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Pain mechanisms underlying vascular headaches. Progress Report 1989
M A Moskowitz1, M G Buzzi, D E Sakas
1Stroke Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
Insights
Vascular headaches involve cephalic blood vessels and sensory nerves. This review explores the trigeminovascular system, a key pathway in headache pathophysiology.
Area of Science:
- Neurology
- Vascular Biology
- Pain Research
Background:
- Vascular headaches are common neurological issues.
- Cephalic blood vessels are primary headache sources.
- Sensory nerves release neuropeptides causing vasodilation and pain.
Purpose of the Study:
- To review the trigeminovascular system's role in headache.
- To update knowledge on headache pathophysiology.
Main Methods:
- Literature review of vascular headache mechanisms.
- Analysis of the trigeminovascular system's function.
Main Results:
- The trigeminovascular system is a common pain pathway.
- This system explains pain referral and drug actions.
- It suggests local mechanisms for enhanced blood flow.
Conclusions:
- The trigeminovascular system is central to vascular headaches.
- Understanding this system clarifies headache patterns and treatments.
Abstract:
Vascular headaches are among the most prevalent yet poorly understood problems in clinical neurology. Headaches may develop in association with hypertension, seizures, stroke or without a recognizable pathophysiology such as during migraine and cluster headaches. Cephalic blood vessels (pial and dural vessels) are implicated as the most important source for all headaches and are innervated by sensory fibers which arise from ganglia innervating the forehead, scalp and neck. Sensory fibers contain vasoactive neuropeptides which become released from peripheral (perivascular) and central terminations to mediate vasodilation and pain, respectively. The presence of vascular headache implies activation of this final common pain pathway which we have termed the trigeminovascular system. The presence of vascular headache implies activation of this final common pain pathway which we have termed the trigeminovascular system. The existence of such a system a) clarifies certain pain patterns which develop following stimulation of cephalic blood vessels, b) suggests a mechanism to explain the referral of pain to the forehead, c) provides a mechanism to explain the action of certain antimigraine drugs, d) suggests a local mechanism which enhances blood flow under certain pathological conditions. Hence, this review will update existing knowledge about the trigeminovascular system and its role in headache pathophysiology.