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Now the second important thing that has come up in the last several years is the role of the trigeminal nerve. Stimulate the trigeminal nerve, the trigeminal ganglion, impulses go in the wrong direction. If you look more peripherally you see blood vessel changes. You have vasodilatation, you have edema, you have CGRP, calcitonin gene-related protein, and substance P released in the blood vessel wall. Now some of these changes – I said about vasodilatation and plasma leakage – so there is a sterile inflammation taking place in the blood vessel wall simply because of stimulation of the trigeminal neurons, sensory neurons. So if you activate the trigeminal system you have blood vessel changes. This is proven repeatedly and convincingly. These kinds of changes that take place in the blood vessel can be blocked by Imitrex-like substances. Now this seems to be mediated by serotonin receptors, all these changes. There are receptors in the blood vessels, wall. There are a bunch of receptors even in the neurons in the brainstem. Some of the newer migraine drugs that are coming out, like zolmitriptan, is a more selective serotonin blocker at the brainstem neuronal level. Whereas Imitrex is a more peripheral serotonin blocker.
When the sagittal sinus is stimulated in experimental animals, producing a brain insult, what happens is ome of the brainstem neurons light up. C-phos expression means it’s an acute change. These neurons are getting ready to fight. These kind of changes you see even in the C1 and the C2 regions, all the way down from the brainstem to C2. Some kind of non-specific insult can activate brainstem C1, C2 neurons, which includes the trigeminal system. We already saw that the activation of the trigeminal system can produce blood vessel changes. We saw some of these changes taking place in the occipital cortex spreading depression, producing aura. So these are the fragments of information available to us. Now what is the primary trigger? Maybe the whole thing comes from the hypothalamus. Sometimes when you fast you get headaches. Periods, hormonal changes can trigger headaches. All these very primary insults, stress, seem to be triggered at the hypothalamic level. For some reason, from time to time, all these other neurons act up and produce aura, produce blood vessel changes. Blood vessel changes of course still are considered to produce pain. Pain then is a protective phenomenon. So this is our understanding of migraine pathophysiology in a nutshell.
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There is some evidence that migraine may actually be an ion channel-opathy. There is an entity called hemiplegic, familial hemiplegic migraine. They have migraine, they have hemiplegia and it is familial. Now the gene for that is in the 19th chromosome. Now there are some other potassium channel diseases that are linked to the similar area on the 19th chromosome. So you have migraine on one hand, on the 19th chromosome, familial hemiplegic migraine. You’ve got some potassium channel problems linking to the same region, then you have idiopathic migraine at the other extreme. People are trying to link all this together and suggest that migraine is familial. There may be some ion that has gone wrong somewhere on some chromosome. Maybe it’s the 19th chromosome. So this is the latest thinking, explanation of why migraine is familial. This is all hot off the press. There is no proof. Canadian online pharmacy news.

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