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What Is Behind the Migraines?

The role of the hypothalamus

Is that headache killing you? Or is it making you kill yourself ? Now, French researchers have connected activity in the hypothalamus nucleus of the brain to migraine attack. This area has been connected for a long time to headaches caused by physiological processes, like hunger.

The new research published in the journal "Headache" by a team from Rangueil Hospital, employed Positron Emission Tomography (PET) on 7 patients with migraine without aura, the most widespread type. Migraine had been linked to activity in the brain stem and midbrain, and a hypertrophy in some cortex zones.

This research was made in the moment of the migraine attack, on patients rushing to hospital without self-medicating, on average at three hours after the onset of the attack. These migraines were spontaneous, not artificially triggered by using chemicals.

"When you induce the attack you miss the hypothalamic activation. We suspect the hypothalamus may play a role in the start of the migraine attack. But to prove it we would need to do similar study before the start of an attack", said lead researcher Dr Marie Denuelle.

"It has been suggested for many years that the hypothalamus is involved in the early stages of migraine attacks. But there are other factors involved in the early generation of headache", said Dr Andrew Dowson, director of headache services at Kings College Hospital, London.

A hypothalamus turn on had been previously observed just in cluster headache, a much more severe condition. With attacks on a regular basis: for episodes of months annually, or daily at regular intervals in the chronic type of the condition. The attacks can be so severe that some patients committed suicide.

The role of the hypothalamus in migraines reveals why migraine drugs, like the triptans, sometimes work on easing a cluster headache attack.

Still, "the area [of the hypothalamus] reported as activated in migraine is about 10mm more anterior than the cluster headache area. The hypothalamus is not one thing but a collection of discrete neurons", warned Professor Peter Goadsby, of the Insitute of Neurology at University College London.

"Migraine is a series of systems that go wrong - a system disorder. Multiple structures are involved."