Uncovering the causes of migraine

Written by: Dr Stefan Schumacher
Published:
Edited by: Laura Burgess

Migraine is more prevalent than diabetes, epilepsy, and asthma combined. It causes 25 million lost days of work or school every year in the UK. For a long time, our understanding of the causes of a migraine was limited. In recent years, however, we’ve seen significant advances in theories about how migraines occur. In this article, we speak to Dr Stefan Schumacher, a consultant neurologist based in Greater Manchester with a special interest in the treatment of a headache and migraine.

What does a migraine feel like?

My patients often describe to me that they have a pressure above their eyes on the whole front of the head, which then worsens into a throbbing pain or a pulsing sensation. This can either be on one side of the head or on both sides. It can also spread to the rest of the head. This pain can build up quite quickly in hours or sometimes even minutes. The pain is significant and horrible for the patients. The migraine itself can go alongside a very high sensitivity to light, sounds, smells and touch. Patients can sometimes not stand the smell of food and perfume. Many migraine patients have to lie down and find relief in a dark room. A high number of our patients feel sick with the pain and some also vomit often quite frequently. However, there are quite a number of my patients who just experience nausea and no vomiting. The actual migraine attacks are often also described as lightheadedness and slight dizziness. Afterwards, patients feel weak, sometimes even confused – and often suffer from low mood. We distinguish two “warning signs” for migraine: One is called prodrome and the other one is aura.

Prodrome
These start one or two days before a migraine. The symptoms are:

  • mood changes
  • depression
  • neck pain
  • increased thirst and urination
  • some patients also yawn more frequently


These so-called prodromes occur less than auras, which is the second pre-stage and warning of a migraine.

Auras
These normally affect the visual system and show with flashing lights or zig-zag vision. Some patients also have visual loss. These auras build up gradually and can last between 20 and 60 minutes. Sometimes, auras can be caused by certain movements or speech disturbances. Auras can also be triggered by a foul smell or tobacco. The patient can also have sensory symptoms (pins and needles) in the arm or legs. Sometimes, I see weakness or numbness in the face or one side of the body. Aura can even affect the speech so that patients cannot express themselves. In rare cases, patients have unusual jerky movements. In my clinical experience, many of my patients have a migraine without an aura and this has been shown in large international studies.
 

Why do I get a migraine?

There is not just one cause for migraine. Migraine is a complex condition. We used to think that a migraine was caused by problems in the cerebral arteries with blood flow. However, today’s understanding is that chemical compounds and hormones also play a very important part, for instance, serotonin and oestrogen. These so-called trigger chemicals cause a narrowing of the blood vessels and this is the theory behind how a migraine happens. There is a lot of research currently being done in this area to further our understanding of how these factors interact.
 

What triggers a migraine?

Although an actual cause for a migraine has not yet been identified, in my work with migraine patients, I have often seen certain triggers which worsen headaches. These are:

  • stress in any form
  • depression
  • sleep deprivation
  • hormonal shifts
  • tiredness
  • insomnia


Certain foods and drinks can sometimes worsen or sometimes even cause a migraine, especially:

  • red wine
  • cheese
  • chocolate
  • nuts


(Unfortunately, these foods and drinks are often very well-liked by patients and they all enjoy them!)

I also see patients whose migraines are brought on by changes in the weather. Finally, a lot of migraine patients are light sensitive and hence flickering lights in certain clubs or even from PC screens can cause or worsen a migraine.
 

Why are some people more prone to a migraine than others?

In general, more females suffer from migraines than males. I assume that the reason for this is the hormonal changes in women. The fluctuation in oestrogen seems to trigger the headaches. For example, many of my female patients suffer from increased migraine before or during their periods. I call this menstrual migraine. Meanwhile, it is always very interesting for me to see that women who become pregnant or enter the menopause often have much fewer headaches. Certain contraceptives like combined oral hormones worsen the migraine. It is therefore very important for us to ask female patients if they are on contraception and, if so, what medication they are taking. Many of our patients have a family history of migraines, and therefore have a high increased risk for developing migraines. I sometimes have patients who have migraines through three or even four generations. Finally, a patient’s age plays a very significant part in migraines. They normally start in adolescence and are less severe in ages 50-70. Migraine is not a very frequent problem we find in elderly patients.

By Dr Stefan Schumacher
Neurology

Dr Stefan Schumacher is a leading consultant neurologist based in Greater Manchester, who specialises in multiple sclerosis (MS), Parkinson’s disease, headaches and migraines.

Dr Schumacher was born and educated in Germany and moved to the UK in 2007 where he worked as a consultant neurologist in Salford Royal Hospital and Royal Bolton Hospital. He currently works in the private sector at the Spire Manchester Hospital and BMI Alexandra Hospital.

Dr Schumacher studied medicine in Florence, Italy and Saarbruecken and Freiburg, Germany. In Germany he worked in a number of medical centres, including Neurosurgery University Hospital, Giessen and a specialised centre for MS and Parkinson’s disease in Bad Laasphe.

For nine years Dr Schumacher was a consultant and the Medical Director of the Wicker Clinic in Bad Wildungen. His department was one of the first in hospitals in Germany to be certified by the German Society for MS. He participated in MS research and was in charge of phase 3 trials with MS medication.

Dr Schumacher was the German Deputy for medical exchange with several Arab countries such as the United Arab Emirates, Qatar, Oman and Egypt. He was a lecturer at the University Hospital Marburg and a teacher and an examiner for medical students at Marburg University.

As a passionate long-distance runner, he holds a special interest in sport-related health issues in neurology. Dr Schumacher is a member of the committee 2.5 Neurology and Sport of the German Society of Neurology and has presented in the past on scientific conferences for this committee.

Dr. Schumacher was born and educated in Germany. He is a son of a German father and English mother from Windsor/Berkshire, he was brought up bilingual.

He studied medicine in Florence, Italy and Saarbruecken and Freiburg, Germany. After graduation he worked in different medical centres in Germany incl. neurosurgery university hospital in Giessen and a specialised centre for Multiple Sclerosis and Parkinsons Disease in Bad Laasphe.
During his time in neurosurgery Dr Schumacher had a special interest in intense care medicine and was one the responsible physicians of the ITU in University Hospital Giessen/Germany which was managed by neurosurgeons and neurologists.

For 9 years Dr Schumacher was consultant and medical director of the Wicker Clinic Bad Wildungen. His special interest at that time was Multiple Sclerosis (MS) and Parkinsons Disease (PD). Dr Schumacher's department was one of the first hospitals in Germany which were certified by the German Society for MS
(" Deutsche Multiple Sklerose Gesellschaft"). Dr Schumacher participated in MS research and also was in charge of Phase 3-trials with MS medication.

Dr Schumacher is member of 3 national neurological societies: ABN (Association of British Neurologists), DGN (Deutsche Gesellschaft fuer Neurologie ) and AAN (American Academy of Neurology).

Dr. Schumacher was German deputee for medical exchange with several Arab countries such as Emirates, Qatar, Oman and Egypt.
He was a lecturer at the University Hospital , Marburg (Prof. Oertel, Neurology) and a teacher and examiner for medical students in Marburg/ University.

Dr Schumacher and his family moved to UK in 2007 and worked as a consultant neurologist in Salford Royal Hospital (prior known as Hope Hospital) and Royal Bolton Hospital. Since 1.4.2016 Dr Schumacher works part time in NHS at Salford Royal Hospital.
Dr Schumacher works 4 days weekly in 2 private hospitals in Manchester : Spire Hospital in Didsbury and Alexandra Hospital in Cheadle.

Being himself a passionate long-distance runner, Dr Schumacher has since years a special interest in sport-related health issues in neurology. Dr Schumacher is member of the committee 2.5 "Neurology and Sport" of the German Society of Neurology (DGN) and has presented in past on scientific conferences for this committee.

Chronic migraine is a very common neurological problem and often patients find it very difficult coping with this condition. Dr Schumacher has a special interest in new treatments for this.. BOTOX (Botulinum toxin type A) is now recommended as an option for the prophylaxis of adults suffering from chronic migraine (NICE Guidance 2012). This is a very interesting new treatment for migraine sufferers and Dr Schumacher is planning  this treatment soon for private patients in BMI The Alexandra Hospital in Cheadle.

 

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