Migraine (mechanism of disease)

This is a flowchart on migraines, covering the etiology, pathophysiology, and manifestations.

ADDITIONAL TAGS:
Activation of autonomic nervous system
↑ parasympathetic tone
Risk factors / SDOH
Cell / tissue damage
Nervous system path
Migraine
Medicine / drugs
Infectious / microbial
Hormones / metabolic
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Diet / consumption
Genetics / hereditary
Flow physiology
Pathophysiology
Etiology
Manifestations
Activation of meningeal nociceptors
Dilatation of intracranial blood vessels
Activation of trigeminal neurons
Vasoactive neuropeptides (substance P, CGRP) released
Proinflammatory molecules (histamine, bradykinin, serotonin, prostaglandins) released
Neurogenic inflammation
Trigeminovascular pathway:
Wave of depolarization in cerebral cortex
Excitation then suppression of neural activity
Cortical spreading depression:
Vasodilation (might be epiphenomenon):
70%: Genetic predisposition to poor brain habituation to external stimuli (stress, hormonal changes)
Hyperexcitable brain
Initiation of migraine
Dysregulation of pain sensitization in the trigeminal (CN V) system
Nausea, vomiting
Change in appetite
Yawning
Fatigue
Anxiety
Depression
Potential triggers
Alcohol, nicotine, citrus fruits, dairy, tyramine foods (chocolate, red wine)
Poor sleep habits
Emotional stress
Weather changes
Menstruation, hormone intake (OCPs)
Lacrimation
Nasal congestion
Stages of migraine attack:
Prodrome (1-2 days before headache):
Change in mood
Difficulty reading
Difficulty writing
Aura (25%; lasting 60 min before headache; gradual, reversible):
Visual (most common):
Scintillating scotoma (arch-shaped visual def, central → peripheral)
Flashing lights/spots/lines
Blurry vision
Distorted color perception
Numbness
Pins and needles
Aphasia
Paresis (atypical)
Dizziness (atypical)
Headache (usually lasting 4-24 hours):
Headache; usually unilateral, especially fronto(temporal), retro-orbital; can be pulsating, throbbing, or pounding; worse with physical activity
Photophobia
Phonophobia
Postdrome:
Exhaustion
Euphoria
Muscle weakness
Change in appetite