Abstract:
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 inhibition originating in the brainstem. A wide range of evidence from the literature that cortical activation induced by a number of different mechanisms often produces headache is presented to support this notion. Several nuclei in the brainstem appear to participate in the selective control of trigeminovascular sensation through descending inhibitory mechanisms that arise in the cortex. In this review we focus on 2 of them, the periaqueductal gray matter and nucleus raphe magnus. Our own past results and those of others show that this inhibition is specific for craniovascular sensation and involves the neurotransmitter 5-hydroxytryptamine. Finally, we summarize our own recent experiments, which show that cortical activation by migraine triggers (including cortical spreading depression) inhibits neuronal discharge in the brainstem and facilitates trigeminovascular sensation. CONCLUSION:If the hypothesis can be proven and the neurotransmitters involved in the hypothetical trigger pathway can be identified, it may be possible to develop novel migraine preventative therapies.
journal_name
Headachejournal_title
Headacheauthors
Lambert GA,Zagami ASdoi
10.1111/j.1526-4610.2008.01230.xsubject
Has Abstractpub_date
2009-02-01 00:00:00pages
253-75issue
2eissn
0017-8748issn
1526-4610pii
HED1230journal_volume
49pub_type
杂志文章,评审相关文献
HEADACHE文献大全abstract:BACKGROUND:Many children suffering from chronic headache and migraine present with comorbid functional disability, including physical, social, emotional, and academic activities. For children severely impaired by headache, intensive interdisciplinary pain rehabilitation treatment (IIPT) can improve functioning. However...
journal_title:Headache
pub_type: 杂志文章
doi:10.1111/head.13389
更新日期:2018-11-01 00:00:00
abstract::Calcitonin-gene-related peptide (CGRP), a neuropeptide broadly distributed in neuronal and non-neuronal regions throughout the body, plays a fundamental role in migraine and cluster headache (CH) pathophysiology. CGRP functional blockade alleviates neurogenic inflammation and reduces pain pathway sensitization. Two ty...
journal_title:Headache
pub_type: 杂志文章,评审
doi:10.1111/head.13583
更新日期:2019-07-01 00:00:00
abstract::The present study evaluated the effects of relaxation treatment in 36 adolescents aged 13 to 18 years (mean +/- SD, 15.4 +/- 1.55 years) suffering from migraine or migraine and tension-type headache as compared with a waiting-list condition group. The subjects rated various characteristics of migraine and tension-type...
journal_title:Headache
pub_type: 杂志文章
doi:10.1046/j.1526-4610.2001.111006290.x
更新日期:2001-03-01 00:00:00
abstract::Reports of increased prevalence of headache in adults and clinical impressions of similar trends in children prompted this epidemiological study on migraine and other headaches. The first stage was carried out in 1974 in children starting school, and the second stage in 1992 using the identical study design, the same ...
journal_title:Headache
pub_type: 杂志文章
doi:10.1046/j.1526-4610.1996.3608466.x
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:Hypnic headache (HH) is a rare primary headache characterized by strictly sleep-related headache attacks. METHODS:This paper reviews the pertinent literature on HH. RESULTS:Disease information is mainly based on case reports and small case series (around 250 cases) published since its first description in ...
journal_title:Headache
pub_type: 杂志文章,评审
doi:10.1111/head.12447
更新日期:2014-10-01 00:00:00
abstract:OBJECTIVE:To investigate whether the use of more detailed close-ended questions as part of the routine headache history is helpful when patients initially deny that they are sensitive to light and noise during migraine headaches. BACKGROUND:According to the International Headache Society 2004 criteria, the diagnosis o...
journal_title:Headache
pub_type: 杂志文章
doi:10.1111/j.1526-4610.2007.00920.x
更新日期:2008-03-01 00:00:00
abstract::This study is the first double-blind placebo-controlled trial of fluoxetine for chronic daily headache (CDH) and migraine. After a one month single-blind baseline on placebo, subjects with CDH (n = 64) and migraine (n = 58) were randomly assigned to a three month trial of fluoxetine (20 mg) or an identical placebo. Fl...
journal_title:Headache
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1111/j.1526-4610.1994.hed3409497.x
更新日期:1994-10-01 00:00:00
abstract:OBJECTIVE:This analysis evaluates and ranks efficacy endpoints often used in headache trials concerning their clinical relevance in relation to the patient-related criterion "global assessment of overall efficacy" based on data gained in a large trial investigating different over-the-counter drugs in the treatment of h...
journal_title:Headache
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1111/j.1526-4610.2008.01242.x
更新日期:2009-05-01 00:00:00
abstract::Several studies have examined patients' attitudes to a consultation for migraine and other headaches. However, a patient's assessment of the problem for which they seek treatment may differ from that of the referring primary physician which may, in turn, differ from the specialist's. This study set out to examine this...
journal_title:Headache
pub_type: 杂志文章
doi:10.1111/j.1526-4610.1995.hed3502104.x
更新日期:1995-02-01 00:00:00
abstract:OBJECTIVE:To confirm the efficacy of rizatriptan 10 mg orally disintegrating tablet (ODT) for the elimination of migraine-associated nausea. BACKGROUND:Pooled studies of rizatriptan analyzing elimination of nausea as a secondary endpoint showed that 65% of rizatriptan patients reported elimination of nausea at 2 hours...
journal_title:Headache
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1111/j.1526-4610.2007.00954.x
更新日期:2008-03-01 00:00:00
abstract:OBJECTIVE:This study aimed to evaluate the association between misdiagnosis of spontaneous intracranial hypotension (SIH) and subdural hematoma development. BACKGROUND:Although SIH is more prevalent than expected and causes potentially life-threatening complications including subdural hematoma (SDH), the association b...
journal_title:Headache
pub_type: 杂志文章
doi:10.1111/head.13132
更新日期:2017-11-01 00:00:00
abstract::A 48-year-old slender woman presented with a rare case of spontaneous intracranial hypotension syndrome manifesting as patulous Eustachian tube. The patient complained of sudden onset of ear fullness and nasal voice as well as typical orthostatic headache. Patulous Eustachian tube was identified by observation of sync...
journal_title:Headache
pub_type: 杂志文章
doi:10.1111/j.1526-4610.2006.00661.x
更新日期:2007-01-01 00:00:00
abstract::We performed greater occipital nerve blocks on 24 migraineurs with unilateral migraine and trigeminal nerve distribution allodynia. Using a visual analog scale for migraine pain, brush allodynia in the trigeminal nerve distribution and photophobia were reduced 64%, 75%, and 67%, respectively, after 5 minutes. Allodyni...
journal_title:Headache
pub_type: 杂志文章
doi:10.1111/j.1526-4610.2008.01146.x
更新日期:2008-07-01 00:00:00
abstract::Approximately 18% of all patients referred for a cranial computed tomography complain of headache only. We reviewed 363 consecutive patients in order to assess the value of this examination in the diagnostic approach. Despite the vast number of normal examinations (88.4%), we advocate the routine use of a cranial comp...
journal_title:Headache
pub_type: 杂志文章
doi:10.1046/j.1526-4610.1996.3606347.x
更新日期:1996-06-01 00:00:00
abstract:BACKGROUND:Migraine can be disabling, but it varies greatly in frequency and intensity between individuals. It is not clear which clinical features have the greatest impact on a migraineur's quality of life. OBJECTIVE:To determine the influence of headache intensity and frequency on headache-related disability. METHO...
journal_title:Headache
pub_type: 杂志文章
doi:10.1046/j.1526-4610.2003.03206.x
更新日期:2003-11-01 00:00:00
abstract::A 72 year old woman with attacks of severe lancinating pain in the right frontotemporal region of her face had, on CT scan of the skull base, fibrous dysplasia of the right sphenoid bone, involving the areas traversed by the trigeminal nerve. Her pain ceased following treatment with methysergide. In patients with hemi...
journal_title:Headache
pub_type: 杂志文章
doi:10.1111/j.1526-4610.1990.hed3005277.x
更新日期:1990-04-01 00:00:00
abstract::A 67-year-old man with a 12-year history of trigeminal neuralgia experienced multiple fainting episodes preceded by right facial pain. One episode resulted in cardiac arrest with successful resuscitation. Pacemaker insertion prevented further episodes of syncope despite the occurrence of pain. The fainting episodes an...
journal_title:Headache
pub_type: 杂志文章
doi:10.1046/j.1526-4610.1996.3606392.x
更新日期:1996-06-01 00:00:00
abstract::A questionnaire study on headaches, using a door-to-door survey, was carried out in a representative sample of the general Greek population, including 1737 men and 1764 women, from 15 to 75 years of age. The parameters evaluated included age, sex, education, socioeconomic status, region of domicile, frequency of heada...
journal_title:Headache
pub_type: 杂志文章
doi:10.1046/j.1526-4610.1996.3603168.x
更新日期:1996-03-01 00:00:00
abstract:BACKGROUND:New treatments are needed to treat chronic daily headache (CDH) and chronic cluster headache (CCH). New treatments are needed to treat this population and intravenous (IV) lidocaine is a novel treatment for CDH. OBJECTIVE:The aim of this study was to examine the use of IV lidocaine for refractory CDH patien...
journal_title:Headache
pub_type: 杂志文章
doi:10.1111/j.1526-4610.2008.01281.x
更新日期:2009-02-01 00:00:00
abstract::Migraine is a debilitating condition characterized by a cycle of painful headaches and headache-related symptoms interspersed with periods of worry, distress, and apprehension. The negative impact of migraine on patient functioning, workplace productivity, and other daily activities has been demonstrated through the u...
journal_title:Headache
pub_type: 杂志文章,评审
doi:10.1111/j.1526-4610.2007.01040.x
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVE:We conducted the present study to determine whether there are headache precipitating and aggravating factors that differentiate migraine from tension-type headache and headache precipitating and aggravating factors that differentiate tension-type headache from migraine. METHODS:We interviewed 38 patients wit...
journal_title:Headache
pub_type: 杂志文章
doi:10.1046/j.1526-4610.2001.041006554.x
更新日期:2001-06-01 00:00:00
abstract::More than 60 years ago Aristides Leão coined the term spreading depression (SD) to describe a transient "depression" of electrocorticographic activity that lasts up to several minutes and slowly "spreads" in all directions in cortex by way of gray matter contiguity.(1) Today we know that SD is an intrinsic electrophys...
journal_title:Headache
pub_type: 杂志文章,评审
doi:10.1111/j.1526-4610.2010.01647.x
更新日期:2010-04-01 00:00:00
abstract:OBJECTIVE:To describe a standardized methodology for the performance of peripheral nerve blocks (PNBs) in the treatment of headache disorders. BACKGROUND:PNBs have long been employed in the management of headache disorders, but a wide variety of techniques are utilized in literature reports and clinical practice. MET...
journal_title:Headache
pub_type: 杂志文章,评审
doi:10.1111/head.12053
更新日期:2013-03-01 00:00:00
abstract::A self-administered questionnaire covering the diagnostic criteria of the International Headache Society was completed by 1208 undergraduates of the National University of Singapore to determine the prevalence and characteristics of headaches in this population. The relationship between headaches and depressive illnes...
journal_title:Headache
pub_type: 杂志文章
doi:10.1046/j.1526-4610.1997.3701026.x
更新日期:1997-01-01 00:00:00
abstract:OBJECTIVE AND BACKGROUND:Pupillometric investigations into migraine have suggested that an autonomic disturbance is part of the pathogenesis of that condition. This observation is controversial, however, which may reflect that the putative sympathetic hypofunction is either subtle or transient. In this study, we assess...
journal_title:Headache
pub_type: 杂志文章
doi:10.1111/head.12139
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVES:To provide a guide to the use and limitations of continuous opioid therapy (COT, or daily scheduled opioids) for refractory daily headache, based on the best available evidence and expert clinical experience. BACKGROUND:There has been a dramatic increase in opioid administration over the past 25 years, with...
journal_title:Headache
pub_type: 杂志文章,实务指引,评审
doi:10.1111/j.1526-4610.2010.01733.x
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:Borderline personality disorder (BPD) may be disproportionately common in the migraine patient population, but specific migraine features in the BPD subgroup remain incompletely characterized. PURPOSE:To define more clearly the clinical characteristics of migraine patients with BPD, to evaluate their clinic...
journal_title:Headache
pub_type: 杂志文章
doi:10.1111/j.1526-4610.2007.00649.x
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:Mechanical compression of the trigeminal root by an artery is thought to cause trigeminal neuralgia. The 5-HT(1B/1D) receptor agonist may inhibit neurogenic inflammation and vasodilation near the irritated trigeminal root. OBJECTIVE:To examine the effectiveness of a 5-HT(1B/1D) receptor agonist, sumatriptan...
journal_title:Headache
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1526-4610.2006.00405.x
更新日期:2006-04-01 00:00:00
abstract:BACKGROUND:Variables that are thought to precipitate migraine or tension-type headache episodes in children hitherto have only been studied using retrospective reports. As such, there is little empirical evidence to support the actual predictive association between presumed headache triggers and actual headache occurre...
journal_title:Headache
pub_type: 杂志文章
doi:10.1111/j.1526-4610.2009.01586.x
更新日期:2010-05-01 00:00:00
abstract::A 33-year-old woman developed persistent postural headache following epidural anesthesia (L2-L3 level). Iohexol myelography (L5-S1 puncture) demonstrated no epidural extravasation of contrast material (Figure A), but subsequent computed tomography (CT) axial images (B, C) revealed leakage of dye through the needle tra...
journal_title:Headache
pub_type: 杂志文章
doi:10.1046/j.1526-4610.2003.03114.x
更新日期:2003-06-01 00:00:00