What Are Migraines?

So today we are going to talk about

migraines

. Migraines can affect up to 12% of the population. Women are more affected than men. Most people will tell you that a migraine is a headache. However, migraine sufferers will probably tell you that there is a bit of a headache. more than just a headache and we're going to get into that, we're going to talk about multiple phases that go into a migraine and there are also multiple types of

migraines

and to help us with this story we're obviously going to use some anatomical wonders to help us describe migraines , so let's get to it, let's define a real migraine.

Migraine is a complex neurological disorder that can be divided into four different phases. We will talk about each of these phases as they apply to a migraine, the first phase is called the premonetary phase and can begin up to 72 hours before the actual headache and people will experience symptoms such as fatigue, photophobia, which is sensitivity to light , irritability, sometimes depression, they may also notice that they may yawn more, have food cravings and even stiffness and certain muscles, especially in the neck, so the next question might be

what

is actually starting this phase or causing this phase and they believe that it is a real alteration in homeostasis and if you talk about homeostasis or keeping the body in balance, I have to talk about the structure called the hypothalamus, so the hypothalamus is in the central nucleus of the brain and you can see that I am tracking with the probe.

Here now some other structures that you may have heard of are something like this, the pituitary gland, which is underneath the hypothalamus and here you can see this expansion called the brainstem. If you follow it down, it becomes the spinal cord, but again we come to this structure in the central nucleus known as the hypothalamus and this thing again. is involved in homeostasis, so how is it involved in homeostasis? Well, it is the main autonomic center of the brain, therefore it takes care of certain parts of the nervous system that you don't have to think about, it is also involved in regulation and release. hormones, this is probably why women are a little more affected by migraines than men, it is also involved in the regulation of certain behaviors, also food cravings, thirst and hunger mechanisms, and even participates in the regulation of body temperature, so if we take a step back and look closely, this is

what

the hypothalamus is involved in and compare it to the pre-monitoring symptoms that we talked about about things like fatigue, cravings food, you can see the relationship between the symptoms and what the hypothalamus actually does, are there things that a person with a migraine can do that influences whether they have a migraine or not or possibly triggers a migraine and the answer is yes, the data has shown that people with migraines their brain tends to be a little more sensitive to certain environmental stimuli and they have collected a lot of data about certain environmental stimuli that are possible migraine triggers and this can be a pretty long list so buckle up belt because they think that some of these triggers are emotional stress hormones, not eating, the weather, sleep disturbances, even smells, neck pain, alcohol. bright lights smoke certain types of foods, even exercise and even sexual activity, the latter is a little unpleasant, but fortunately that list goes from most common to least common and the study we cite here only 5% of people reported that sex was the trigger, so everyone can probably still engage in safe consensual intercourse, so move on, why do we care about all this information in the conservative pre-mana phase?

Remember that you can start up to 72 hours before the headache and if you can get ahead and start the treatment even before the headache starts, the results are much better, so many times when a patient comes to the clinic with me and I talk to him about his migraine, I ask him if you can track or trace the previous three days specifically the types of foods that you ate what your mood was if you had any of these symptoms what your sleep patterns were and if you can get this information may be useful for future migraines now the problem is who doesn't No Yawn smile everyone who doesn't have food cravings so it can be a challenge but with enough information many times these migraine patients can get enough information to find their triggers and what their symptoms are in this premonitory phase and in the next phase. of a migraine is the aura phase, only about a third of people with migraines experience this phase and what is in aura and aura is a completely reversible neurological symptom and there are four types of auras that you will typically see in a migraine, the The first and most common is the actual visual aura that is blotchy or blurred vision, sometimes like small zigzag lines.

You may also get a sensory aura that produces a tingling sensation on one side of the body, usually on the upper extremity or on the side of the face, you may get language. aura which is difficulty with expression and speech and even a motor aura which is weakness on one side of the body again, sometimes you will see that in the upper limb or on the side of the face, so what is responsible for the aura phase? The theory is a hypothesis: is there something called cortical spreading depression? What is cortical spreading depression? Well, let's look at the term cortical which refers to the cortex and in this case we are going to use the brain to help us with this, so if you orient yourself towards The brain that I am tracing here is called the cerebrum and the outer surface of the brain is known as cerebral cortex and that can give us the idea of ​​cortical in depression that extends cortical, by which we mean outside. surface of the brain called the cerebral cortex now the depression that spreads, what do they mean by that?

Well, they believe that there is this depression of neurons, in other words, neurons that depolarize, which are neurons that activate and spread throughout the cerebral cortex, and they think of it almost like a drop of water and about that domino effect and because of this depression that spreads, the neurons tend to remain depolarized, which is a neuron that fires before recharging or repolarizing for longer than normal and they believe that this is responsible for the aura symptoms that just As I mentioned above , now some people might say, well, what about people who don't get the aura and the answer is that they think there may be this cortical depression happening that spreads to areas of the brain that are not under consciousness and so on?

People may still have this spreading cortical depression and they don't have the aura, they may just not notice it. Finally, we are in the third stage of migraine, which is the actual headache phase, now characterized by a throbbing and throbbing characteristic. that tends to be unilateral, some patients will have it on both sides of the head and even the back of the head, but most commonly it is unilateral. Now many patients will also experience nausea, vomiting, photophobia, which is sensitivity to light, photophobia, sensitivity to sound and Even some people become sensitive to smells, few people will have this called cutaneous allodynia, which is sensitivity to touch, as if The skin will become hypersensitive and even touching a certain area of ​​the skin will cause pain.

What is the cause of this? to do our step-by-step approach and the premonetary phase and extended cortical depression is believed to enhance or activate this trigeminal vascular system. Now some of you may have heard of this thing called the trigeminal nerve and this nerve activates in this trigeminal vascular system. system and this is going to be the cause of the pain now the trigeminal nerve why it is called the trigeminal nerve well three tri means three there are three branches that branch from the skull coming out of the brain stem and expanding over the face so a part of the branch It goes to the forehead and around the eye and that is called the ophthalmic division of the trigeminal nerve, the other one around the cheek is called the maxillary division and the third is called the mandibular division.

This nerve is sometimes called the great sensory nerve. facial nerve because everything you touch on your face reaches the brain via the trigeminal nerve, that's important for certain migraine locations, but there are some internal structures that we really need to talk about that play a key role in the pain. from a migraine, okay, so the internal structure that we want to show that the trigeminal nerve also controls is this thing called the dura mater that I'm pinching here the dura mater is a connective tissue structure that surrounds the brain and has sensation and specifically can sense pain and when the trigeminal nerve is activated during a migraine it can sensitize the nociceptors in this tissue that are pain receptors and that signal will then reach the brain and detect the pain here before going into more detail.

I just want to show you how this is wrapped, if I remove the skull here, you can see how the mat surrounds the outside of the brain as I take it out of here, now that we know the origin of the pain that comes in from the dura mater through the trigeminal nerve in the brain we have to describe well, well, why do I feel pain around the eye or the forehead or in some people in the back of the head when the stimulus is essentially coming from inside that tissue called the dura mater? a history of referred pain and to describe referred pain we have to describe neurons that converge in similar places in the brain;

For example, if I have a sensory neuron in the forehead and a neuron in the dura that goes to the same area of ​​the brain and converges on a similar nucleus within the brain that sometimes tricks the brain into thinking that the pains come from here despite that the stimulus comes from a different structure and because they converge on the same area that can cause areas of pain, say on the forehead or on the forehead. back of the head in these converging neurons and that gives you an idea of ​​why you might have different places of migraine pain, so finally Ritz, the last phase of a migraine, the last phase of a migraine is called the post phase drum and it's essentially, persistent migraine symptoms now migraines can be debilitating in part because it just hurts to do anything like turn your head, sneeze, cough and things of that nature and the next day after a migraine, many people You'll notice that oh, I turned and felt pain.

I sneezed, I had pain in that same area and the reason is something called nerve sensitization that we talked about, the trigeminal nerve in those tissues, those sensory fibers are nociceptors, they essentially become sensitized to stimuli that normally wouldn't cause pain and, again, that it's because you turn your head it can hurt or you sneeze and it can hurt now and it usually goes away after a day, but that's why you have this fourth and final phase of a migrant called post Rome, so I hope that gives you give you guys an idea or at least more details on how migraines work, let us know if you have any questions or comments below and we'll see you next time