Title

Major Neuroanatomical And Neurochemical Substrates Involved In Primary Headaches

Abstract

Neuroanatomical structures involved in head pain are primarily the sensory distribution of four cranial nerves: the trigeminal-and to a lesser extent, facial, glossopharyngeal, and vagus-as well as the terminations of the upper three cervical nerves.In addition, various pain sensitive cranial structures including the scalp and its blood supply, the head and neck muscles, intracranial and meningeal arteries, and dura mater including the venous sinuses are the major anatomical substrates of various types of headaches. Although brain tumors, different types of hemorrhage, hypertension, and meningitis may present as a headache, the migraine, cluster, and tension headaches are the three major types of primary headaches. Current opinion suggests a primary central nervous system activation may initiate a migraine. Several triggering factors such as disturbances of brain oxygenation and metabolism, alterations in the serotonin levels, low levels of brain tissue magnesium, altered transport of ions across the cell membrane, abnormal mitochondrial energy metabolism, and genetic abnormalities including mutations of the P/Q type calcium channel gene, Na+/K+ pump ATP1A2, or sodium channel Nav1.1 mutations have been linked to the pathogenesis of migraines. Patients with mutations in the calcium channel gene are more sensitive to environmental factors, which results in a wave of cortical spreading depression in the patient after the attack is initiated.Moreover, several recent clinical and diagnostic studies indicate a dysfunction of the brainstem periaqueductal gray matter during migraine, or initiation of migraine by activation of the brainstem including the dorsal rostral and midline pons. Consistent with this, an active locus in the posterior hypothalamus has been implicated in cluster headache (CH). The headache phase involves the activation of the trigeminovascular system and possibly dilatation of the cranial blood vessels presumably mediated by the release of vasoactive substances and neuropeptides including the calcitonin gene-related peptide (CGRP). Increased serum CGRP levels were detected during migraine and CH. In addition, in CH, there is a release of parasympathetic peptide, vasoactive intestinal peptide. Currently, inhibiting the release of vasoactive substances and neuropeptides including the CGRP or nitric oxide, or blocking their receptors in the neuroanatomical substrates of head pain is a major focus in treatment of headaches. © 2010 by Nova Science Publishers, Inc. All rights reserved.

Publication Date

12-1-2010

Publication Title

Neuroanatomy Research Advances

Number of Pages

1-58

Document Type

Article; Book Chapter

Personal Identifier

scopus

Socpus ID

84895285930 (Scopus)

Source API URL

https://api.elsevier.com/content/abstract/scopus_id/84895285930

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