Engineering the Invisible: A Biomedical Look Into the Phases of Migraine
Migraines affect over a billion people worldwide and still remain a medical mystery.
Imagine knowing a migraine was coming, hours or even days before it hits. No scrambling for painkillers, no canceling plans last minute—just time to prepare, treat, and maybe even stop it in its tracks. That’s not fiction, it’s where biomedical engineering is taking us.
Migraines affect 15% of the world’s population, yet they remain one of the most misunderstood neurological diseases. But by combining neuroscience, wearable tech, and creative engineering, we can detect the earliest shifts in the brain and body. Silent siganls that are measurable. Imagine devices like smartwatch sensors that read your heart and sweat patterns, miniaturized brain scanners that can track blood-flow changes, and implantable chips that detect migraine molecules and release treatment precisely where it’s needed.
The idea started during a casual car ride with a friend. Unstructured. Unplanned. Just pure curiosity—the kind that sparks innovation. He mentioned migraines, which I’d heard of but didn’t really know much about. So, as soon as I got home, I spent the afternoon diving into research, reading everything I could find related to the concept.
By the end, you’ll see migraines from a different perspective and be opened up to new innovation.
What Is a Migraine?
A migraine is a neurological disease that causes headaches, which may involve acute pain or a pulsing feeling, usually on the lateral side of the head. It may also lead to nausea, vomiting, and severe sensitivity to stimuli such as light and sound.
Migraines may last from 4 to 72 hours approximately. Like other neurological diseases, they occur in stages. Migraines consist of four: Prodrome — Aura — Attack — Postdrome.
As a disclaimer, migraines are still not fully understood in terms of what causes them or what really happens in the brain and neurons. It is believed they may occur due to factors such as DNA, environment, sleep, among others.
The Four Phases
Prodrome: Early Warning Signals
This is the starting stage, which, from an engineering perspective, is a great opportunity to create solutions to detect migraines early. This is what I am interested in.
During prodrome, there is hypothalamic and brainstem dysfunction. These structures are located at the base of the brain. They are key areas for homeostasis (body regulation of sleep, hormones, stress, and more), which are active throughout our whole lives. They are very complex and can be considered part of a second autonomous brain that regulates actions we can’t consciously control. It regulates respiration, hormones released when scared, and cardiac rhythms.
What happens in prodrome is that these systems become dysregulated. This leads to orexin release (a brain chemical that helps regulate wakefulness and arousal), stress neuropeptides, and an increase in cortisol (the stress hormone). This causes a feeling of stress even in calm situations, and CGRP precursors are released—this is a migraine pain molecule released during headaches. As a consequence of these changes, heart rate varies, sweat glands become activated, and brain waves change in response to the symptoms. It makes sense, if what regulates the body is dysregulated, then there are going to be consequences in such systems.
It would be interesting if we could detect these changes and know that a migraine attack is coming. Here is where the creative combination acts. Going to the basics, we need a sensor to detect such changes. The variables we are going to hone in on are heart rate, sweat activity, and sleep disturbances. Using the creative tool of outside-scope connection, we can identify that smartwatches do a similar function. So let’s use that—but modified.
A PPG (photoplethysmography) measures heart rate variability. Before a migraine, the hypothalamus becomes altered, and this leads to heart rate variation. We could measure heart rate and its variation (there should be less HRV during prodrome). Additionally, we can measure EDA (electrodermal activity), which measures skin conductance that increases when your sweat glands are more active—again linked to sympathetic nervous system activation. (There should be EDA spikes = arousal and tension.)
So, we can create a PPG + EDA wrist sensor used during sleep or resting time. We integrate a compute model to analyze the data and identify normal and pre-migraine results. Once it is trained, it is ready to detect these changes and flag you before the attack. This stage can last between 1–2 days, so you have some time.
Aura
Up until now, the brain and body are undergoing some changes, yet in the aura phase the patient still does not feel any pain.In this phase the patient begins to encounter visual changes, tingling, and speech disturbances, it is believed to be caused by Cortical Spreading Depression (CSD). This is a neuronal depolarization followed by a halt of neural activity. Neurons work with concentration gradients and polarize their ions to transmit messages across the brain, so CSD is a big deal for the brain and its communication, that is why it is exposed in changes in areas such as vision and speech . This effect is followed by changes in blood flow in the area: hyperemia and oligemia (increased/decreased flow).
So, a good marker to measure would be this specific change in blood flow to this specific brain area. For this, engineers and physicians use fNIRS (functional Near-Infrared Spectroscopy — a noninvasive method to track blood oxygenation changes in the brain), which measures local changes in oxygenated (HbO) and deoxygenated hemoglobin (HbR) in the cortex and reflects regional blood flow and thus neuronal activity — exactly what we need to identify.
It looks like we are engineering a way to detect migraines at home and in a minimally invasive way. Integrate it into the migraine assistant watch! Innovation still needs to take place — fNIRS devices are big and uncomfortable (they resemble a swim cap with many sensors and cables). Researchers and engineers would have to prototype a miniaturized version of it which measures specific brain locations that interest physicians for migraine detection. Definitely something plausible.
Attack
For this stage, CGRP is released (a protein that acts as a messenger) from trigeminal nerves (bilaterally located, originating from the brainstem). CGRP causes vasodilation, inflammation, and pain signal amplification. It increases the pain signal, leading to more blood flow to the area. Over time, pain increases, and the brainstem and spinal cord become sensitive, leading to worsening of pain, nausea, and other symptoms.
As you might have figured out through ideation, we need a unique implantable biosensor (right below the cranium). Designing such a device is complex — one must understand biocompatibility and CGRP detection. To solve this, microfluidics and MEMS are developing technologies that may serve well for this purpose. CGRP is one of the main molecular signals of a migraine; it is a protein released during attacks that amplifies pain and inflammation. We could measure its fluctuations and monitor the effectiveness of CGRP blocker treatments.
Let’s go further: why not turn it into a drug-release chip too? When it detects elevated CGRP, it releases treatment.
Postdrome
Here, the levels of homeostasis are restoring; the patient may feel fatigue, tiredness, and mild discomfort after the attack. Your brain has just been through panic, so these are normal symptoms. The patient may take some time to recover fully. Throughout this process, we could continue the release of treatment, monitoring the decrease of vasodilation, and controlling the prodrome variables of sleep, HR, and sweat.
Biomedical Engineering Opportunities
The impact this tech can have is emotional: help millions predict and intervene in migraine attacks. Be personalized (based on aura patterns). Enable early neuromodulation or closed-loop therapy. Provide rich research data on human brain vascular–neural coupling.
Future of Personalized Migraine Tech
We are engineering a way to detect and intervene in migraine attacks by integrating:
- Smartwatch-based PPG + EDA sensors
- Wearable fNIRS to detect cortical changes
- Implantable CGRP-detecting biosensors with drug-release potential
Each phase offers opportunities for intervention, and with enough training and data collection, a personalized assistant for migraine patients is within reach.
Conclusion
From an unplanned conversation to an exploration of neurology and biomedical engineering, this article shows how curiosity can lead to innovative thinking. Biomedical engineering can be used to better understand medical complexities, furthermore it allowes us to measure, track and eventually prevenet such migrains attacks. Medicine has profound beauty, it is complex, focusing on the diagnisotic and analysis of such diesease can help engineers create new innovations which are closer to our modern medicine.
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