Headache and Migraine Specialists

Headache &
Migraine Specialists

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What Actually Causes Headaches?

Most experts agree that the majority of headaches and migraines are a result of nerve cell membranes in the brain stem not working normally causing a fault in the way that sensory information is processed and perceived; what actually start out as normal messages from the sensory nerves supplying the head and face become exaggerated and distorted causing us to feel head pain. The question is what causes these cells to behave in this way in the first place?


Neck Disorders

Upper NeckIt is well documented that headaches can be caused by disorders of the neck.  We call these types of headaches cervicogenic i.e. coming from the cervical spine.  At first this is not something that most people would perhaps consider, but actually the nerves from the upper part of the neck share synapses (nerve junctions) with the sensory nerves from the head and face in the brain stem. The mixing of these two sets of sensory nerves is one way in which the brainstem can become sensitised and normal messages from the head and face become distorted and felt as head pain.  Whilst we see disorders of the neck as a significant influence, we are not suggesting for a moment that it is the only factor.

Genetic Factors


Migraine certainly has a significant genetic component and most migraine sufferers also have a brother, sister, mother or father who also suffer. Changes in the way nerve cell membranes function in some migraine patients can predispose them to having a more sensitised, ‘excitable’ brain, one that is more easily provoked and likely to have headache attacks. There is also evidence that the areas of brain that normally act to dampen or supress pain signals going to the sensory part of our brains is not so effective in chronic headache patients. This is essentially the same ‘biology-gone-wrong’ in the central nervous system as observed in other chronic pain states such as fibromyalgia.

Food and Drink Triggers

Red Wine

Patients often report some types of food and drink as triggers for their headaches.  Impurities in alcoholic drinks and the by-products that your body produces as it breaks down alcohol appear to be linked to headache and migraine. A substance called tyramine which is found in aged cheeses, red wine and some processed meats has been suggested and other substances including caffeine, chocolate and MSG (found in take away food) also appear to be linked. It is not clear why these substances seem to cause headaches and most people just learn through trial and error to avoid certain food types as a way of managing their symptoms.

Menstrual Migraine

Menstral Migraine

There are more female migraine sufferers than males and this is whilst they are in their reproductive years, implying a hormonal influence. Before the onset of menstruation and after menopause, the incidence of migraine is similar between males and females. Changing levels of oestrogen seem to cause migraine which is usually, but not always, experienced at the start of each menstrual cycle when oestrogen concentration is at a relatively low level. However migraine usually affects only one side of the head during an attack so why would a hormone in the blood only affect one side of the body? Clearly there is more to it that just hormone concentration.


StressLevels of stress also seems to play a part in the development of headaches and migraine although it is not entirely understood why. As with some other factors it appears sometimes as though it is not the stress itself but changes in the levels of stress that seems important. Lots of people will tell us that they get a migraine when a period of stress has passed and they are then able to relax more. Somehow trying to maintain relatively constant levels of stress rather than have large fluctuations in it seems to be preferable but this is not necessarily so easy to manage.



There is evidence that a low level of the neurotransmitter serotonin is related to migraine. Serotonin has a controlling effect on the brain stem and decreased serotonin levels has the potential to cause elevated sensitivity of the brain stem which may lead to migraine and headache. Serotonin is also related to stress, fatigue and pain sensitivity generally.  Normal levels or serotonin on the other hand correlates to activity and a sense of general well being.  Serotonin levels in our body are not fixed, we are able to control them through a healthier diet, exercise and healthy sleep patterns.


Unanswered Questions

Why, if migraine is strongly related to oestrogen, is this type of headache usually felt only on one side of the head when these hormones carried in your blood get everywhere?

Also why do some women get migraine associated with their menstrual cycle and others not when the levels of oestrogen in these two groups appear to be the same?

Why does the same trigger for a headache sometimes result in an attack and on other occasions does not?

These and other unexplained observations lead us to believe that brain biology on its own is an inadequate explanation for most peoples head pain.


How do these factors interact? What actually triggers a headache or migraine attack?

When enough of these triggers are present at any one time, a headache or migraine attack becomes more likely as a critical threshold is reached. Our treatment approach works on the premise that in taking away, or at least minimising, pain information from the neck as one significant trigger, other factors then present on their own may not add up to the threshold required to start the headache process.

A migraine sufferer might have eaten some cheese or chocolate but with a healthy neck the migraine is avoided. If the same food trigger is consumed whilst the neck is stiff or painful, a ‘perfect storm’ exists – the headache threshold is reached and a headache attack is triggered.

This would explain how many of our patients are able to continue doing things that they were previously forced to avoid following successful treatment and also why our sensitivities to certain triggers, which one has to assume are pretty constant, sometimes cause an attack but on other occasions do not.

We have seen many patients with previous alcohol or food triggered migraine that, with a healthier neck, are then able to enjoy a few glasses of wine or eating their favourite cheese or chocolate again. We also see many women who, with a healthier neck, no longer get that monthly migraine attack at the start of their menstrual cycle.


Warning: Please ensure that you have consulted a doctor regarding your headache or migraine. Most headaches and migraines are non-life threatening however it is advisable to seek the opinion of your GP or Neurologist if you develop sudden or severe symptoms, especially if these are different from previous attacks.

Upper Neck Problems Can Cause Headache & Migraine – Cervicogenic Headache. Mixing of the Sensory Nerves from the Upper Neck with the Trigeminal Nerves from the Head and Face can Cause Head Pain. Migraine has a Significant Genetic Factor & Headaches Can Have Food & Drink Triggers – Alcohol, Caffeine, Cheese, Chocolate & MSG. Changing Levels of Oestrogen can Cause Menstrual Migraine.

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