When we hear the word migraine, most of us immediately picture someone clutching their head in pain, hiding in a dark room. While head pain is a major symptom, it barely scratches the surface of what a migraine truly is. This neurological disorder comes with a host of other symptoms—some that appear days before the headache even begins. Let’s break down what actually happens in the brain during a migraine and why no two experiences are the same.
The First Signs: Warning Signals from the Brain
Before a migraine hits, the body often sends subtle—and sometimes strange—signals. These early signs may appear hours or even days in advance and can include:
- Mood swings
- Fatigue
- Nausea
- Light and sound sensitivity
- Sleep disturbances
- Yawning
- Increased thirst
All of these are linked to one important area in the brain: the hypothalamus. This part of the brain regulates our internal balance—hormones, body temperature, water levels, and sleep cycles. During the pre-migraine phase, the hypothalamus becomes unusually active. That heightened activity may explain the odd sensations people often feel right before the pain phase.
The Mysterious Aura Phase
Not everyone with migraines experiences an aura, but those who do often describe it as one of the most surreal parts of the experience. Auras can include:
- Temporary visual distortions (like zigzag lines or blind spots)
- Tingling sensations
- Difficulty speaking
These are not hallucinations but rather neurological disturbances. They occur when there’s a sudden change in electrical charge across neurons, creating a wave of altered activity that spreads across the brain. The affected part of the brain determines the symptoms. For example, if it moves across the visual cortex, people may see flashing lights or dark spots in their vision.
What’s still unclear is what causes this initial change in charge—but once it starts, it can quickly cascade, triggering various aura effects.
The Headache Hits: Trigeminal Nerve Takes the Stage
When the actual migraine pain begins, one key player becomes involved: the trigeminal nerve. This nerve covers much of the face and scalp, as well as some of the blood vessels and protective layers around the brain.
Under normal conditions, the trigeminal nerve sends signals about touch and temperature. But during a migraine, it gets sensitized. This means that even normal activities—like coughing, bending over, or being exposed to light—can feel painful. It’s not just the pain that gets worse; the threshold for what causes pain drops dramatically.
Who Gets Migraines—And Why?
Migraines are surprisingly common, but they don’t affect everyone equally:
- Around 33% of women and 13% of men experience migraines at some point in their lives.
- Women are far more likely to be affected, which points to hormonal involvement.
For many women, migraines decrease significantly after menopause when hormone levels stabilize. However, just before menopause, when hormones fluctuate even more, migraine frequency or intensity often worsens. This suggests a close connection between sex hormones and migraine activity.
A Web of Other Health Issues
Migraines rarely exist in isolation. People with migraines are more likely to also suffer from:
- Depression
- Panic disorders
- Sleep disturbances
- Stroke
The link between migraines and these conditions is still not fully understood. It could be that migraines increase the risk of these illnesses—or that shared genetic factors make individuals prone to both.
The Role of Genetics
While no single gene has been pinpointed as the cause of migraines, genetics almost certainly influence who gets them. Certain genes affect:
- How excitable our neurons are
- How easily those neurons transmit pain signals
- How well the brain blocks out those pain signals
People who suffer from migraines may simply have brains that are more reactive to external stimuli and less capable of filtering out pain once it begins.
So, What Is a Migraine Really?
Despite how common migraines are, there’s still a lot we don’t know. What sets off the hypothalamus? Why do some people get aura and others don’t? Why do some outgrow migraines while others develop them later in life?
Here’s what we do know:
- A migraine is a neurological disorder, not just a bad headache.
- It affects multiple areas of the brain, including the brainstem, cerebral hemispheres, and nervous pathways.
- It’s influenced by hormones, genetics, and environmental factors.
Final Thoughts: Understanding the Bigger Picture
For those who’ve never had one, a migraine might just seem like an inconvenient headache. But for millions, it’s a recurring, exhausting, and unpredictable condition that affects daily life, work, relationships, and well-being.
By recognizing that a migraine is more than pain—that it’s a brain-wide event involving various systems and stages—we can better support those who suffer from them and push for more research and solutions.
