Published September 24, 2018 By Adam Lowenstein

Why ME?

So often a question I get from migraine headache patients is a derivative of “Why me?”

“What did I do to bring on these migraines?”

“What can I change so these migraine headaches stop?”

“Why are these migraines so bad for me but nobody else?”

So just to address the last question specifically, you are not alone.  Thousands if not millions of sufferers around the world have migraines just like yours.  You as an individual may not see that, but those of us who treat migraines do.

Why Do Migraines Happen

As for the other questions, migraines happen for a reason.  Many migraine headaches, as discussed so many places elsewhere on our website, happen because of nerve entrapment and irritation from adjacent structures. Remember, these nerves that so often cause migraines are in the face and neck, NOT the brain itself.  But why are your nerves irritated?

There are several reasons why these peripheral nerves can be irritated and can be traced down to a specific reason:

  1. Trauma and whiplash injury, even in the distant past, can cause irritation, inflammation, and even scar tissue to a nerve or the structures next to a nerve.  This is particularly common in the back of the head and neck at the occipital nerves.  While migraine headaches might arise shortly after a traumatic event, sometimes the nerve is shocked from the trauma, and it takes a while for it to resume sending signals to the brain.  When those signals do come back, they can be pain signals from the new irritation resulting from the trauma. Alternatively, scarred muscle tissue in the neck from whiplash might not become symptomatic until something else happens. A childhood whiplash injury may not present as chronic pain until that child grows into an adult with the associated stresses of life.  The combination of stress and the old scar can then push on the nerve, causing severe migraine pain or occipital neuralgia.
  2. Stress can be a culprit alone, even without prior trauma.  Nerves in the face above the eye, in the temple, and particularly in the back of the neck all run through muscle groups that tend to become tight and tense with emotional stress.  These stresses cause the muscles to contract near and around the nerves, causing intermittent pain that can become chronic with the persistence of the condition.
  3. The third reason that patients can have migraine pain from nerve impingement is something we can call “individuality.”  Why do you have brown hair?  Why is your nose shaped as it is, or why is your height different than that other people?  Just in the same way that we are all built slightly differently, some people have a natural anatomy that gives rise to migraines.  For example, one of the treatable forms of nerve entrapment that we fix with migraine surgery is called “Supra-orbital syndrome” and can be caused because of a bone that squeezes on the nerve.  In the upper orbit (eye socket) there are spots with the supraorbital nerve and supratrochlear nerves exit the orbit and head up to provide feeling to the forehead.  In some people, at the spot where either one or both of these nerves change directions, they goe through a small hole or tunnel at the edge of the bone, called a foramen.  In others, they go through a notch in the bone, rather than a complete tunnel made of bone.  So just as your nose is a given shape, the amount of room in that foramen or notch can be variable.  In cases where your anatomy provides a narrow opening for a large nerve to go through, that supra-orbital or supra-trochlear nerve (or both) can be squeezed by a foramen or notch that is too small to allow the nerve to pass gently without irritation.  And this is not to mention the other things, like arteries and veins, that also go through that foramen or notch that can fight for room just like when your spouse takes up too much room on the bed.  These issues can happen elsewhere in your head and neck as well – a blood vessel just happens to cross the greater occipital nerve in you where the vessel does not come near the nerve in a non-migraine patient.  It’s just the anatomy you were dealt, just like the size of your feet (for another off-the-top analogy).

Closing Remarks

The question of “Why me?” is one that plagues so many patients with all different types of diseases.  My friend with diabetes asks that all the time.  Unfortunately, cancer patients have that question pop up all too often.  For men, women, and children with migraine headaches, the question also persists.  But the good news is that in any of these scenarios, surgical decompression of the nerves by removing the scar, bone, or muscle causing the irritation has a 90% success rate in providing relief of migraine pain.  I dearly wish we had such a simple surgery with such an amazing success rate for diabetes or cancer. If you are suffering from persistent migraines contact us at Migraine Surgery Speciality Center in Santa Barbara, CA.

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