migraine may feel that they want to lie down in a quiet, dark room, especially if they are feeling sensitive to sound and light. Symptoms can last a day or longer, and even after the pain subsides, the affected individuals may feel fatigued and unwell 1,3. Common triggers that can result in migraine symptoms include hormonal shifts, stress, certain foods, and the weather. Triggers and experience of migraine can vary from person to person, as well as over time1.
Migraines have been a part of the human experience for a long time. Hippocrates, in fact, described migraine symptoms in 400 B.C. And yet, their cause hasn’t been well-understood4.
Experts have known for a long time that migraines are more likely to affect those assigned as female at birth and that migraines appear to run in families5.
For a long time, experts believed that the pain and discomfort experienced with migraine was caused by contraction (squeezing) or tightening of the smooth muscle cells in blood vessels, followed by relaxation. Medication that causes contraction of blood vessels, was first used to treat migraine in 19256.
As late as the 1980s, the only available treatments to prevent migraine were medications that had been developed for other purposes, such as blood pressure lowering medications (antihypertensives)7.
Researchers realised that serotonin, a type of chemical that sends messages between nerve cells in the body, appears to play a role in the development of migraine headaches. This led to the development of medicines called “triptans” which bind to and activate serotonin receptors in the central nervous system to help stop a migraine attack7,8.
Improved understanding of the causes of migraine, including sensitisation of pain pathways and origin of attacks in the central nervous system, has been the primary driver for the discovery of medications for migraines over the last 30 years3.
At the moment, there are 2 types of treatment for migraine, acute and preventative:
Acute treatments are taken as needed when a migraine attack occurs and can include pain relieving medications available from a supermarket or pharmacy. Medications available with a prescription (such as triptans discussed above) are also available.
Preventative medication is usually prescribed to patients who experience 3 or more migraines per month and can be prescribed by a general practitioner or neurologist9.
There are also lifestyle management tools that can help prevent migraine, these include keeping a headache diary to understand triggers such as certain foods or lacking or consuming too much caffeine for example. Other tools include trying to keep a regular sleep schedule, exercise, staying hydrated and trying to manage stress9.
For patients who experience migraine symptoms, it is important to speak to your doctor to discuss and confirm the diagnosis and find the best tailored treatment plan.