New Findings on Migraines

This Vox article on migraines is a rare quality on on the subject.

Experts used to think migraines were solely caused by the abnormal expansion of blood vessels in the brain, according to Zhang. Over the past couple of decades, that thinking has evolved: Scientists now believe the brains of people with migraines are exquisitely sensitive to the effects of certain neurotransmitters, in particular calcitonin gene-related peptide, or CGRP.
"The CGRP molecule is essentially a pain molecule," says Zhang. Headache researchers have found that people with migraines had higher blood CGRP levels during headaches than people without migraines, and that giving migraine-prone people infusions of the molecule triggered headaches. These discoveries made the molecule a target for a flurry of drug discovery, and since 2018, the FDA has approved eight new migraine drugs.

Nurtec is one of the newer drugs and it has been wonderfully effective for me. I've been taking it every other day since late 2021 and it effectively prevents my migraines. Rizatriptan had helped, too, but it wasn't preventative and I was going through the maximum 10 pills a month. If you're a migraine sufferer and put off seeing a neurologist, let me tell you to change that. The new drugs work.

Anticipatory anxiety, the worry about something bad to come, is one of the types of stress that can trigger migraines. That can make it challenging to disentangle actual migraine triggers from beliefs about triggers. Lipton remembers a patient who blamed his migraines on changes in barometric pressure, which his smartwatch pinged him about in real time. "I took away his watch, and his headaches got a lot better," he says. "Beliefs about triggers cause anticipatory anxiety, which increases the probability of headache."

This is also true for me. It's undiagnosed, but I'm pretty sure I have a low-level general anxiety disorder which I highly suspect it's also one of my migraine triggers. How frustrating is it that fear of a thing could make that thing happen? Very.

He notes that migraine triggers are often cumulative: For example, many women can drink alcohol without getting a migraine at most times of the month, but a glass of wine during their menstrual cycle can lead to a headache.

Absolutely. After keeping a migraine journal for years, I found this to be true for me. I learned that migraines were regularly occurring on overcast or rainy days. That itself, wasn't enough to cause a migraine, but it was if I had had multiple drinks the night before. Or if I was stressed about something, or my diet had been bad for a day or two. Keeping tabs on all of this has been a huge help.

When it comes to prevention, the greatest boon has been the ability to work from home. No commute, no fluorescent office lights, no social anxiety and forcing myself to be pleasant. Also, when at home, comfortable on a couch in soft natural light.

Migraines are the worst. I've been suffering from them since I was in 3rd grade, when my eyesight went south and I needed glasses. And when my social anxiety was coming on board. If you're suffering from regular headaches and haven't looked into treatment, you absolutely should. I put it off for a very long time and regret it.