What causes migraines, and why do I get them?

What causes migraines is an inherited sensitivity of the brain. In people with migraine the brain reacts more strongly to stimuli, and a nerve in the head, the trigeminal nerve, can set off a chain reaction that leads to pain and other symptoms. Hormonal changes, stress and disrupted sleep can make an attack more likely, but they are triggers, not the cause.

Why do I get migraines?

If you regularly have migraine attacks, you have probably wondered why. It is a question many people ask, especially because an attack often comes unexpectedly and has a big impact on daily life. Migraine is not an ordinary headache. It is a complex brain condition involving several factors, including genetic predisposition and neurological processes.

Is migraine genetic?

Yes, migraine is first and foremost a genetic condition. If one of your parents has migraine, you are more likely to develop it yourself, because the predisposition is passed on through your genes. It does not always follow a straight line, though: migraine can seem to skip a generation, and not everyone who inherits the predisposition develops frequent attacks.

What does that mean in practice? The brains of people with migraine are more sensitive to stimuli. This heightened sensitivity can lead to severe headache and other symptoms, such as nausea and sensitivity to light and sound, during a migraine attack.

What happens in the brain during a migraine attack?

During a migraine attack there is an abnormal reaction in a nerve in your head, the trigeminal nerve. This nerve sends signals to the blood vessels around your brain, which can lead to inflammation and pain. One of the substances released in this process is CGRP (calcitonin gene-related peptide), which is why newer medicines that block CGRP, or its receptor, can prevent attacks in many people.

So migraine is not simply a headache. It is a complicated reaction of your brain to stimuli that your body cannot process well.

What else can trigger a migraine attack?

Besides genetic predisposition, other factors play a part in when an attack starts:

• Hormonal changes, especially in women. This explains why attacks often occur around a period.
• Stress, or the moment stress falls away.
• Disrupted sleep, such as too little sleep or an irregular rhythm.
• Skipped meals or not drinking enough, for some people.

You cannot always point to a clear reason for an attack. What we do know is that the brain of someone with migraine remains in a vulnerable state, even between attacks.

Is migraine my fault?

No. People sometimes wrongly believe that you can prevent migraine by avoiding certain things, such as working too hard or not resting enough. That is a misunderstanding. Migraine is an inherited condition of the brain. It is not the result of your choices or your lifestyle, and there are scientifically proven treatments that can reduce the impact migraine has on your life.

Can migraine be treated?

Yes. Migraine cannot be switched off, but treatment can reduce how often attacks happen and how severe they are. Acute treatment, such as triptans, is taken during an attack. Preventive treatment, such as the gepants atogepant and rimegepant or the monoclonal CGRP inhibitors erenumab, fremanezumab and galcanezumab, is taken to make attacks less frequent.

Help from a migraine specialist

We understand that migraine is more than a headache. It is a condition that can affect your whole life. Our migraine specialists are ready to support you with personal attention and proven treatments, fully online by video, and you do not need a referral. Read more about what migraine is, see how our treatment works, or take the migraine test.