Overview

Pathophysiology

The pain incurred during a migraine is due to activation of trigeminal afferents that innervate the meninges.

This causes release of vasoactive neuropeptides, including substance P and calcitonin gene-relatede peptide (CGRP), which results in neurogenic inflammation due to vasodilation and plasma protein extravasation.

Neuronal sensitization also occurs, causing the central nociceptive pathways to become more sensitive to both painful and nonpainful stimulation.

• complex, partly due to dysregulation of serotonergic control of cerebral blood vessels
• during migraines there is a relative deficiency of neuroactive serotonin which results in cerebral vasodilation;
• between attacks, there is often an excess of serotonin

Thus, as a general rule 5-HT receptor agonists are used in the acute treatment of migraine whilst 5-HT receptor antagonists are used in prophylaxis.

Triggers - CHOCOLATE

Ch – Chocolate/Cheese

O – Oral contraceptive

C – caffeine (or withdrawal)

Ol – alcohol

T – travel

E – exercise

Food that might trigger Migraine

• Wine, particularly red wine