The most common type of vascular headache is migraine. Migraine
headaches are usually characterized by severe pain on one or both
sides of the head, an upset stomach, and at times disturbed vision.
Former basketball star Kareem Abdul-Jabbar remembers
experiencing his first migraine at age 14. The pain was unlike the
discomfort of his previous mild headaches.
"When I got this one I thought, '
is a headache'," he
says. "The pain was intense and I felt nausea and a great
sensitivity to light. All I could think about was when it would
stop. I sat in a dark room for an hour and it passed."
Symptoms of migraine.
Abdul-Jabbar's sensitivity to
light is a standard symptom of the two most prevalent types of
The major difference between the two types is the appearance of
neurological symptoms 10 to 30 minutes before a classic migraine
attack. These symptoms are called an aura. The person may see
flashing lights or zigzag lines, or may temporarily lose vision.
Other classic symptoms include speech difficulty, weakness of an
arm or leg, tingling of the face or hands, and confusion.
The pain of a classic migraine headache is described as intense,
throbbing, or pounding and is felt in the forehead, temple, ear,
jaw, or around the eye. Classic migraine starts on one side of the
head but may eventually spread to the other side. An attack lasts 1
to 2 pain-wracked days.
The common migraine--a term that reflects the disorder's greater
occurrence in the general population--is not preceded by an aura.
But some people experience a variety of vague symptoms beforehand,
including mental fuzziness, mood changes, fatigue, and unusual
retention of fluids. During the headache phase of a common
migraine, a person may have diarrhea and increased urination, as
well as nausea and vomiting. Common migraine pain can last 3 or 4
Both classic and common migraine can strike as often as several
times a week, or as rarely as once every few years. Both types can
occur at any time. Some people, however, experience migraines at
predictable times -near the days of menstruation or every Saturday
morning after a stressful week of work.
The migraine process
.Research scientists are
unclear about the precise cause of migraine headaches. There seems
to be general agreement, however, that a key element is blood flow
changes in the brain. People who get migraine headaches appear to
have blood vessels that overreact to various triggers.
Scientists have devised one theory of migraine which explains
these blood flow changes and also certain biochemical changes that
may be involved in the headache process. According to this theory,
the nervous system responds to a trigger such as stress by creating
a spasm in the nerve-rich arteries at the base of the brain. The
spasm closes down or constricts several arteries supplying blood to
the brain, including the scalp artery and the carotid or neck
As these arteries constrict, the flow of blood to the brain is
reduced. At the same time, blood-clotting particles called
platelets clump together--a process which is believed to release a
chemical called serotonin. Serotonin acts as a powerful constrictor
of arteries, further reducing the blood supply to the brain.
Reduced blood flow decreases the brain's supply of oxygen.
Symptoms signaling a headache, such as distorted vision or speech,
may then result, similar to symptoms of stroke.
Reacting to the reduced oxygen supply, certain arteries within
the brain open wider to meet the brain's energy needs. This
widening or dilation spreads, finally affecting the neck and scalp
arteries. The dilation of these arteries triggers the release of
pain-producing substances called prostaglandins from various
tissues and blood cells. Chemicals which cause inflammation and
swelling, and substances which increase sensitivity to pain are
also released. The circulation of these chemicals and the dilation
of the scalp arteries stimulate the pain-sensitive nociceptors. The
result, according to this theory: a throbbing pain in the head.
Women and migraine
.Although both males and females
seem to be affected by migraine, the condition is more common in
adult women. Both sexes may develop migraine in infancy, but most
often the disorder begins between the ages of 5 and 35.
The relationship between female hormones and migraine is still
unclear. Women may have "menstrual migraine"--headaches around the
time of their menstrual period--which may disappear during
pregnancy. Other women develop migraine for the first time when
they are pregnant. Some are first affected after menopause.
The effect of oral contraceptives on headaches is perplexing.
Scientists report that some women with migraine who take birth
control pills experience more frequent and severe attacks. However,
a small percentage of women have fewer and less severe migraine
headaches when they take birth control pills. And normal women who
do not suffer from headaches may develop migraines as a side effect
when they use oral contraceptives. Investigators around the world
are studying hormonal changes in women with migraine in the hope of
identifying the specific ways these naturally occurring chemicals
Triggers of headache
.Although many sufferers have
a family history of migraine, the exact hereditary nature of this
condition is still unknown. People who get migraines are thought to
have an inherited abnormality in the regulation of blood
"It's like a cocked gun with a hair trigger," explains one
specialist. "A person is born with a potential for migraine and the
headache is triggered by things that are really not so
These triggers include stress and other normal emotions, as well
as biological and environmental conditions. Fatigue, glaring or
flickering lights, the weather, and certain foods can set off
migraine. It may seem hard to believe that eating such seemingly
harmless foods as yogurt, nuts, and lima beans can result in a
painful migraine headache. However, some scientists believe that
these foods and several others contain chemical substances, such as
tyramine, which constrict arteries--the first step of the migraine
process. Other scientists believe that foods cause headaches by
setting off an allergic reaction in susceptible people.
While a food-triggered migraine usually occurs soon after
eating, other triggers may not cause immediate pain. Scientists
report that people can develop migraine not only during a period of
stress but also afterwards when their vascular systems are still
reacting. For example, migraines that wake people up in the middle
of the night are believed to result from a delayed reaction to
Other forms of migraine
.In addition to classic and
common, migraine headache can take several other forms:
paralysis on one side of the body, a condition known as hemiplegia.
Some people may experience vision problems and vertigo--a feeling
that the world is spinning. These symptoms begin 10 to 90 minutes
before the onset of headache pain.
, the pain is around the eye
and is associated with a droopy eyelid, double vision, and other
Basilar artery migraine
involves a disturbance of a major
brain artery. Preheadache symptoms include vertigo, double vision,
and poor muscular coordination. This type of migraine occurs
primarily in adolescent and young adult women and is often
associated with the menstrual cycle.
Benign exertional headache
is brought on by running,
lifting, coughing, sneezing, or bending. The headache begins at the
onset of activity, and pain rarely lasts more than several
is a rare and severe type of migraine
that can last 72 hours or longer. The pain and nausea are so
intense that people who have this type of headache must be
hospitalized. The use of certain drugs can trigger status
migrainosus. Neurologists report that many of their status
migrainosus patients were depressed and anxious before they
experienced headache attacks.
is characterized by such migraine
symptoms as visual problems, nausea, vomiting, constipation, or
diarrhea. Patients, however, do not experience head pain. Headache
specialists have suggested that unexplained pain in a particular
part of the body, fever, and dizziness could also be possible types
of headache-free migraine.