For Neurologists

This sec­tion is under­go­ing devel­op­ment. Please check back later.

I do not think that the cur­rent expla­na­tion of headache,  known as the “trigemi­no­vas­cu­lar the­ory” really “explains” migraine, and it does not really coin­cide with my expe­ri­ences with my patients. What fol­lows is a list of our patients’ obser­va­tions about their headaches that must be explained by a the­ory on the eti­ol­ogy of migraine. Once the trip­tan med­ica­tions became avail­able and were shown to work for the lit­tle headaches that we have called “ten­sion headahces” , “sinus headaches” , “mus­cle con­trac­tion headaches” I think that all headaches derive from the same mech­a­nism; a “spon­ta­neous turn­ing on of the head pain sys­tem”. The sever­ity and accom­pa­ny­ing symp­toms are only a mat­ter of the degree of  exci­ta­tion, I don’t believe that there are mul­ti­ple dif­fer­ent kinds of spon­ta­neous headaches, nor does there need to be mul­ti­ple mechanisms.

I present an alter­na­tive view of the eti­ol­ogy of migraine under the headache sec­tion, with fur­ther read­ing at the end of that sec­tion and in the Lec­ture sec­tion as well.

Keep in mind that migraine is some­what unique in neu­rol­ogy. It is a spon­ta­neously gen­er­ated pain syn­drome that occurs fre­quently in nor­mal humans. By def­i­n­i­tion it has few or no find­ings and can­not really be dupli­cated by ani­mal injury mod­els that are sold as rep­re­sent­ing “migraine”. Headache here refers to spon­ta­neous head pain in a nor­mal per­son with­out a mass or infec­tion or other irri­ta­tion of the head pain fibers by a rec­og­niz­able dis­ease such as a viral syn­drome etc.

Also remem­ber that every the­ory of patho­phys­i­ol­ogy is only as good as its applic­a­bil­ity in pre­dict­ing patients’ out­come. We human beings cre­ate thoughts about what our patients tell us. We for­mu­late a pat­tern or a pic­ture that explains their expe­ri­ence and tries to pre­dict a cura­tive or treat­ment reg­i­men to help them. The­o­ries are just ideas, they are not “truth”. The part that is almost invari­ably true is the patient’s descrip­tion of what they have expe­ri­enced. If what we physi­cians are taught by other physi­cians does not match what the patient says, the patient is usu­ally the one that is right.

The expe­ri­ences that must be explained by a the­ory to explain headache:

• Spon­ta­neous head and or neck pain with­out a blow to the head or neck.
• Nau­sea accom­pa­nies often.
• Pain may be worse with mov­ing the head.
• Ten­der­ness of the scalp is a resid­ual after sev­eral hours of headache.
• Usu­ally starts at puberty is worse around the men­strual cycle. Is more com­mon in boys in teens then becomes much less com­mon in men after 18 in the same fam­i­lies with women with severe or fre­quent headaches.
• Wors­ened by sleep dis­rup­tion or sleep diorders.
• Resolved with trip­tan medications.
• Trip­tans also take away mild con­fu­sional state and mild bal­ance diosders.