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The Pain Is In The Brain - migraines
Discover, March, 2000 by Curtis Rist
After about 30 minutes, Rennich's aura subsided, and he felt relatively normal for nearly an hour. Then his migraine began. The visual neurons, which had fired abnormally during the cortical spreading depression, had released large amounts of potassium ions. Over time, the potassium spread from the visual cortex to the pain-controlling neurons in the meninges. These neurons, located in the walls of the meningeal blood vessels, began to fire and released neuropeptides, telling the brain to register pain and the blood vessels to dilate. The dilated vessels then prompted the pain neurons to fire again. Essentially, a pain-causing feedback loop was set in motion, creating the agony of a migraine. For migraine patients with with no auras, the cause of the pain is less apparent. Some neurologists suspect that the cortical spreading depression may begin in a section of the brain not involved in sensory processing, so the initial effects aren't noticeable.
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At some time, most of us have had a headache--a signal that we are under stress or overtired or that we drank too much alcohol the night before. But some 40 million Americans suffer debilitating headaches that have no discernible cause. For years, researchers were convinced that the problem was either within the meningeal blood vessels, or, more often, the patients themselves. "If someone gets kicked in the knee, they feel that stimulus as pain; that's rational," says Goadsby. "But what we find in people with chronic headaches is the pain without the physical stimulus; that's irrational." When physicians ran out of possible explanations, they often referred patients to psychiatrists. "Since doctors didn't know what the problem was, they would sometimes try to blame the patients for imagining things," says Cutrer, who has suffered from migraines since age 14. "Now we know that the brain itself is the new arena for headache research."
In people with chronic headaches, the brain appears to be sensitive to such environmental factors as light and stress, monthly hormonal cycles among women, or quirky things such as eating a raw onion or playing basketball. "We're going from research where we thought the brain wasn't involved, where now we are sure it is," says Goadsby This new view has already led to the development of specific drugs that stop headaches in mid-attack and prevent them altogether.
For those with headaches, this comes as welcome news: Some 6 million people in this country alone suffer from what are called chronic tension-type headaches, similar to the ones everyone has at least occasionally--except that for these people they strike almost daily Migraines, which tend to affect one side of the head, afflict between 23 million and 26 million. Unfortunately, the number of migraine diagnoses has been steadily rising: A recent study in the journal Neurology showed that the incidence of migraine diagnosis increased by 56 percent in women and 34 percent in men during 1989 (compared to figures for 1979-1981). And approximately a million people suffer from cluster headaches, an excruciating phenomenon that hits mostly men. According to the first recorded description of such a headache, dating from the 1700s, the sufferer felt "as if his eye was slowly being forced out of its orbit with so much pain that he nearly went mad."
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