Can the symptoms associated with migraine provide information on brain structures triggering the migraine attacks?

Abstract

Introduction The structures that trigger the migraine attack have been enigmatic for decades. The concepts contending that a migraine attack begins in the brainstem have been described by Burstein et al. (2012) and others stating that it starts in the cortex have been described by Goadsby et al. (2009). Purpose To determine whether the above concepts are still valid today and if migraine associated symptoms: photophobia, phonophobia, nausea and vomiting can provide us with information about brain structures triggering the migraine. Material and methods The material was synthesized proceon the basis of international articles – randomized studies, cohorts, clinical cases and others over the past 20 years and some older articles to clarify the onset of a migraine attack and concrete mechanisms „starting” this process of pain and suffering. The PubMed database was used in order to select the data from the literature. Results A possible perception of light due to intrinsically photosensitive retinal ganglion cells (ipRGCs) containing melanopsin photopigment has been identified. Noseda et al. determined that ipRGCs project directly to the thalamic neurons processing and transferring both visual and nociceptive signals to the somatosensory association cortex. The studies on phonophobia using magnetic resonance imaging (MRI) showed a significant activation of the temporal lobe and the cuneus. In the study conducted by Maniyar et al. on the pathogenesis of nausea and vomiting associated with migraine the results demonstrated the involvement of the nucleus tractus solitarius located in the brainstem. Conclusions This analysis confirmed the hypothesis that the brainstem remains to be the anatomical structure responsible for triggering the migraine in patients with a prevalence of nausea and vomiting but the cortex remains to be responsible for it's triggering in patients having photophobia and phonophobia.