MIGRAINE [ back to Glossary Index ]
Migraine is an intense, usually one-sided headache of vascular origin, which is often accompanied by extra sensitivity to light, noise or other varieties of stimuli, and which in a subgroup of people is preceded by a display of dazzling, sparkling lights called an aura. It is now known that the aura is a hallucination caused by overexcitation of neurons in the occipital lobes where the brain   processes visual inputs from the eyes. Migraine is sometimes accompanied by nausea alone or with nausea and vomiting. Migraine has a genetic component in that many "migraineurs" have a positive family history for this neurologic disorder. However, it does require an environmental trigger, which can be head trauma, as is true with epilepsy.

Migraine, whether transient or chronic, is one of the very worst sequelae of TBI.  Surveys of patients with migraine show it forces them to take days off work, restrict hobbies, restrict social activities and quarrel with family and friends. Surveys also show migraine patients report "dramatic improvement" in the "quality of their lives" when they seek out neurologic care and are fortunate enough to find a prescription drug which significantly reduces the frequency and intensity of their headaches. The International Headache Society defines Traumatic Migraine as migraine which appears within 2 weeks of head trauma to a person with no prior history of migraine and who experiences frequent migraines for more 8 ore more weeks continuously after onset.

In earlier days migraine was treated with blood vessel constrictors called ergotomines (like Wellbutrin) which helped to stop or "abort" a migraine headache already in progress. Somewhat more recently, migraines were treated with combination pills like Midrin which have aspirin, caffeine and NSAIDs or with anti-depressants such as Elavil or Trazadone. Most recently migraines have been treated with pills like Imitrex, Amerge and Maxalt, known as triptans or 5HT receptor agonists. These pills relieve the pain of migraine headaches faster, more completely and with fewer side effects than any previous oral medications. They tend to kick in and stop the migraine in about 2 hours, which is a major advance because migraines can last a day or longer. These wonder drugs work by mimicking serotonin in the brain. Intra-nasal administration of a lidocaine drip works even faster, in as little as 15 minutes, but is very hard to self-administer, and works no better than triptans in terms of the duration of relief provided.  Neurologists are also using medications like Depakote, an anti-convulsant, to prevent migraines from occurring in the first place. A recent study indicates that subcutaneous injection of histamines can prevent onset of migraines in some migraine patients.

Persons who develop migraines following a TBI should not suffer in silence, but rather should pursue aggressive treatment with a neurologist before the migraines grind them down.  Although no one knows for certain what causes migraine, a strong scientific consensus has developed that the cause is over-excitation of the trigeminal nerve (which supplies the forehead, eyes, cheeks and jaw) that is accompanied by expansion of the blood vessels in the meninges (the layers which cover the brain), release of inflammatory chemicals from those blood vessels and inflammation of the meninges.