Abstract
A trigger is an integral part of any acute migraine attack. In this article, the author argues that triggers, identifiable or not, must be present in all attacks of migraine headache. It is hypothesized that triggers, internal or external, induce the onset of cortical spreading depression (CSD) in a pre-existing hyper-excitable cortex of a migraine brain, initiating the process of pain generation. The author hypothesizes on a second site of action of triggers at the level of trigeminal nuclear complex (TNC) in brain stem, the cell station of second order neuron pathway for migraine pain transmission to the sensory cortex. The author suggests existence of a hypothetical 'gate' at TNC level where incoming trigeminal migraine pain impulses would 'compete' with descending inhibitory signals from brain stem pain modulatory neurons, to get entry into the central nervous system. The author draws analogy with the 'gate control' mechanism operative at the dorsal horn level for spinally transmitted somatic and visceral pain. It is suggested that the hypothetical 'gate' at TNC level is controlled by activity of 5HT receptors, thus supporting the concept of an additional site of action of triptans in aborting acute migraine pain. The sugge...Continue Reading
References
Nov 1, 1996·Cell·R A OphoffR R Frants
Mar 11, 1999·Annals of Neurology·W M MullenersP J Koehler
Jul 5, 2001·Headache·W M MullenersJ W Vredeveld
May 3, 2003·Nature Reviews. Neuroscience·Daniela Pietrobon, Jörg Striessnig
Jun 1, 1962·Brain : a Journal of Neurology·R MELZACK, P D WALL
Feb 3, 2004·Annals of Neurology·Michael A MoskowitzTurgay Dalkara
Apr 19, 2005·Headache·K Michael Welch
Aug 3, 2005·The Neuroscientist : a Review Journal Bringing Neurobiology, Neurology and Psychiatry·Daniela Pietrobon
Aug 27, 2005·Nature Reviews. Drug Discovery·Peter J Goadsby
Sep 24, 2005·Headache·Anouk CustersEdward P Chronicle
May 1, 2007·Nature Neuroscience·Takahiro TakanoMaiken Nedergaard
Sep 17, 2008·Headache·Geoffrey A Lambert, Alessandro S Zagami
Oct 16, 2008·The Journal of Headache and Pain·A ChakravartyD Roy
Mar 18, 2009·Neurologic Clinics·Peter J Goadsby
Aug 26, 2009·The Journal of Headache and Pain·Ambar ChakravartyD Roy
Citations
May 22, 2010·Current Pain and Headache Reports·Christina SjöstrandElisabet Waldenlind
Jun 10, 2014·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·Giuseppe CosentinoFilippo Brighina
Sep 19, 2014·Current Pain and Headache Reports·Justin M DeLange, F Michael Cutrer
Nov 3, 2012·Drugs·Ryan J CadyRoger K Cady
Sep 8, 2010·Expert Review of Neurotherapeutics·Massimo LeoneCaroline McGown
Nov 6, 2013·Pediatric Neurology·Nathan WatembergMuhammad Mahajnah
Dec 8, 2015·Headache·Jonathan M Borkum
May 29, 2012·Pathologie-biologie·D Sarrouilhe, C Dejean
Nov 2, 2011·The Journal of Headache and Pain·Dorothée NeutLouis Vallée
Jan 3, 2013·Headache·Filippo BaldacciUbaldo Bonuccelli
Oct 24, 2014·Headache·Richard B LiptonDawn C Buse
Sep 2, 2015·BMC Research Notes·Panagiotis IliopoulosPetros Skapinakis
Oct 26, 2016·Headache·Marco Aurélio FornazieriRichard L Doty
Oct 16, 2013·Cephalalgia : an International Journal of Headache·Geoffrey A LambertAlessandro S Zagami
Dec 18, 2013·Cephalalgia : an International Journal of Headache·A Laine GreenFrank Porreca
Apr 25, 2017·Journal of Child Neurology·Lise SolotareffSylvie Nguyen The Tich
Mar 30, 2013·Arquivos de neuro-psiquiatria·Marcela Dalla Bernardina FragaMarcelo Rodrigues Masruha
Sep 24, 2011·Cephalalgia : an International Journal of Headache·Geoffrey A LambertAlessandro S Zagami
Sep 18, 2010·Cephalalgia : an International Journal of Headache·Anne Werner HaugeJes Olesen
Nov 26, 2010·Cephalalgia : an International Journal of Headache·M BjørkT Sand
Jul 31, 2013·Neurological Research·Sanjeev K BhoiUsha K Misra