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Migraine 2010
- 1. New Developments in Migraine -or- ( Why do humans get so many headaches?) Stasha Gominak, M.D. East Texas Medical Center Neurologic Institute 700 Olympic Plaza, Suite 912 Tyler, Texas
- 2. Despite what we were all taught, migraine is not a vascular disorder
- 3. I believe that migraine is a disorder of electrical hyper excitability of the head pain system coming from a brainstem “migraine generator”
- 4. I believe that all humans with normal head anatomy who have spontaneous head pain have “migraine”. It comes in different sizes but all with the same mechanism.
- 6. The pain system of the head was put there to tell us not to bang our heads.
- 7. PET Scans in Migraine Patients show that the posterior brain stem is hyper metabolic Weiller C, May A, Limmroth V, et al. Nature Med 1995;1:658-660
- 8. The migraine sufferer has a normal wiring diagram but inherits a gene that allows the pain wires to turn “on” without a blow to the head.
- 9. The Gene Mutations that Cause Migraine
- 14. This may be why the brain stem nuclei are inappropriately “on” in migraine patients
- 15. Any migraine sufferer will tell you, (if you ask), that they go to bed not just because their head hurts but because they also “can’t think right” Migraine is not just a disorder of head pain. Any theory about migraine has to explain this global change in brain functioning .
- 16. 1960’s Magnetic Field Studies Starting with the visual aura they observed electrical suppression, starting in the back during visual aura, moving slowly forward taking 15 minutes to go from back to front
- 17. Magnetic Field Studies electrical suppression, starting in the back during visual aura, moving slowly forward, 15 minutes to go from back to front
- 18. Magnetic Field Studies electrical suppression, starting in the back during visual aura, moving slowly forward, 15 minutes to go from back to front
- 25. What is unique about the head pain system that makes it turn on spontaneously? The other, analogous pain areas of the rest of the spinal cord don’t just switch on when ever they feel like it.
- 27. What causes this excitation? Remember our friend the astrocyte?
- 28. Astrocytes act more as a syncytium joining all of the neurons of the brain
- 38. Hypothalamus GnRH Anterior Pituitary LH/FSH Ovaries inhibin, estradiol, progesterone Adapted from MacGregor EA. Neurologic Clinics 1997;15(1):125-141. Menstruation and Releasing Hormones
- 51. Do animals have migraines? (Bella can’t tell us if she has a headache.) I always get a headache when I have to ride in the car.
Editor's Notes
- The hypothesis of migraine pathophysiology is consistent with the clinical observations that sinus-like symptoms often accompany migraine. Migraine is a neurovascular disorder involving activation of the TNC. Pain can be referred anywhere along the trigeminal nerve network including the sinus area. Activation of the TNC can cause reflex activation of the cranial parasympathetic nerves and thereby lead to sinus-like symptoms.
- But it is now recognized that during menstruation, it is more complex than just a change in estrogen and progesterone. In fact, there are multiple migraine triggers (eg, sleep, light, weather, foods, etc) as well as multiple neurotransmitters that are involved. Multiple things can occur during the menstrual cycle that can trigger a migraine. This makes sense, when one considers the fact that the majority of female migraineurs experience migraines outside of the menstrual cycle as well as within the cycle. For these reasons, simply treating with hormones is often inadequate, especially across attacks and across people.