We don’t really know for sure. What we know is that they involve minor and temporary blood circulation abnormalities in the brain (which is why aspirin, beta blockers and triptans can help) and that they also involve inflammation to some extent (why anti-inflammatory drugs sometimes work too).
All the exams we can perform on the brain (imaging, recording brain activity…) are all normal in people with migraines, both during an episode and out of episodes.
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