neurologic disorders
Migraine
Pathophysiology of Migraine
Migraine is thought to be a neurovascular pain syndrome with altered central neuronal processing (activation of brain stem nuclei, cortical hyperexcitability, and spreading cortical depression) and involvement of the trigeminovascular system (triggering neuropeptide release, which causes painful inflammation in cranial vessels and the dura mater). Many potential migraine triggers have been identified; they include the following: Drinking red wine Skipping meals Excessive afferent stimuli (eg, flashing lights, strong odors) Weather changes Sleep deprivation Stress Hormonal factors, particularly menstruation Certain foods Food triggers vary from person to person. Traumatic Brain Injury (TBI) , Fluctuatingestrogenlevels are a potent migraine trigger. Many women have onset of migraine at menarche, severe attacks during menstruation (menstrual migraine), and worsening during menopause. For most women, migraines remit during pregnancy (but sometimes they worsen during the 1st or 2nd trimester); they worsen after childbirth, whenestrogenlevels decrease rapidly. Oral contraceptives and other hormone therapy occasionally trigger or worsen migraine and have been associated with stroke in women who have migraine with aura. Familial hemiplegic migraine, a rare subtype of migraine, is associated with genetic defects on chromosomes 1, 2, and 19. The role of genes in the more common forms of migraine is under study. In some families, the migraine phenotype varies considerably, causing primarily headache in some family members, vertigo in others, and hemiplegia or an aura in others. This finding suggests that migraine may actually be a more generalized disorder and not just a headache disorder. 