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The Mode of Action of Migraine Triggers: A Hypothesis
Geoffrey A. Lambert, Alessandro S. Zagami
Posted: March 2009  
Headache  2009;49:253-275

Objectives:   To review conjectured modes of action of migraine triggers and to present a new hypothesis about them.

Background:   Migraine attacks are initiated in many migraineurs by a variety of "triggers," although in some patients no external trigger can be identified. Many triggers provoke attacks with such a short latency that only some kind of neural mechanism can explain the triggering.

Results:   We present here a hypothesis that the pain of migraine has its ultimate origin in the cortex, but that the immediate generator is in the brainstem. Our hypothesis is that most migraines have triggers that produce excitation of cortical neurons and that this directly causes withdrawal of descending sensory inhabitation originating in the brainstem.

Conclusion:   If the hypothesis can be proven and the neurotransmitters involved in the hypothetic trigger pathway can be identified, it may be possible to develop novel migraine preventative therapies.