There are two major theories about the causes of migraine: the neuronal and vascular theories. The neuronal theory - which is more widely accepted today - states that neuronal activity is sufficient to cause a migraine, and is supported by abnormal signal processing and lack of cerebral vasodilation (blood vessel dilation) between episodes, as well as hypothalamic activation during migraines. The vascular theory states that vasodilation is sufficient to cause a migraine, and is supported by the migraine-inducing effects of substances that result in vasodilation and the vasoconstrictive effects of drugs that treat migraines.

Both theories suggest that migraines are associated with the hyperexcitability of local brain tissue due to increased glutamate levels.

Causes of migraine

There are significant genetic factors implicated in migraine. Twin studies have shown a high rate of heritability (about 30-60%). Familial hemiplegic migraine (FHM) is an autosomal dominant form of migraine associated with an aura (visual disturbance) and transient unilateral motor weakness, and is passed down if a person has at least one first or second-degree relative with FHM. The three known genes underlying FHM help control neuronal activity through the availability of glutamate.

Genetics of migraine

An aura describes the visual (most common), sensory or motor symptoms that often characterize migraine. It may be caused by an electrophysiological phenomenon known as cortical spreading depression (CSD), a wave of depolarization that starts in the occipital lobe and slowly spreads before a period of hyperpolarization.

From top-left, clockwise: zigzags, negative scotoma, one-sided loss of perception, positive scotoma.

Migraine aura

1. Premonitory/prodrome: begins up to 3 days before headache and is associated with fatigue, mood changes, muscle tenderness and photophobia (sensitivity to light).
2. Aura: occurs in one-third of migraines. See "Migraine aura" node.
3. Headache: throbbing pain caused by activation of the trigeminovascular pathway, which transmits nociceptive (pain) information 
4. Postdrome: marked by a reduction in headache. Symptoms include soreness in the area.

Stages of migraine

* Non-steroidal anti-inflammatory drugs
* Triptans
* CGRP receptor antagonists
* Ergotamines

Treatments for migraine

In migraine, light indirectly activates nociceptors (pain receptors) in the eyes; there is cross-talk between vision processing and pain pathways, for which the posterior thalamus has been implicated. Light increases activity in the trigeminovascular neurons of the thalamus.

Neurobiology of photophobia

There is a notable gender disparity in the prevalence of migraines, with women experiencing them more frequently than men.

Gender Differences in Migraine Prevalence

A 34-year-old patient reports experiencing episodes of intense, throbbing pain isolated to the left side of their head. During these episodes, they feel nauseous and find it necessary to retreat to a dark, silent room because ordinary light and sounds are unbearable. Based on this specific combination of symptoms, which condition is the most likely diagnosis?

A migraine is a type of primary headache, thought to be caused by the swelling of blood vessels and an increase in blood flow. It is characterized by severe, often unilateral pain, and can be accompanied by symptoms like an upset stomach, disturbed vision, nausea, and sensitivity to light (photophobia) and sound (phonophobia). Migraines are reported more frequently by women than by men.

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University of Michigan - Ann Arbor

A headache with no underlying cause. The most common type of headache (over 90% of cases).
* Migraine
* Tension-type headache
* Trigeminal autonomic cephalgias
* Stimulus-induced headache
* Thunderclap headache
* New daily persistent headache

Primary headache

Psychophysiological disorders are physical diseases or conditions characterized by genuine physical symptoms. These symptoms are either initially caused or significantly worsened by stress and other emotional factors. The term itself highlights the interplay between psychological ('psycho') and physiological ('physiological') elements in these conditions.

Psychophysiological Disorders

A headache is a continuous, sustained pain located anywhere in the head or neck region. Headaches are broadly categorized into two types: primary headaches, which have no underlying medical cause (e.g., migraines, tension headaches), and secondary headaches, which are symptoms of another condition (e.g., infection, trauma).

Headache

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

Migraine

Tension-type headaches are the most commonly experienced kind of headache, accounting for about 42% of all headaches worldwide. They are characterized by relatively mild, dull, bilateral pain. In the United States, over one-third of the population experiences tension headaches each year. The primary trigger is the tightening of facial and neck muscles, often due to environmental factors like stress.

Tension-type headache

A group of headaches distinct from migraine and tension-type headaches.

* Cluster headaches: produce intense pain episodically. Symptoms are severe unilateral orbital (eye) pain lasting 15 min to 3 hr, ipsilateral autonomic symptoms such as lacrimation (tears) and nasal congestion/discharge.
* Short-lasting neuralgiform headaches: rare, severe and brief pain that occurs on one side of the head. SUNCT are associated with ipsilateral conjunctival tearing, while SUNA are also associated with nasal congestion/discharge.
* Paroxysmal hemicrania: rare, severe brief pain occurring on one side of the head, orbitofrontally.

Trigeminal autonomic cephalgias

Refers to headaches triggered by specific stimuli. Examples include: cold exposure ("ice cream headache"), external pressure on the head, or exertion of the head.

Stimulus-induced headache

A headache with sudden onset (< 1 minute) and severe pain. They can be either primary or secondary headaches.

Thunderclap headache

A type of primary headache that may begin with a viral infection but no clear cause. It occurs on a daily basis after onset for at least three months.

New daily persistent headache

A physician is reviewing the cases of four patients, all of whom are complaining of headaches. Based on the information provided, which patient is most likely experiencing a headache that is not a symptom of another underlying medical condition?

- Cardiovascular
- Gastrointestinal
- Respiratory
- Musculoskeletal
- Skin

Types of Psychophysiological Disorders

Cardiovascular disorders, which affect the heart and blood circulation system, are serious medical conditions that are central to the study of psychophysiological health. Extensive research has consistently demonstrated a strong link between these disorders and psychological factors, showing they are significantly influenced by stress and negative emotions like anger, negative affectivity, and depression.

Cardiovascular Disorders

Asthma is a chronic and serious respiratory disease characterized by the obstruction of airways, which makes it difficult to expel air from the lungs. This obstruction is a result of two primary factors: inflammation that causes the airway walls to thicken, and the tightening of muscles surrounding the airways, which leads to their narrowing. Consequently, individuals with asthma may experience recurring episodes of symptoms such as wheezing, chest tightness, shortness of breath, and coughing, which often occurs more frequently in the morning and at night.

Asthma

Tension headaches are a common psychophysiological disorder characterized by a dull, aching pain often described as a tight band around the head. Stress and other emotional factors are known to be significant triggers that can either cause or worsen these headaches.

Tension Headaches

Numerous studies have provided evidence that stress has a detrimental effect on the body's immune system, weakening its ability to function properly. This compromised immunity is a key mechanism by which stress and emotional factors can contribute to the onset or exacerbation of physical diseases, such as psychophysiological disorders.

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