What Is Migraine and What Causes It in Adults?

Migraine is a neurological condition, not just a bad headache, and it shows up differently in different people, sometimes as throbbing head pain with nausea and light sensitivity, sometimes with visual disturbances that arrive before the headache even starts. Episodes range from a few hours to three days, and how often they occur varies widely.

According to Dr. Guruprasad Hosurkar, a neurologist in Bangalore specialising in Parkinson’s disease and movement disorders, “Migraine is consistently underdiagnosed in adults because patients attribute the episodes to stress or eye strain for years before seeking a neurological assessment, and by that point the condition has often become chronic.”

Pinning down a single cause isn’t really how migraine works, and most patients have a combination of factors that shift over time.

• Neurological sensitivity: Something called cortical spreading depression, a wave of electrical activity that moves across the brain followed by suppression, is now considered the main mechanism behind most migraine attacks, and it explains why the migraine brain reacts to things others barely notice.
• Hormonal changes: Oestrogen has a real influence on migraine frequency, women often notice attacks worsening around their period or as they approach perimenopause, and the same contraceptive pill that helps one patient can make things considerably worse for another.
• External triggers: The usual suspects are skipped meals, poor sleep, alcohol, dehydration and bright lighting, but here’s the thing, none of them produce an attack every single time, which is part of why managing migraine without medical guidance tends to go in circles.
• Genetics: A close family member with migraine puts you at meaningfully higher risk, and research has consistently found inherited variants in serotonin pathways among people with chronic migraine.

When headaches come paired with dizziness or balance problems, it’s worth looking at both together, and a vertigo treatment evaluation alongside a migraine workup often makes clinical sense.

Not all migraine looks the same, and getting the type right is what actually determines how it gets treated.

• Migraine without aura: This is the most common form, one-sided throbbing pain with nausea or light sensitivity and no warning signs beforehand, and it’s the one most frequently dismissed as a tension headache or sinus problem for years before anyone looks at it neurologically.
• Migraine with aura: Around a quarter to a third of patients get aura first, usually visual disturbances like zigzag lines or temporary blind spots, though some also get brief speech or sensory changes that fully clear up within an hour.
• Chronic migraine: This is defined as 15 or more headache days a month for over three months, with at least eight of those meeting migraine criteria, and at this point a single treatment approach rarely works, both preventive and acute strategies are needed together.
• Vestibular migraine: Dizziness and vertigo are the main event here, not head pain, and because patients typically end up with ENT first, it often goes undiagnosed for years, and a broader movement disorders treatment assessment becomes relevant when the neurological picture is complicated.

If dizziness is part of the pattern, looking into vertigo treatment can help work out whether that piece needs its own evaluation or fits within the same consultation.

Dr. Guruprasad Hosurkar has spent over 22 years in neurology and movement disorders, led the rollout of India’s first Adaptive Closed-Loop DBS programme at KIMS Hospital, and was named Inspiring Neurologist of the Year by the Economic Times in 2021. What patients consistently say is that they left the first appointment actually understanding what was happening and with a plan that made sense, not another referral and more waiting.

References:

• Migraine: Pathophysiology, Epidemiology and Treatment — National Institute of Neurological Disorders and Stroke, NIH
• Migraine Classification and Diagnostic Criteria — PubMed, NCBI