What is migraine?

Migraine is a type of headache with a marked periodical and recurrent character that is accompanied by nausea, vomiting and a hypersensitivity to light and sound. It is more common in women than in men.

A typical attack often begins with warning signs such as mood and emotional changes or a tendency to certain foods (e.g. restlessness, changing smell perception, increased urination, irritation, dizziness, depression, concentration disorder). This phase is usually followed by an 'aura' (visual field disturbances, flashes of light, seeing zigzag lines, seeing circles, seeing 'hot air’, etc.) after which the actual headache starts. Most patients complain of pulsation and throbbing pain behind the eyes on one or both sides of the head.

After the headache phase, one is heavily tired unable to concentrate and the head remains more sensitive to pain.

Migraine attacks can break out at any time of the day but it is not exceptional that they start in the first phase of relaxation (the weekend, start of the holiday). A migraine attack usually takes 4 to 72 hours.

How does migraine develop?

Impulses of the cerebral cortex, the thalamus and the hypothalamus activate the so-called 'center for migraine', which is probably located in the brainstem (raphe nuclei - nuclei for the production of Serotonin - and the locus coeruleus). By activating this center in the brainstem, blood circulation and the activity of the cerebral cortex decreases. This can explain the development of an aura.

Serotonin appears to play an important role in migraine (raphe nuclei). Receptors for serotonin are located in the blood vessels of the brain and in the ends of the fifth cranial nerve (trigeminal nerve).

This can explain, on the one hand, why vasomotor function is disturbed in migraine. During the first phase, the blood vessels of the brain are constricted (vasoconstriction) while they are dilated (vasodilatation) during the headache phase.

On the other hand, it explains the pulsating and throbbing pain sensation, the trigeminal nerve or facial nerve, in fact, is responsible for the feeling in the face.

When the trigeminal is overstimulated, it can provoke autonomic reactions such as nausea and vomiting.

How is migraine treated?

Migraine can usually be treated well with medication. The disadvantage of drugs is that they can have unpleasant side effects. If medication does not adequately suppress the migraine, or gives too many side effects, neuromodulation can be applied. This was scientifically demonstrated by colleagues in Liège.

The precise effect of neuromodulation in migraine is not clear yet, but it may have an influence on the functioning of brain stem cores, which may play a role in the development of migraine.