Migraine headaches are the result of a disturbance in the neurochemistry of the central nervous system. They are relatively common, affecting three times as many women as men. Migraine sufferers typically report a definite pattern to their headaches, and they can report what stimuli bring them on. Most migraine sufferers experience their first attack before the age of 20. There is no single cause of migraines, but the tendency to get migraines does tend to run in families. When a migraine occurs, it means that something has altered several of the neurotransmitter-sensitive receptors located on the outside surface of the nerve cells (neurons) so that the nervous system is no longer able to constantly maintain the natural balance that the nervous system is intended to maintain.
Neurotransmitters are chemicals that nerve cells (neurons) use to communicate messages to each other. Receptors are special areas that receive these chemical messages. The key neurotransmitter in migraine is called serotonin (often referred to in the scientific literature as 5-HT or 5-hydroxytryptophan). If something interferes with the normal functioning (production, release, receptor docking, and/or re-uptake) of serotonin, that disrupts the normal functioning of the nervous system and can lead to various symptoms associated with migraine.
The severe pain associated with migraine occurs when the mechanism that normally inhibits and/or mediates pain is disabled. There is no actual tissue damage occuring during a migraine attack. Instead, the pain results from a deranged neurochemistry. Migraine pain is like a loud fire alarm bell ringing when there is no fire. Scientists suspect that a caffeine withdrawal could be the possible cause of common migraines. Why? Well, caffeine is a powerful psychoactive drug that is addictive. Caffeine withdrawals produce all the same symptoms as migraine. Chronic caffeine use causes a number of changes to the central nervous system. Caffeine use increases the number of some types of serotonin receptors and some types of adenosine receptors as well.
Adenosine is another neurotransmitter; adenosine strongly inhibits serotonin release. Chronic caffeine use increases the number of adenosine receptors.(The body is trying to compensate for the constant presence of caffeine, which occupies and blockades adenosine receptors and thus interferes with adenosine reception.) When caffeine is withdrawn, however, the chronic caffeine user is left with too many adenosine receptors. Having too many adenosine receptors is equivalent to having too much adenosine. As a result, serotonin release is inhibited and this leads to migraine symptoms.
As you know there are many drugs used against migraine. Many of these drugs contain caffeine, for good reason: caffeine relieves migraine by reversing caffeine withdrawal. Migraine drugs that contain caffeine include Fiorinal (40mg caffeine), Fioricet (40mg caffeine), Excedrin (65mg caffeine), Anacin (32mg caffeine), Cafergot, Norgesic Forte (60mg caffeine), and others.
Sumatriptan (Imitrex) is effective in relieving migraine attacks presumably because the sumatriptan molocule mimics (is very similar to) the serotonin molocule, and thus is called a serotonin agonist (helper). Sumatriptan, in other words, makes up for the shortfall of serotonin by occupying certain types of serotonin receptors. Sumatriptan is called a selective serotonin agonist because it has a greater affinity for (sticks more to) certain types of serotonin receptors than others.
Other drugs, such as Prozac, Paxil, and Zoloft, are intended for the treatment of depression but they also seem to reduce frequency and/or severity of headaches including migraine (although they are not as effective as sumatriptan against oncoming migraine attacks). These drugs are called selective serotonin reuptake inhibitors, which means they interfere in the reuptake of serotonin back into the interior of the nerve cells (neurons). To understand what reuptake means you need to understand that neurotransmitters, once released, must be quickly grabbed and transported back into the interior of nerve cells for reuse. That must happen to “clears the boards” for the next message. If something (like Paxil) interferes with re-uptake of serotonin, that makes more serotonin available to dock with serotonin receptors. That explains why these anti-depressant drugs help reduce migraine to a certain extent.
If caffeine withdrawal causes migraines then there is a way to end your migraines without surgery. You would have to either quit caffeine entirely or else maintain consistent daily caffeine intake. To do either you would need to be aware of all caffeine sources in food, drink, and medications. It can be done.