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Migraine – how does it develop? [1] (1) Perception disturbances improve C Vessel wall is damaged vessel dilates aura abates cerebral cortex blood vessels neuron blood vessel nerves trigeminal nerve pain inflammation red blood cells A Increased activity of neurons increased release of inflammatory mediators inflammation Aura B Vessel walls swell due to inflammation decrease in regional blood flow in the brain perception disturbances (aura) Severe pain D Severe inflammation of the vessel wall + disturbance of the body’s own pain inhibition each pulsation = severe pain © 2013 Grünenthal GmbH Inflammation (1) modified from www.apotheken-umschau.de/Migraene. Accessed February 2013 Chronic Pain Migraine – how does it develop? [1] The development of migraine is a complex process, the mechanisms of which have only partly been clarified. The sequences described here represent the current state of knowledge in a modelled and simplified manner. C Triggering factors lead to increased activity of the neurons in the brain. Secretion of neurotransmitters and inflammatory mediators gives rise to inflammation of the blood vessels. B Aura As a result of this inflammation, blood flow in the brain temporarily decreases. The reduced blood flow appears to be a cause of perception disturbances that precede the pain. The reduced blood flow “migrates” at a rate of 3-4 mm/min from the posterior to the anterior regions of the brain – parallel with the spread of the aura in the field of vision. Perception disturbances improve As a result of damage to the vessel wall and vessel-dilating nerve impulses, the normal cerebral blood flow is restored, so that the aura abates. D Intense pain Two mechanisms are responsible for the intense pain. Firstly, pain sensors are sensitised by the inflammation of the vessels. Secondly, the body’s own pain-inhibiting system is disturbed in migraine. These mechanisms together lead to every pulsation being perceived as intense pain. © 2013 Grünenthal GmbH A Inflammation [1] Davidoff RA. Migraine: Manifestations, Pathogenesis and Management (2002) 2nd edition. Oxford: Oxford University Press 11 Migraine – how does it develop? Chronic Pain