To understand how a migraine attack begins, we need to look at the smallest workers in your brain: neurons.

Neurons are specialized nerve cells that transmit electrical and chemical signals. You can think of them as a giant network of electrical cables that continuously transmit information. Everything you think, feel, and perceive happens through these cells.

They communicate with each other via chemical messengers: neurotransmitters. When this communication is disrupted, it can be the starting point of a migraine attack.

But why does this system get out of balance? To function properly, neurons need six essential pillars.

The pillars of healthy neurons

1. Fuel (energy)

Neurons work 24/7. They are among the most energy-intensive cells in your body.

Although your brain accounts for only about 2% of your body weight, it uses 20-25% of your total energy consumption.

This energy primarily comes from glucose, but also from other fuels like ketones. When the fuel supply fluctuates – for example, due to a drop in blood sugar, chronic stress, or a disturbed energy metabolism – neurons can literally run into trouble.

An energy crash in the brain is an alarm signal.

Without sufficient fuel, neurons can no longer properly execute their electrical signals.

This can lead to:

• Overstimulation
• Reduced signal transmission
• Increased sensitivity to pain

And these are all characteristics we see in migraines.

2. Correct electrolyte balance

Neurons create electrical signals using sodium, potassium, and calcium.

These minerals ensure that electrical impulses are correctly built up and transmitted. The system only works if the concentrations inside and outside the cell are precisely balanced.

A disruption – for example, due to stress, dehydration, hormonal fluctuations, or deficiencies – can cause neurons to:

• Fire too quickly
• Recover insufficiently
• Become more sensitive to stimuli

Migraine is therefore often seen as a state of increased neuronal excitability.

3. Oxygen

Oxygen is necessary to convert fuel into energy (ATP).

Without sufficient oxygen, glucose cannot be burned efficiently. This leads to reduced energy production and an accumulation of waste products.

Factors affecting oxygen supply:

• Tension in neck and shoulder muscles
• Poor circulation
• Chronic stress
• Lack of sleep

When neurons do not receive enough oxygen, their resilience decreases.

4. Balance between oxidants and antioxidants

Energy production generates free radicals (oxidants). These are reactive molecules that can cause damage if they accumulate.

Fortunately, your brain has antioxidants that neutralize these substances. But if too much oxidative stress arises – for example, due to:

• Chronic inflammation
• Lack of sleep
• Nutritional deficiencies
• Exposure to toxins

then damage can occur to cell membranes and mitochondria (the cell's powerhouses).

In migraine, we often see elevated markers of oxidative stress.

This makes neurons more vulnerable and sensitive to dysregulation.

5. Neurotransmitters in balance

Neurons communicate via neurotransmitters such as:

• Glutamate
• Serotonin
• Dopamine
• Oxytocin

Especially glutamate plays an important role in migraine. This is a stimulating neurotransmitter. When there is too much glutamate, neurons can become overactive.

Too little serotonin, on the other hand, is also associated with migraine.

So, it's not about one substance, but about balance.

When neurotransmitters become unbalanced:

• Communication becomes more chaotic
• Overstimulation occurs
• Pain processing can change

6. The neuron itself (cell health)

The neuron must be structurally healthy:

• Intact cell membrane
• Well-functioning mitochondria
• Sufficient micronutrients

If the cell structure is weakened, the entire system becomes unstable.

What goes wrong in migraine?

A migraine attack rarely arises from a single cause. Usually, one or more of these pillars simultaneously become unbalanced.

Important causes of dysregulation include:

• Blood sugar fluctuations
• Chronic stress
• Magnesium deficiency
• Inflammation (neuroinflammation)
• Lack of sleep
• Hormonal changes
• Oxidative stress

When these factors come together, they create a brain that:

• Has less energy
• Is more sensitive to stimuli
• Has difficulty recovering

And that is precisely the situation in which a migraine attack can occur.

Migraine is not ‘just a headache’

Migraine is not a simple pain problem. It is a sign that the brain is temporarily overloaded or dysregulated.

The pain you feel is the result of:

• Disrupted neuronal activity
• Inflammatory reactions
• Changes in blood vessels
• Increased sensitivity of the nervous system

When you only treat migraine with pain relief, you suppress the signal. But the underlying dysregulation often persists.