What causes migraine?
Migraine can be considered as a software problem of the brain rather than a problem with the hardware. So, the brain scans which look at the structure of the brain are usually normal.
It was previously thought that migraine pain is caused by relaxation and dilatation of blood vessels. But this view has been shown to be incorrect. Two well-conducted studies have shown that there is no significant dilatation of blood vessels during migraine 1,2
Dr Maniyar and his colleagues conducted a study using special scans called PET scans which look at the function of the brain3,4,5. They have shown activation of areas that control pain in the head and neck region right at the start of the migraine attack. This is a very good indication that migraine pain is caused by changes in the function of certain key pain controlling areas. One of the important areas to be activated early on is the hypothalamus.
The hypothalamus plays a very important role in maintaining ‘constancy’ of the internal environment of the brain. The hypothalamus also plays an important role in reacting to any ‘changes’ or challenges. So, you can see why many migraine patients experience attacks whenever there is a change to their routine like lack of sleep, oversleep, stress, weather changes, menstrual periods etc.
The ‘activations’ in these key areas are likely to be mediated by chemicals. There are a few candidates. One of them called CGRP is likely to play an important role. There is good research being conducted to see if antibodies directed against CGRP may help in migraine. There are other potential chemicals also.
There are still many unanswered questions in migraine but the futures looks bright. It is time we aggressively seek to find answers for a problem that is common and affects so many people’s lives.
1. Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross-sectional study. Amin FM, Asghar MS, Hougaard A, Hansen AE, Larsen VA, de Koning PJ, Larsson HB, Olesen J, Ashina M. Lancet Neurol. 2013 May;12(5):454-61
2. Migraine headache is not associated with cerebral or meningeal vasodilatation–a 3T magnetic resonance angiography study. Schoonman GG, van der Grond J, Kortmann C, van der Geest RJ, Terwindt GM, Ferrari MD. Brain. 2008 Aug;131(Pt 8):2192-200
3. Brain activations in the premonitory phase of nitroglycerin-triggered migraine attacks. Maniyar FH, Sprenger T, Monteith T, Schankin C, Goadsby PJ. Brain. 2014 Jan;137(Pt 1):232-41
4. The origin of nausea in migraine-a PET study. Maniyar FH, Sprenger T, Schankin C, Goadsby PJ. J Headache Pain. 2014 Dec 3;15:84
5. Photic hypersensitivity in the premonitory phase of migraine–a positron emission tomography study. Maniyar FH, Sprenger T, Schankin C, Goadsby PJ. Eur J Neurol. 2014 Sep;21(9):1178-83
To make an appointment for a private consultation with Dr Maniyar, Please call at the following numbers depending on your desired hospital –
1. City of London Medical Center, Tower Hill (London Bridge Hospital branch) – +44(0)20 7234 2009
2. The London Independent Hospital (BMI), Stepney Green, London – 020 7780 2400
3. The Nuffield Brentwood Hospital, Essex – 01277 695695 ‘
Alternatively, you can call Dr Maniyar’s secretary on 07594 994675 to discuss the consultation, rates, conditions etc. Please leave a message if the phone is not answered straightaway and somebody will contact you on the same day. You can also email at email@example.com or contact Dr Maniyar directly at firstname.lastname@example.org