Pain in the Brain: Getting Ahead of Headaches

Story by Meghan Jackson | Image courtesy of


Anyone who suffers from migraines is familiar with the flashing, the pounding and the don’t-you-dare-talk-to-me feeling that comes along with them. And for anyone who is fortunate enough not to get them, the best words to accurately describe one are absolutely debilitating. As a recipient of whatever gene it is that gives us the kiss of headache death, I tend to take the somewhat dramatic “why me?” approach to dealing with them. But recently, I took the opportunity to figure it out. Really — why me? Why anyone? Is there something different about a brain that gets migraines from a brain that doesn’t? What do we do differently that gives us this life-halting illness? After speaking with two neurology specialists in Georgia, I came to the conclusion … not much.

It’s important to understand that there are three main types of headaches considered primary headaches: tension headaches, cluster headaches and of course migraine headaches. These are all caused from a variety of factors, which can include genetics, chemical activity in the brain, nerves or blood vessels in the head or muscles in the head and neck.

The basic medical definition of a migraine is a complex neurovascular disorder that’s associated with the activation of pain receptors in the brain. More colloquially, a unilateral, throbbing headache, generally on one side of the head and accompanied with nausea, vomiting and sensitivity to light and sound (sounds fun, right?). Or the much less technical description that I usually spew out: one step short of death (dramatic, remember?). It’s also the most common primary headache. Different from a tension headache or cluster headache, which are described as mild pain that feels somewhat like a tight band around your head, and severe clusters of pain generally behind an eye or on one side of the head that may occur multiple times throughout the day, respectively, a migraine is believed to originate in the brain stem.

Genetics lay the groundwork for them to form in most cases, but there are also a number of environmental factors that contribute to sending someone into a migraine — whether they carry the genes or not. The aspect that makes it so challenging to control is that there isn’t one universal thing that causes them. The triggers are different for everyone, and many factors are involved. The most common triggers, as explained to me by Dr. Frank Berenson of Atlanta Headache Specialists and one of two physicians in Georgia boarded in headache medicine, are poor sleeping habits, poor eating habits, dehydration and stress, and food triggers, such as red wine, chocolate or meats containing nitrites.

When I ask about medications, Berenson is quick to mention that the first step for patients is a lifestyle modification, which is partly monitoring dietary intake and physical activity that could trigger migraines. “People who have migraines really need to maintain a regular schedule. They need to sleep regularly, eat regularly, and really take care of themselves.” And while this statement applies to all people, not just those suffering from migraines, I understand that he means making a significant effort to keep a routine and manage triggers. Migraines are like a delicate grenade, and even the smallest touch of the pin can cause it to fall out and explode.

And while there are a plethora of prescription and non-prescription drugs that can be effective when lifestyle changes give no relief, it’s something to be careful with. Berenson stresses the medication phenomenon that can be caused when drugs like Excedrin or Aspirin are overused and begin to make headaches worse instead of relieving them, also known as rebound headaches.

When asked about the recent FDA approval of Botox for treatment of migraines he says that he often does use it as a treatment, but only for certain cases. It turns out that aside from its youth-restoring properties, Botox relaxes the muscles around the head and blocks calcitonin gene related peptide (CGRP), a neurochemical that causes headaches, giving it the ability to be very effective in the treatment of chronic migraines in patients 18 and older (stops aging and headaches? Sign me up). Some other non-medicinal remedies he recommended were riboflavin, magnesium and a naturally occurring plant called butterbur.

As far as brain patterns, there is not any real evidence that indicates a difference between migraine sufferers and non-sufferers or that would suggest someone to be more susceptible than others. In fact, most cases that call for imaging of the brain are done to find an underlying cause. This is the type of thing that Carter Cooper, Neurology Physician Assistant at Peachtree Neurosurgery, deals with everyday.

Besides significantly inhibiting the ability to function in society, migraines can also indicate there could be a more serious issue present, such as a tumor. The patients Cooper sees have already seen their general practitioner and are sent to him with the belief that there is, in fact,  a more serious underlying cause. He tells me that questionable symptoms include when a headache feels new or different in location, characteristics or intensity and that it’s also relevant to acknowledge the time of day a headache occurs. “A lot of the time our headaches come near the end of the day, when we’re so stressed out by finances and family and schedule and time pressures and traffic — that it would be crazy not to get a headache. So, a headache at the end of the day can be very normal and is not worrisome, but a headache that awakens you in the early morning hours, that’s unusual.” However, he assures me that primary headaches are not commonly cause to be concerned.

It’s easy for migraine patients to get frustrated. A headache coming on means leaving work, canceling plans or missing out on life in general to lie alone in a dark room. On the bright side (a bright side — who knew?) migraines are not commonly signs of deeper issues and can be managed in most cases with lifestyle modification. Whether that means drinking more water, avoiding certain things all together or never leaving home without medicine, it’s safe to say that the 37 million Americans who suffer from them can live fairly normal lives. And while there are very few aspects of migraines that help people see the glass half full, no one who gets them can argue that they don’t bring a greater appreciation for days they wake up feeling healthy.