The site of pain origin during migraine attacks

Fifty patients were examined during a migraine attack to seek the site of origin of the headache. There being no single specific test for an intra-or extracranial source of head pain, we employed a series of manoeuvres: coughing, rapid side-to-side head rotation, and breath-holding for 30 seconds--indicative of an intracranial component. Digital compression of the superficial temporal artery, and a blood pressure cuff round the head to occlude the scalp circulation, were used as evidence of an extracranial component. Patients were asked to comment on the effect each of these procedures had on their headache. The observations suggest that in 49/50 an intracranial factor was operative, and in 21 of these no extracranial component was apparent. In 28/49 there seemed to be both intra- and extracranial contributions to the headache. One patient did not respond to any test. The evidence presented seems to implicate intracranial structures in the pathogenesis of migraine headaches.