Clue to migraine headache cause

Clue to migraine headache cause

Migraines can be debilitating
Scientists may be a step closer to uncovering the cause of certain
types of debilitating migraine headaches.
A French team observed activation in the hypothalamus region of the
brain as sufferers had a migraine attack.

The hypothalamus has long been suspected as it regulates
physiological responses to factors known to trigger headaches, such
as hunger.

It is hoped the discovery, featured in the journal Headache, could
lead to new treatments.

It’s easy to think that migraine is a specific brain disorder, but
it is a series of systems that go wrong

Professor Peter Goadsby
Insitute of Neurology

The researchers, from Rangueil Hospital, used a technique called
Positron Emission Tomography (PET), which contrasts functional
activity within the brain, on seven patients with migraine without
aura, the most common type of migraine.

Previously, activation in the brain stem and midbrain, and a
thickening in some areas of the cortex were seen in migraine
sufferers.

The present study may have seen a more detailed pathogenesis of the
condition for two reasons.

First, timing was crucial: to capture an attack as it happened,
patients rushed to hospital without self-medicating, arriving on
average around three hours after the onset of the migraine.

Second, the observed headaches were spontaneous, and not chemically
induced as in other laboratory studies.

Lead researcher Dr Marie Denuelle said: "When you induce the attack
you miss the hypothalamic activation.

"We suspect the hypothalamus may play a role in the start of the
migraine attack.

“But to prove it we would need to do similar study before the start
of an attack.”

Dr Andrew Dowson, director of headache services at Kings College
Hospital, London, said: "It has been suggested for many years that
the hypothalamus is involved in the early stages of migraine attacks.

“But there are other factors involved in the early generation of
headache.”

Suicide headaches

Activation of the hypothalamus had previously only been seen in
cluster headache, a different and altogether more crippling
condition.

Cluster headache sufferers experience headaches on a regular basis:
for certain months of the year in the episodic form, or every day at
regular intervals in the chronic form.

So debilitating can the attacks be that they have been
dubbed “suicide headaches” because some sufferers have taken their
own lives.

The new evidence for hypothalamic activation in migraine may explain
why some migraine drugs, particularly the triptans, can sometimes be
effective at aborting a cluster headache attack.

However, Professor Peter Goadsby, of the Insitute of Neurology at
University College London, said there were distinct clinical and
physiological differences between cluster headache and migraine.

He said: "The area [of the hypothalamus] reported as activated in
migraine is about 10mm more anterior than the cluster headache area.

“The hypothalamus is not one thing but a collection of discrete
neurons.”

Professor Goadsby said a cascade of changes in the brain seemed to
cause the migraine problem.

"It’s easy to think that migraine is a specific brain disorder, but
it is a series of systems that go wrong - a system disorder.

“There is no single holy grail. Multiple structures are involved.”

Migraines can be debilitating
Scientists may be a step closer to uncovering the cause of certain
types of debilitating migraine headaches.
A French team observed activation in the hypothalamus region of the
brain as sufferers had a migraine attack.

The hypothalamus has long been suspected as it regulates
physiological responses to factors known to trigger headaches, such
as hunger.

It is hoped the discovery, featured in the journal Headache, could
lead to new treatments.

It’s easy to think that migraine is a specific brain disorder, but
it is a series of systems that go wrong

Professor Peter Goadsby
Insitute of Neurology

The researchers, from Rangueil Hospital, used a technique called
Positron Emission Tomography (PET), which contrasts functional
activity within the brain, on seven patients with migraine without
aura, the most common type of migraine.

Previously, activation in the brain stem and midbrain, and a
thickening in some areas of the cortex were seen in migraine
sufferers.

The present study may have seen a more detailed pathogenesis of the
condition for two reasons.

First, timing was crucial: to capture an attack as it happened,
patients rushed to hospital without self-medicating, arriving on
average around three hours after the onset of the migraine.

Second, the observed headaches were spontaneous, and not chemically
induced as in other laboratory studies.

Lead researcher Dr Marie Denuelle said: "When you induce the attack
you miss the hypothalamic activation.

"We suspect the hypothalamus may play a role in the start of the
migraine attack.

“But to prove it we would need to do similar study before the start
of an attack.”

Dr Andrew Dowson, director of headache services at Kings College
Hospital, London, said: "It has been suggested for many years that
the hypothalamus is involved in the early stages of migraine attacks.

“But there are other factors involved in the early generation of
headache.”

Suicide headaches

Activation of the hypothalamus had previously only been seen in
cluster headache, a different and altogether more crippling
condition.

Cluster headache sufferers experience headaches on a regular basis:
for certain months of the year in the episodic form, or every day at
regular intervals in the chronic form.

So debilitating can the attacks be that they have been
dubbed “suicide headaches” because some sufferers have taken their
own lives.

The new evidence for hypothalamic activation in migraine may explain
why some migraine drugs, particularly the triptans, can sometimes be
effective at aborting a cluster headache attack.

However, Professor Peter Goadsby, of the Insitute of Neurology at
University College London, said there were distinct clinical and
physiological differences between cluster headache and migraine.

He said: "The area [of the hypothalamus] reported as activated in
migraine is about 10mm more anterior than the cluster headache area.

“The hypothalamus is not one thing but a collection of discrete
neurons.”

Professor Goadsby said a cascade of changes in the brain seemed to
cause the migraine problem.

"It’s easy to think that migraine is a specific brain disorder, but
it is a series of systems that go wrong - a system disorder.

“There is no single holy grail. Multiple structures are involved.”