Research into migraine prodrome- what is going on in the brain prior to pain

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Migraine Really Is a Brain Disorder  “BOSTON, Massachusetts — Positron emission tomography of patients experiencing the premonitory phase of migraine, prior to the headache setting in, shows activation in several areas of the brain, indicating that migraine is a brain disorder and not a response to pain stimuli.”

I think this article is a little poorly named, or maybe the study is… we know a migraine is a brain disorder. It is neurological. It happens in the brain. It occurs in stages. It can have an aura. It does not necessarily have pain at all. Aside from that this is a fascinating study because it actually is looking at the brain prior to the pain phase of the migraine to see what exactly Is going on in the brain and where it is going on. And that is pretty cool.


“Premonitory symptoms of migraine can include yawning, neck discomfort, nausea, thirst, photophobia, phonophobia, craving sweet or savory foods, and mood swings. It’s not clear what proportion of patients with migraine experience these early symptoms, which are often quite subtle, Dr. Goadsby said. Estimates vary widely, from about a third to 80%.”

The Prodrome stage is that very first stage of a migraine attack, prior to an aura if a person has an aura… and ‘stage’ or ‘phase’ is a flexible term because it can be quite noticeable or not noticeable at all, or you might skip it altogether. Not always the same symptoms and sometimes in hindsight you go ‘ah yes that is why I craved chocolate’… not necessarily always helpful in predicting a migraine, while at other times the intense increase in photophobia or sudden phonophobia or mood swing pretty sure sign of migraine onset.

“They found that compared with baseline scans, there was activation in several key areas, including the hypothalamus, an area involved in low-level regulation of sleep, appetite, mood, and fluids. “It seems likely that the hypothalamus is pivotal in the onset of migraine,” commented Dr. Goadsby.
Other structures that were activated included the midbrain, around the periaqueductal grey, which has been shown to be active during a migraine attack, and an area in the pons that past migraine imaging has also shown to be active.
“This shows you the areas of the brain that are involved at the earliest in the attack,” said Dr. Goadsby.
Scans of the 8 patients plus another 2 patients experiencing photophobia symptoms, again before they felt any pain, showed activation in the visual cortex. “This suggests that the photophobia experience can be dissected away from the pain experience,” said Dr. Goadsby.
Similarly, scans of patients experiencing nausea had activation of an area of the medulla that includes nausea and vomiting centers. “So it’s entirely plausible that those areas are activated by the migraine process and that’s why nausea and vomiting are so common in migraine; it’s not simply a response to the pain,” said Dr. Goadsby.
“It was thought that nausea and pain were highly linked, but that doesn’t seem to necessarily be the case,” he added.”

This is fascinating to me. I never thought the nausea was linked to pain by the way… it begins before the pain and is not the same sort of nausea that is felt from acute pain… it is just a sort of too uncontrolled for that. Too not dependent on pain levels as well. Photophobia as well they have already done studies that show people with migraines are actually a little photophobic outside of the migraine attack itself and we know it occurs before the pain phase so definitely not linked to pain. I think most fascinating is the hypothalamus activation early in the migraine attack affecting mood, sleep, and appetite… that is pretty important… rather explains those mood swings, cravings, and nap attacks.

Pretty interesting study showing what really goes on in this phase and leading to more understanding of migraines in the brain. The more they understand the whole process the more they can come up with more treatment possibilities in the future.

See Also: Migraine: The Prodrome Stage


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