Migraine and the hypothalamus.




J Neurol Neurosurg Psychiatry

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A migraine headache can be debilitating for hours and sometimes for days. The migraine headache is considered a vascular headache, although the precise mechanism and cause remain unknown. There are several known triggers, some of which include food allergies, blood sugar disturbances, stress load, mechanical injury, and hormonal fluctuations. Treating a migraine means working with these triggers.

Migraine may be classified as migraine without aura, formerly called common migraine, or migraine with aura, formerly known as classic migraine. The differences are based upon the presence or absence of neurologic symptoms prior to the onset of headache. The aura may consist of flashing lights, or zigzag lines, or may manifest as blind spots in the vision. Some people even experience speech difficulty, tingling in the face or hands, confusion, or weakness of an arm or leg. The majority of people suffering from classic migraine have an aura that develops 10-30 minutes prior to development of the actual headache. According to recent studies, the aura is believed to be the response to a trigger that creates a neuronal depression. This may result in as much as a 25-35 percent reduction in cerebral blood flow, and is certainly enough to cause the symptoms associated with the aura. Auras are experienced by approximately 10 percent of those who have migraines.1

Recently, a small study examined the role of the hypothalamus in chronic migraines. Twenty-six patients, 17 with chronic migraine and 9 without, were recruited and required to give 13 blood samples each. The 9 healthy patients were matched for sex and age to the migraine group. Every hour for 12 hours, the levels of melatonin, prolactin, growth hormone, and cortisol were monitored. Irregular patterns were seen in the patients suffering from migraines. These abnormalities included, increased cortisol levels and decreased prolactin peak In addition there was delayed nocturnal melatonin peak, and lower concentrations of melatonin in those who also suffered insomnia. The authors concluded that actions of the hypothalamus are involved in chronic migraine and that insomnia might be an important issue relevant to the outcomes of the study.2


1. Silberstein SD, Lipton RB. Overview of diagnosis and treatment of migraine. Neurology. 1994;44(suppl 7):S6-S16.
2. Peres MF, et al. Hypothalamic involvement in chronic migraine. J Neurol Neurosurg Psychiatry. Dec 2001; 71:747-751.