Study author Peter Goadsby, MD, PhD, professor, neurology, and director, Headache Program, University of California at San Francisco, and president, International Headache Society and his colleagues have published results showing activation occurring in the brain, prior to a  headache setting in – demonstrating that migraine is a brain disorder and not a response to pain stimuli.

“This is an important step in solidifying our ideas that migraine is fundamentally a disorder of the brain, not a disorder of structures outside the brain. We were able to address the question that people have wondered about for many, many years, that is, what is the degree to which pain is driving the initial symptomatology – and we got clear answers to that.”

Premonitory symptoms of migraine – symptoms occurring up to one or two days prior to a migraine attack – can include yawning, neck discomfort, nausea, thirst, photophobia, phonophobia, and mood swings.

In the past, it was thought that migraine was a disorder of the blood vessels. More recently, the view has been that migraine is a reaction to pain stimuli. “I think our new research suggests that this is just not true,” said Dr. Goadsby.

Using nitroglycerin, a well-documented trigger for migraine, researchers induced premonitory symptoms in patients who have migraine without aura. Researchers then scanned the patients’ brains during the premonitory phase.

“Before this, all the imaging of migraine has been during the headache and the question has risen as to the degree to which what’s happening in the brain is just a response to pain, or is something more fundamental, a part of the process of the migraine. By studying the premonitory symptoms, you get rid of that question because these patients don’t have any pain,” said Dr. Goadsby.

Interestingly, scans of patients having nausea had activation of an area of the medulla that includes nausea and vomiting centers. Dr. Goadsby suggests that it’s very possible that those areas are activated by the migraine process, and that’s why nausea and vomiting are so common in migraine; it’s not just a response to the pain. “It was thought that nausea and pain were highly linked, but that doesn’t seem to necessarily be the case,” he added.

Dr. Goadsby hopes the research will “shift thinking” to consider migraine as a brain disorder, but he stressed that this should not lessen the importance of the pain that migraine patients endure.

“From a big picture treatment perspective, this says to me that we probably won’t get away with developing drugs that don’t get into the brain to have substantial effects on migraine prevention,” he said…….. Medscape   July 2, 2013



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