Chapter 8 - Pathophysiology and precipitants of migraine

Abstract

Publisher Summary It is inevitable that very little research on the pathophysiology of migraine has been done specifically in children, although children have been the subject of a number of empirical trials of dietary manipulation in the hope of preventing attacks. The pain of headache is believed to originate from dilated sensitized blood vessels. It has been known for nearly two centuries that digital pressure on the superficial scalp arteries will relieve the discomfort temporarily. During headache, there is an increase in the amplitude of pulsations in the superficial temporal artery and treatment with ergotamine simultaneously reduces the pulsations and the headache. There is some evidence of increased extracranial blood flow during headache, although no change could be demonstrated in temporal muscle blood flow during unilateral common migraine attacks. There is now considerable evidence that the platelet release reaction occurs in migraine. Increased platelet microaggregates are found in the circulation both during and between attacks. The pathophysiologies of migraine in children and in adults are not so dissimilar as to invalidate a combined approach. There is no universally accepted integrated pathogenetic scheme for the migraine attack.