Headache pathophysiology

Editor-In-Chief: Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

The brain in itself is not sensitive to pain, because it lacks pain-sensitive nerve fibers. Several areas of the head can hurt, including a network of nerves which extend over the scalp and certain nerves in the face, mouth, and throat. The meninges and the blood vessels do have pain perception. Headaches often result from traction to or irritation of the meninges and blood vessels. The muscles of the head may similarly be sensitive to pain.

Pathophysiology

Physiology

The normal pathophysiology of cluster can be understood as follows:
vascular dilation,trigeminal nerve stimulation and histamine release.^[1]

Pathogenesis

The exact pathophysiology of cluster headache is not completely understood.

It is understood that cluster headache is caused by either vascular dilation,trigeminal nerve stimulation and histamine release.^[1]
Previously thought cluster headache was a type of vascular headache, but current proof implies that pathophysiology of cluster headache includes the brain, trigeminovascular and cranial parasympathetic system.^[2]
One of the theories of migraine pain in patients without aura is extracranial arterial dilatation.^[3]

Genetics

Genes involved in the pathogenesis of migraine include:

MTDH
LRP1
TRPM8

The development of familial hemiplegic migraine is the result of multiple genetic mutations such as:

CACNA1A
ATP1A2
SCN1A^[4]

References

↑ ^1.0 ^1.1 Weaver-Agostoni J (2013). “Cluster headache”. Am Fam Physician. 88 (2): 122–8. PMID 23939643.
↑ May A, Schwedt TJ, Magis D, Pozo-Rosich P, Evers S, Wang SJ (2018). “Cluster headache”. Nat Rev Dis Primers. 4: 18006. doi:10.1038/nrdp.2018.6. PMID 29493566.
↑ Amin FM, Asghar MS, Hougaard A, Hansen AE, Larsen VA, de Koning PJ; et al. (2013). “Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross-sectional study”. Lancet Neurol. 12 (5): 454–61. doi:10.1016/S1474-4422(13)70067-X. PMID 23578775.
↑ Andreou AP, Edvinsson L (2019). “Mechanisms of migraine as a chronic evolutive condition”. J Headache Pain. 20 (1): 117. doi:10.1186/s10194-019-1066-0. PMC 6929435 Check |pmc= value (help). PMID 31870279.

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[pmid23939643-1] 1.0 ^1.1 Weaver-Agostoni J (2013). “Cluster headache”. Am Fam Physician. 88 (2): 122–8. PMID 23939643.

[pmid29493566-2] May A, Schwedt TJ, Magis D, Pozo-Rosich P, Evers S, Wang SJ (2018). “Cluster headache”. Nat Rev Dis Primers. 4: 18006. doi:10.1038/nrdp.2018.6. PMID 29493566.

[pmid23578775-3] Amin FM, Asghar MS, Hougaard A, Hansen AE, Larsen VA, de Koning PJ; et al. (2013). “Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross-sectional study”. Lancet Neurol. 12 (5): 454–61. doi:10.1016/S1474-4422(13)70067-X. PMID 23578775.

[pmid31870279-4] Andreou AP, Edvinsson L (2019). “Mechanisms of migraine as a chronic evolutive condition”. J Headache Pain. 20 (1): 117. doi:10.1186/s10194-019-1066-0. PMC 6929435 Check |pmc= value (help). PMID 31870279.

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