What is migraine?

Hi all,

I’ve been reading some great stuff from Carolyn Bernstein’s book, “The Migraine Brain” and thought we needed some information on mvertigo about exactly what migraine is based on the current science-based evidence.

We tend to hear all sorts of alternative ideas out there (usually without any basis and always without evidence) about how we should treat this based on what practitioners think migraine is. Reading through a chiropractor’s site last night made me think this info is even more necessary because migraine is not something we have done to ourselves because we have led a life that is “too stressed out”, or that we have let ourselves become “too toxic”, or that this is some sort of mechanical problem in the neck. The “toxic” and “detox” argument is particularly vacuous because it’s been used for decades to explain just about any human disease state, makes no logical sense, and is utterly baseless (zero evidence). Yes, cervicogenic vertigo exists in the medical literature but it is extremely rare and usually shows up after whiplash injuries. Furthermore, there are no nerves running through the neck that directly impact the vestibular system (according to Steve Novella, neurologist). We’ve also had lengthy discussion on mvertigo about a gut-migraine connection months back. The jury is still out for me on the latter but if there is a connection it would be more about killing off a potential trigger derived from the gut (some evidence about an effect on the immune system exists) in the same way a bad tooth might be constantly irritating the trigeminal nerve in the face. But the gut does not cause migraine and the associated vertigo we know all too well.

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EDIT: it appears even “cervical vertigo” may not exist based on this new report (Rev Med Suisse. 2009 Sep 30;5(219):1922-4):

Cervical vertigo: myth or reality?
Patients displaying vertigo associated with cervical symptoms: what is the origin? Diagnosis of cervical vertigo is sometimes retained. It remains very controversial. Indeed there is neither a convincing pathological mechanism nor a diagnostic test.

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[size=130]So what is migraine? And where does it come from?[/size]

First, the biggest myth out there is that migraine is some type of headache which we all know is just plain wrong. It is in fact a complex neurological disease that affects the central nervous system. Headache is one symptom but migraine almost never consists of head pain alone and in some, there is no head pain at all. Put simply, migraine is caused by abnormal brain chemistry. It is not something you caused or the result of some emotional problem in your life, or some unconscious effort to be sick to avoid life’s problems. Migraine is a real genetic disorder, in most cases inherited from one or both parents. It is a chronic illness, meaning you cannot get rid of it or wish it away, BUT there is much that can be done to manage it and eliminate triggers (lifestyle changes and/or medication) to the point of it no longer interrupting your life.

The things that trigger an attack in a migraineur vary greatly from one person to the next and can be almost anything. Triggers don’t just merely upset your brain but send it careening out of control with a biochemical chain reaction that results in anything from severe head pain to vomiting, dizziness or even temporary paralysis. The brain is a very complex organ that hates change. While other organs of the body are quite flexible and can handle an increase in output or lots of abuse we throw at them, the brain is not so forgiving. Even in a person without a migraine brain, a night without a good sleep or even too much booze probably means feeling lousy the next day or even developing a mild headache. By contrast, a migraine brain is super high maintenance and hypersensitive – like a diva or a thoroughbred race horse. It wants everything to stay the same and wants to be treated like royalty … throw anything new at it or upset the balance and it can/will react angrily and we pay the price. About 10% of North Americans, British, and Australians have such a brain – that’s about 30 million people (75% women) in the US alone, more than diabetes and asthma combined! Worse only about 50% know they have it.

A myth that still exists out there is that migraine is the result of just a vascular problem – that it is caused by vasodilation or the expanding of blood vessels on pain sensitive structures in the brain. We now know that migraine is a neurological disease that involves much more than the blood vessels (blood vessels expand as a result of the attack). Migraine involves aspects of the central nervous system, neurotransmitters and other brain chemicals, electrical impulses, the body’s inflammatory response, the trigeminal nerve (located in the face and head), and others. The physical reaction that begins the migraine attack is called “cortical spreading depression (CSD)”. CSD is a dramatic wave of electrical excitation that spreads across the surface of the brain (the cerebral cortex) and is set off by a migraine trigger. Because the cerebral cortex is involved in language, thought, perception, and memory, it’s often why a migraine attack trashes one or all of these causing cognitive problems. In MAV the hyperexcitability in the brain stem overlaps with the vestibular system and causes the dizziness/ dysequilibrium/ vertigo. After headache, dizziness and/or vertigo is the second most common symptom associated with migraine.

Scientists are pretty much certain now that CSD explains many if not all aspects of migraine. This model also explains why certain drugs work to prevent migraine, by raising the threshold for aggravating a CSD event. Migraine also involves what is called an “ionopathy” or abnormality of the flow of chemicals in your brain across cell membranes and includes serotonin, dopamine, and noradrenalin. Many migraineurs have lower than normal levels of magnesium, a mineral that plays a role in how calcium behaves and in the regulation of serotonin. Still some migraineurs have problems with calcium channels and explains why a drug like Verapamil (a calcium channel blocker) works for some. Dopamine is yet another brain chemical that some migraineurs have trouble processing. It’s no wonder that given the wide range of biochemical problems associated with migraine that one drug can be effective for one person (SSRI for example which targets serotonin only) and not another – or it may require a two or three-pronged approach to end the attacks in someone with a number of chemical abnormalities. There is, however, no scientific evidence showing that two or more migraine meds is any more effective than one on its own.

All of this makes me wonder why such a genetic problem like migraine even exists at all and why was this not weeded out by evolutionary processes. Clearly the human body is far from perfect and, while the body is an amazing piece of machinery, evolution has certainly left a number of loose ends.

Scott :slight_smile:

Hey Scott,

Thanks very much for this really informative and interesting summary of what migraine is and how it operates - and written in lay terms so that those of us with hazy memories of high school science (ie, people like me) can understand :slight_smile: .

Evolution gets a lot wrong - myopia, flat feet, back problems, sunburn, schizophrenia, psychosis just to name a few. I can only assume that our intelligent brains’ ability to compensate for these shortcomings is what keeps us going with our species’ inferior bodies. Hopefully those same brains (the really clever scientist and doctor brains) will sort migraine out once and for all!


Here’s a classic example of some of the junk out there. I just hope the person that asked this question about Lexapro found the right answer. So how would you feel if someone told you the dizziness you feel is your brain’s way of creating a symbolic punch for oppressed aggression? This post is so absurd I wonder if they just made this up on the spot? :lol:

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Migraines, and all variations of it, are purely psychogenic. They are caused by suppressed aggression. Generally, people who get migraines are sweet natured people who wouldn’t hurt a fly, but all humans have aggressive impulses. There is no way to eliminate them, but aggression always has to express itself somehow, and if an aggressive urge can’t be gratified by attacking another person, it turns inward. It’s like wishing to hit someone on the head, but since this is prohibited by ones own conscience, the only head a truly peaceable person can hit is his own. Thus the migraine. Any vertigo associated with the migraine is symbolic dizzyness from a symbolic punch.

The way Lexapro works for migraines is simply that it mellows out the afflicted’s internal psyche. Marijuana generally works wonders on migraines for the same reason. Psychotherapy works in some instances, but in my humble opinion it is better to keep the migraines and stay sweet natured.

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Scott: Thanks for posting “What is Migraine?”. I think there is so much information out there (some ridiculous) that at times I lose sight of what exactly is happening to my body during migraine. Your posting brought be back to reality about migraine and what I need to do and why.
Thanks again.


Scott -

That is such an enlightening summary of this THING we’re dealing with - you have a gift! YOU should be teaching physicians. And I wonder if maybe you could? Are you near any medical schools? Maybe you could have an impact on docs who haven’t yet learned the wrong stuff about migraine!

There was a program in Madison, Wisconsin when I lived there in the early 80s - my neighbor was one of the women who instructed med students who were doing pelvic exams by allowing them to “practice” on her and giving them feedback. She wasn’t a doctor; she was coordinator of the University’s Women’s Transit program - a rape prevention program is what they called it back then - so I know she was quite the activist type. As I recall, she felt she was making a difference by helping to make sure doctors would be sensitive in both technique and in what they say to women, when they went out into the world and did pelvic exams on thousands more women - some of whom would be young and very scared.

You might be able to make a difference if you could get those docs “when they’re green!” It would be great if they could hear about this from a migraineur who lives with it and who can explain it as eloquently as you do, and you could maybe even answer some questions that come up. I hope that med schools still do have programs that involve non-physicians doing some teaching, even if only for a half hour or so in a clinical rotation!

Well - hoping that you’re near a medical school, and that you’d be interested in doing something like this, and that you’d feel well enough to do it may be getting carried away - sorry! But I hope at least that you’re flattered by the thought that this is SO good that somebody can easily picture medical students sitting and listening to YOU while you deliver this wonderful summary.

I just clicked on your name, Scott - better late than never! :?

For those of you who haven’t done that yet, Scott’s got a PhD, and he’s already working in diabetes prevention at a medical school, so is apparently eminently qualified to teach medical students!!

So maybe my idea wasn’t so farfetched?

Hey Joan,

I too have to reread and be reminded of things to keep migraine knowledge up to date and on the mark. It’s easy to lose sight of what we’re trying to treat after a while. It’s like we get lost in the symptoms of it all and it takes on a persona of its own. Bernstein’s book has been like THE migraine manual for me. The book has forced me to revisit a number of things and reassess my attack strategy. I’ll be referring back to this book over and over again until I have satisfactory control.

Maryalice – thank you for your kind and flattering comments. Your idea is a really good one and one I hadn’t thought of. I might see if there is such a thing going on at Sydney University where I could have a chat with med students about this from a migraineur’s point of view. Not sure if they have this sort of thing set up or not. I am working in the School of Medicine at Sydney Uni so can find out easily enough.

Hope you’re having a great weekend.

Scott 8)

Scott, what an awesome post. The first thing I’m going to do is give this to the people closest to me to read. I remember your desperate posts on the Dizzy board in the early days. You have certainly done a stirling job of educating yourself, and thereby the migraine population on this board, on all things MAV. Well done. Jenny.

Oh, and well done to Adam and his support crew on this site in general. If I’d had all this information available to me in the early days 7 years ago my journey to the correct doctor would not have taken so long. Wow, new sufferers are fortunate if they find their way to mvertigo in the early days.

Jenny - so sorry to hear about your long journey. I’'m just curious - how are you doing now? How you found an effective med? hope so

Hey Scott,

I truly enjoyed your post on “what is migraine”…so much of what you said makes sense. Every now and then i think back just prior to when the symptoms began and i was going thru a tremendous amount of stress and i still tend to believe that if this long stressful period did not happen or if i would have managed or handled it better maybe this condition would not have surfaced. Over the years i’ve come across numberous MAV folks who said prior to their dizzy condition they had gone thru a very stressful time in there life. So based on what you shared with us in this post… there is really no proof that Severe Stress could have played some role in bringing on the MAV condition?

By the way Scott…you are truly a great writer!


Hi Joe,

This is a good point I think. I think we can not know for sure that had you not had the stressful period that this would not have shown up anyway. Perhaps it may not have escalated to this level so quickly, I don’t know, but the point is that stress does not cause or create migraine out of the blue. You already had a migraine brain; you were born with it. When it decided to show it’s face is anyone’s guess. I would think there are many here who would see the link to other things other than stress such as a knock on the head (Lisa), monthly cycles in females, or it just happens for no reason at all other than the fact that you reach a critical age where the genes are expressed – sort of like you start going gray at 36 for example and around the same time, migraine-causing genes are activated too. I think in my case I was already a migraineur but the VN I had caused so much physical trauma (massive anxiety), then trashed my inner ear, it probably greatly increased my brain’s already hyperexcitable state. You’d think that once the VN passed though that it would return to previous migraine levels. Perhaps vestibular damage is always there to make the likelihood of a migraine event more frequent.

My overall point is that no one should tell a migraineur it was their fault because they were stressed out for a month or whatever and that’s why they have developed a chronic condition. It was always there to begin with sleeping like a hibernating bear.


Hey Scott,

You have a good point…makes alot of sense so i can’t argue with you. :slight_smile:


Hi Joe,

Have you had a read of the info from Nicholas Silver? While it may not apply to everyone, he seems to think that for a large percentage of people who develop this “chronic” state of migraine, they need to be certain they are not using ANY painkillers or caffeine – ZERO. In his opinion, the tough cases who fail to gain control are those people who are still popping pain pills or getting caffeine from some source whether it be the odd green tea or sneaking in a piece of chocolate. I avoid caffeine almost entirely but have cracked occasionally and had a gulp of coffee or tea when out with friends just to taste it again and I do chew through a handful of painkillers most weeks. I’m officially on the wagon now for both.


Hello Scott
I am new to this forum and not sure really where best to first post so hope i am not barging in here.
I have had chronic dizziness and mild to severe headaches for 7 months (i also had a previous few month episode about 18 mths ago which seemed to resolve) The doctors diagnosed me with ‘labyrinthitis’ and ‘anxiety’ but i feel after doing my own research that it is more likely that i have MAV.
Every day 24-7 i feel dizzy and off balance, my eyes do not seem to be able to focus properly and i feel as though i am going to fall to the side when i walk. Most days i also have a mild headache though some days especially around my period it is very intense. I also suffer IBS.
I love my life in general (except for this condition of course) and i have no reason to be an anxious person. As i have said to the doctor, anyone would be ‘anxious’ if they felt constantly dizzy and brain fogged.
I hope you can tell me if this sounds like i could have MAV? I would be intrested to find natural self help cures and to try to avoid drug therapy if possible as me and my partner would like to try for a baby.
Just to mention, i do consume a LOT of chocolate based foods and also enjoy nuts, cheeses and garlic sausage type meats. I drink about 3 mugs of tea a day too but do not drink colas or coffee and already avoid sweetners/MSG and artificial additives.
Thanks for this forum, i really hope it helps find what is wrong with me!
Dee :0)

Hi Dee

Just quickly wanted to say that I often feel dizzy and off-balance and it’s not MAV - even though I have been diagnosed with MAV -It’s due to not drinking enough water and not breathing properly! Hyperventilating is a major cause of feeling off balance and “not with it”, and you may find it interesting to research that. Not just a hyperventilation attack with the panting type breathing, but chronic overbreathing which mucks up the oxygen / carbon dioxide balance and causes all sorts of funny side effects.

Also, I take magnesium and riboflavin every day which seems to be lessening the frequency of my vertigo attacks.

Take care


Hi Alex,

How can you be certain it’s not migraine making you dizzy? It seems odd that you’d have chronic dizzy issues from over breathing.

Cheers … S

I am so grateful I have come upon this website! You are better informed than the doctors I have been to. I have tears of relief knowing that my struggles with this are not in my head and that this is really a condition. I saw an ENT who after one minute of seeing me (and a perfectly normal hearing test) said that the dizziness is from BPV. But I felt this wasn’t the case because alot of times the same things that triggered a migraine headache, also triggered a dizziness episode. I do not think Dr.s are informed enough about this condition. I was really losing hope and feeling alone until this site. Thank you!

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I do not think Dr.s are informed enough about this condition. I was really losing hope and feeling alone until this site. Thank you!

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I totally agree.

My ENT doctor knew that I didn’t have BPPV based on my symptoms which included hearing loss and tinnitus in my left ear, also by the inability to reproduce symptoms in his office. He suggested that I could have migraine, but wanted more tests to eliminate other possible causes. My first attacks were vicious and lasted hours to several days where the whole world was spinning out of control and I was throwing up more than I was keeping down. I was staggering/crawling to the bathroom. My dizziness went away and for 10 months I almost felt normal. Then I suffered a sinus infection and the symptoms returned. :frowning:

This time the dizziness didn’t go away and my ENT doc said he’d never seen anyone with 24/7 dizziness before and it couldn’t be vestibular in nature and he had no idea what it could be. :? I guess he has never heard of “chronic MAV” and from what I’m reading, there doesn’t appear to be a lot of us out there…

I am grateful to have found this site as at least now, I realize I’m not alone, nor crazy! :slight_smile:
I printed off the MAV survival guide and gave it to my GP who is open-minded enough to admit he doesn’t know everything and likes to expand his knowledge. Thank-you, Scott, for this incredibly valuable resource!


Hi Scott,

My doctor and I are in the midst trying to figure out my diagnosis. He is encouraging me to explore possibilities and gave me the mvertigo site as a place to start.

Symptoms are imbalance (but not vertigo)/unsteadiness, feeling of exhaustion, a sense of loss of hearing in my right ear, a sense of pressure or fullness in my right ear, cognitive difficulty including mild speech difficulty, no headache pain and no aura-like symptoms. This happens every 3 to 4 months and, after onset, lasts 4 to 9 days, usually closer to a week, and I can sense it coming on sometime during the day before it hits. The symptoms are constant while the condition lasts. It’s been going on for at least a couple of years. My doctor thinks that it could be migraine without headache, but he thinks that a couple of critical symptoms might be missing. Any thoughts? Thanks.