How can we use a picture of a tree as an analogy for the causes of headache? What do we know about headaches and their root cause? The answer remains a mystery still — much like the roots of the tree remain a mystery to those of us that see it above ground. We have some theories about what causes migraines, but the medical and scientific communities remain unable to fully explain this painful phenomenon. Time and time again, I sit in front of patients who’ve had normal scans, with no alarm bells ringing as to something more severe, while they ask me: “but then, what is the cause of my headaches?” Unfortunately, at this time, I can’t (and nor can modern medicine) answer this question with certainty. More often than not, CT scans and MRIs that are performed on patients suffering with migraines come back normal — classifying the headache as “symptoms not attributed to another disorder”. This means that the pain is not caused by bleeding or pressure in the brain, for example. Many causes of a migraine have however been proposed, including blood vessel dilation and contraction, a channelopathy (a problem with cellular ionic transport), cortical spreading depression (an electrical excitatory signal) and muscular tension. The condition is probably genetically determined, and what can be concluded by these well-researched theories is that such patients have a very sensitive brain and may get a migraine under innocuous circumstances or minimal stressors. In terms of progression in research, we can now “see” the anatomical structures deep under our skulls with MRI scans and other imaging techniques. We are even starting to see the ways in which cells work and communicate with each other, just like the roots that connect to the trunk of a tree. But in the case of migraines (and many other areas of medicine) we don’t know the true “cause”of why they start. We are often not treating the cause of diseases, including migraines. However, we do have treatments to make them more tolerable and to go away faster.