People are always quick to recommend painkillers to me as soon as they find out I get migraines. I think it comes from this misconception that migraines are just really bad headaches, which I was told over and over again my migraines were. But when you find out what actually happens in your brain when you have a migraine, you realize it's way more complicated than that.
Around 40 million Americans get migraines, Dr. Nauman Tariq, assistant professor of neurology and director of the Headache Center at the Johns Hopkins School of Medicine, tells Bustle. But around six million Americans experience chronic migraines, says Dr. Tariq, which means they'll have a migraine at least 15 or more days a month. Each person experiences migraines differently, but according to Johns Hopkins Medicine, migraines usually involve a "throbbing or pounding feeling" on the head, neck, and face and can also include nausea and sensitivity to light, noise, and smells.
I always thought migraines were just super bad headaches. I mean, they made me miss work and feel sick for days on end, but they were still just bad headaches, right? But Amaal Starling, M.D. a neurologist and migraine specialist at Mayo Clinic, tells Bustle that migraines aren't even headaches.
"Migraine is abnormal processing of sensations in the brain," Dr. Starling says. That means the brain isn't processing sensory stimulation — like light, sounds, or smells — normally, says Dr. Starling, and the most common sensation people with migraines are processing abnormally is pain — hence, the "worst headache of your life" misnomer migraines are known for.
Dr. Starling says the brains of people who experience migraines are more easily activated by environmental stimuli, like bright lights, loud noises, motion, and strong odors. But because migraines aren't headaches, Dr. Starling says that migraines don't always involve pain. A person could be having a migraine but have mild pain or no pain but still experience other migraines symptoms, like nausea, dizziness, or sensitivity to light or sound.
Dr. Starling says advances in neuroimaging have taught the medical community a lot about the brains of people who have migraines. "Some of the things that we have learned from [functional magnetic resonance imaging] fMRI data is that, [...] even if someone is not having a migraine attack, the brain function of someone who has migraine, even in between an attack, is different from someone who does not have migraine," Starling says.
THE PAIN MATRIX
Neuroimaging data has shown that there is a network of connections in the brain called the pain matrix that's located in multiple areas of the brain, Dr. Starling says, and it's much easier for that pain matrix to become activated in people who experience migraines when they encounter things that trigger their migraines. That made sense to me when it came to environmental stimuli like foods and weather, but what about stress and anxiety?
"Stress is a very well known trigger for migraine," Dr. Starling says. "We know that when someone is having stress that it changes the hormones in the body — cortisol, adrenaline, all of those things change in the body — and those things could potentially activate this [pain] system." But Dr. Starling says the medical community still has a lot more work to do to understand how the stress response is connected to the pain matrix.
WHAT CAUSES MIGRAINES VS. WHAT TRIGGERS THEM
What the medical community does know is that environmental stimuli and stress do not cause your migraines. They trigger your migraines, and that's a major distinction. Migraines are caused by genes you inherit, and that's not something you can change; migraines get fired off in your brain when you encounter certain environmental stimuli that trigger them.
"It's usually a trigger such as poor sleep, stress, dehydration, hunger, or sometimes food triggers like alcohol that can activate a wave of chemicals deep inside the brain stem and a small part of the brain called the hypothalamus," Dr. Tariq says. "It then sends signals to the pain perception regions of the brain called the cortex. This is how we feel the head pain, nausea, and bright light and sound sensitivity."
THE MIGRAINE STIGMA
Dr. Starling says that internal factors, like genetics, are the actual cause of migraine, but because so many people confuse triggers with what's causing their migraines, there's still a lot of stigma and guilt surrounding migraines.
"I see patients who come to me and ask, 'I don't know what I'm doing wrong? I don't know why I keep getting these migraines? [...] I've tried to reduce stress and try to eat right and try to hydrate.' I have to tell them, 'You're not doing anything wrong. You shouldn't feel guilty. You have a genetic neurologic disease. It's not your fault.'"
Let's just pause on that for a moment. For anyone who gets migraines, that's a revelation, so let's repeat it. You have a genetic neurologic disease, and it's not your fault. You're not getting migraines because you slept badly, or didn't drink enough water, or you had that glass of wine; it's a disease like any other.
Dr. Starling says though migraines are caused by genetics, you can sometimes manage what triggers your migraines. That's why some people (like me) take preventative medications for their migraines, which Dr. Starling says can help increase their pain matrix's threshold of activation.
Before I'd talked to Dr. Starling, I'd spent the last year trying to get off my migraine medication because I'd convinced myself I "shouldn't need it." I was meditating every night before bed, drinking tons of water every day, and going to the gym at least once a week. But every time I tried to stop taking it, the headaches started to come back, and I got angry and resentful. But now I know it's not my fault, and it's OK to take medication to deal with my migraines — just like any other treatment for any other chronic illness.
Knowing what's happening in the brain when you have a migraine was completely life-changing for me. I now know that I am doing everything right, and I can stand tall the next time a boss or co-worker or friend says it's "just" a headache. Because now I know I was born this way, and my migraines are not my fault.