Expert Answer: Migraine pathophysiology

What is the difference between the vascular and neurovascular theories pertaining to migraine pathophysiology?

When doctors talk about what’s causing migraine, they’ll mention things like the vascular hypothesis, the neural theory, and the neurovascular model. Although these medical words sound pretty impressive, the words hypothesis, theory, and model tell a very clear story—doctors don’t REALLY know what they’re talking about! Even the smartest doctor knows that we’re really just learning what’s causing migraine—that’s why we have theories rather than fact. Headache doctors spend a lot of time trying to decide what are all of the important factors that cause migraine. They know that once all of the factors have been uncovered, then we really WILL know what’s causing migraine. Today, however, we just have ideas—good ideas—but ideas and theories that are still changing and evolving as we learn more and more by studying migraineurs.

Migraine sufferers often notice the blood vessels at their temples become more prominent and tender during a migraine. And migraine pain is typically described as pulsing or throbbing. This led doctors to look to the blood vessels as the cause of migraine. The blood vessel or vascular theory of migraine really began in 1937 after Drs. Graham and Wolff published an article describing an incredible experiment they conducted. Using 14 patients with migraine, they showed that injecting the drug ergotamine decreased headache pain and caused pulsations in the temple arteries to decrease by half. They could then bring back both the blood vessel pulsing AND the headache by injecting these same people with another chemical called histamine. They were also able to decrease blood vessel pulsing and headache by injecting adrenaline. These experiments linked pulsing vessels with migraine pain, starting many decades of the theory that migraine was caused by abnormally reactive blood vessels.

As doctors did more experiments with migraine sufferers, they began to wonder if there was more to the story than just excited blood vessels. Some experts argued that migraine was really caused by abnormal brain activity or an excited nervous system. These doctors pointed to changes in levels of pain chemicals in the brain and other signs of abnormal nerve functioning in migraine sufferers. After years of very heated debate about which was really the problem, the blood vessels or the brain, Dr. Moskowitz, a doctor at working at Massachusetts General Hospital and Harvard Medical School, reported animal experiments that linked changes in blood vessels and changes in activity in nerves that cause head and face pain. His work suggested both sides were right—migraine sufferers have changes in brain chemicals that result in changes in migraine symptoms AND throbbing blood vessels. The changes in the blood vessels actually occur because nerve chemicals change and signal the blood vessels to expand and become more sensitive to throbbing. This important work was the beginning of today’s neurovascular model.

The neurovascular model is the reason that some migraine therapies (like the triptans) target chemicals in the brain like serotonin and others (like some anti-seizure drugs) work to reduce brain excitability. Once brain chemicals have been correctly balanced, the brain will stop sending migraine signals, like those signals triggering blood vessels to expand.

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Comments

View Comments (22)
  • Bonnie Krisanda
    7 years ago

    nothing works forever and since I am allergic to a great deal of medications starting with NSAIDS and also including drugs like neurontin, elavil, xanax and those type of medications I am being treated with Imitrex which is a triptan. This medication does not work all the time either, I am 53 and have been suffering with migraines since I was 15 or 16. One theory that was given to me was that it was related to my menstral cycle and that it would stop when I no longer menstrated. That was also a bunch of bull. Sine I haven’t had a menstral cycle since I was 32 and had a partial hysterectomy and the other half was done in 2003 and I still get migraines. Any drastic change in the baormetric pressure will also throw me into a severe migraine. So will strong perfumes so I can’t say that I agree with the above theory at all. Guess I will just continue to suffer with migraines till the day they put me in the ground.

  • Min Kang
    7 years ago

    Thanks

  • Tonya Cramer
    7 years ago

    been dealing with migraine everyday for over 10yrs now saw the top specialist in the world no answers no one can figure what or why I have this pain everyday. when they get bad my left side shuts down–i cant speak–i had a stroke due to my migraines no medications will help the pain go away forever.

  • Karen Stanley Haack
    8 years ago

    HUH… Some people have food allergies which trigger migraines…..Find out what your allergic to and don’t eat it…..WALA no more migraines. Go see an allergist for a drug free cure.

  • Debra Nemeth
    7 years ago

    I hope KAREN…that you accept..I would like more info too. This ‘neck of the woods’ isn’t exactly the ‘best’ of the best. Thanks!

  • Debra Nemeth
    7 years ago

    lol…I sent a fb friend request to Karen also.

  • Debra Nemeth
    7 years ago

    @KAREN……The response I recieved from my pcp was “Our allergy testing isn”t all that great”…(?). Do you know what specific test(s) your daughter had done when they tested her for allergies?

  • Rita Fry
    7 years ago

    Beth, My husband just found out also he has these hemiplegic migraines We were thinking strokes until the 3rd time in the ER..They changed his B/P meds not to get rid of the headaches but the side effects of the migraine. It is so frustrating because we have been living in fear of it being a stroke and come to find out it was migraines. Take Care.

  • Elizabeth Simpson
    8 years ago

    Did she ever get a diagnosis of hemiplegic migraines? I was recently diagnosed with them and experience vision loss, paralysis, ataxia, numbness and sensitivity to light and sound as well as severe headache pain. Looking for any solutions I can. Thanks!

  • Karen Stanley Haack
    8 years ago

    We saw 4 neurologist, Endo, GI’s, FP’s,opthamologists, podiatrists, Ear Nose and Throat doctors, chiropracters, alternative therapists, e she was also having numbness and tingling which turned out to be peripherial neuropathy. Tons of C T’s, MRI’s every pill imaginable that they could try and noting worked. She also would faint and could not speak normally. She has had almost 4 years of hell before someone finally sent her to an allergist.

  • Karen Stanley Haack
    8 years ago

    Obviously there are a ton of causes for migraine headache……..The experts never mention it. For some people eliminating foods they are allergic to solves their problems…However my daughter also has to have fungal, mold and ferment free also. Plus an anti-histamin diet. It is hard to find things for her to eat…..But since these items have been eliminated she has been practically migraine free. She was having paraplegia with her migraines, fainting throwing up and vision loss. 24/7 for weeks at a time. I am just trying to help those that haven’t tried an allergist.

  • Teri Robert
    8 years ago

    This is SUCH a misconception. I have lots of food allergies, but not a single one of them is a Migraine trigger. And there is NO cure for Migraine. It’s a disease for which, at this time, there is no cure.

  • Rosette Alcantara Doyle
    8 years ago

    Great article!

  • Beth Patterson-Grinavic Kiessling
    8 years ago

    After 30 years of migraines, with more side syptoms and side effects from meds showing up every day, we no longer know what works or for how long. Doomed to repeat the old cyclicly until on to the next “old” set. A lot of the prescribed anti-seizure and migraine drugs do nothing for pain but my DRs say don’t take OTC. Then what!

  • Michele Ott
    7 years ago

    All the seizure meds make me feel like that.. Have tried multiple variants, some of them more than once. Alergic reactions to triptans including chest pains. How can so many of us have the same stories, have the same suffering, and yet no solutions? Just a series of “guesses” and well, you’ll just have to learn to live in a dark quiet room the rest of your life in bed. How much of an option is that when you have 2 kids ? Sorry again hon, mom has a headache and cant tuck you in bed.

  • Debra Nemeth
    7 years ago

    I had the ‘initial’ series…and then a 2nd series….I thought it was helping…then–I was also taking ‘gabapentin’….STOPPED the gabapentin (rx for migraines..initial use for seizures)–I was becoming so confused I thought I was losing my mind. GABAPENTIN= instant old age…(small % of people are affected by that medication)…..anyway…now that I am not taking the gabapentin…the migraines have returned full blast—even with the botox treatments. What else is there to be done?!

  • Michele Ott
    7 years ago

    I am with you. Suffered since I was 16, now 45. My latest Neuro has so far been less than empathetic, however I’ve finally convinced her to try botox injections. Pray, pray it works. Fingers crossed for you also.

  • Virginia Holmes
    8 years ago

    I get vertigo along with nausea and light sensitive and vomiting and horrible pain..is the vertigo another symptom?

  • Lily Inayat
    8 years ago

    I had cancer 13 years ago, and thats when my migraines started. When the chemo came. I’ve wondered if this was the cause….. but if you have a brain tumor, that could absolutly be causing migraines.

  • Virginia Holmes
    8 years ago

    thank you..i also have cancer and i was wondering if it was the migraines causing it or the cancer..thank you for your help..now i know its the migraines

  • Adele Schlazer Lester
    8 years ago

    For me, vertigo has been part of the prodrome for years.

  • Dr Marcus author
    8 years ago

    Knowledge is power. The more you know, the more empowered you are to manage your migraines!

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