What Happens in the Brain During a Migraine?

🧠 What Happens in the Brain During a Migraine? Understanding the Neurovascular Connection and Migraine Aura

Migraines aren’t just “bad headaches”—they’re complex neurological events. Affecting more than 1 in 7 people worldwide, migraines can cause intense pain and sensory disruptions that impact daily life. But what exactly is going on inside the brain during an attack?

Let’s take a closer look at the science behind migraines, focusing on nerve signaling, blood flow, and aura symptoms.

The Neurovascular Theory: When Nerves and Blood Vessels Interact

For years, migraines were thought to be caused only by changes in blood vessels. Now, research shows it’s a combination of nerve activity and vascular changes—a concept known as the neurovascular theory.

At the start of a migraine, certain brain cells—especially those linked to the trigeminal nerve—become overactive. This triggers the release of inflammatory molecules like CGRP (calcitonin gene-related peptide), which:

●      Cause blood vessels in the meninges (the brain’s protective covering) to swell

●      Lead to inflammation and irritation of nearby pain-sensitive structures

●      Result in the throbbing, one-sided pain typical of migraines

It’s this nerve-and-vessel interaction that separates migraines from other headaches.

💡 Did You Know? New treatments called CGRP inhibitors block this pathway to help prevent or reduce migraine attacks.

Aura: A Sensory Signal from the Brain

About 25–30% of people with migraines experience aura—neurological symptoms that show up 20 to 60 minutes before the headache.

Aura symptoms may include:

●      Flashing lights or zigzag lines

●      Blind spots or shimmering edges

●      Tingling or numbness on one side

●      Trouble speaking or finding words

These symptoms are caused by cortical spreading depression (CSD)—a wave of brain activity followed by a brief period of silence in brain cells. It usually starts in the occipital lobe, which processes vision, explaining the visual symptoms.

CSD also disrupts blood flow, supporting the idea that migraines stem from both nerve and vascular changes. Even though aura is temporary, it signals that the brain is in a hyperexcitable state, which may increase migraine frequency or severity.

Why It Matters

Understanding what happens during a migraine helps guide more effective care. Migraines involve real changes in brain activity and circulation—not just pain.

At South East Center for Headaches, we use this science to personalize care. From established treatments like triptans to newer approaches targeting CGRP or brain excitability, we’re focused on helping reduce migraine burden.

Whether your migraines come with aura or not, you don’t have to live with the pain. Effective, science-based treatments are available to help you feel better and regain control.

Need Support?To learn more about migraine care—or to book a consultation—please contact our office. We’re here to help you feel your best, one step (and one neuron!) at a time.

References

●      Savio, G. et al. (2024). Advances in Understanding Migraine Pathophysiology: A Bench to Bedside Journey. Frontiers in Molecular Neuroscience.

●       Noseda, R., & Burstein, R. (2023). Cortical Spreading Depression: A Model of Migraine Aura. The Journal of Headache and Pain.

●      Charles, A. (2023). The Pathophysiology of Migraine: Implications for Clinical Practice. Current Opinion in Neurology.