Migraine and The Cerebral Cortex - Part I

Nancy Harris Bonk Community Member November 14, 2012
  • In a fascinating presentation at the 54th American Headache Society Scientific Meeting this past June, Dr. Todd Schwedt said, "Migraine is a chronic disorder with episodic manifestations." It was refreshing to hear a Migraine specialist confirm this -- for quite some time it was thought that Migraine was vascular in nature. We now know it's a genetic neurological disease thought to be caused by a cascade of events and overly excited neurons in our brains.  These neurons are easily triggered by certain stimuli that include changes in the weather, hormones, dehydration, sleep issues and certain foods. Pain can be a major component of a Migraine attack, but certainly not the only one. We are just beginning to learn which areas of the brain are connected with this. In his presentation, Dr. Schwedt discussed the areas affected by Migraine, the role played by each and how Migraineurs may have different ways of processing pain compared to those who don't have the disease.

     

    In his session, The Cerebral Cortex and Migraine; Clincial Considerations, Dr. Schwedt explained the brain is so complex that there are many different "regions" involved during the pain process. He referred to these regions as the pain "matrix," including the posterior insula, amygdala, prefrontal cortex, hippocampus and temporal cortex, where each is responsible for a specific job in our body. Dr. Schwedt thinks this "matrix" may play a role in pain activation. But what do these regions, have to do with Migraine?

    • The posterior insula is responsible for the sensory discriminative part of our brains and determines the location, intensity and modality of pain. Migraineurs may have lower pain thresholds during attacks and some have lower thresholds between attacks. An interictal (between attacks) study in both episodic and chronic Migraineurs used heat (applied to the arm and forehead) to show that it took less heat to cause pain in these groups than in the non-Migraine group, indicating they may have atypical pain processing in this region. Other data shows the cortex of Migraineurs may be thicker than in non-Migraineurs.
    • The amygdala here refers to the affective motivational domain and determines our emotional response to feeling pain, fear of pain and pain avoidance. Dr. Schwedt reported he sees many Migraineurs in his practice that live in day to day fear of having a Migraine attack, which can substantially increase disability. A study using functional imaging showed when Migraineurs read pain-related words like stabbing, searing and burning, they were able to activate several regions of the pain matrix. An interesting item from the study turned up: althouth both the control and Migraine groups were able to activate these regions, the Migraine  group had greater activation of the affective motivational regions.  This may indicate that Migraineurs have a bigger emotional response when thinking about pain.
    • The prefrontal cortex is the cognitive domain when it comes to pain processing - when we expect  pain, pain memory and our attention to pain. It seems when we expect pain, it may be worse than if we weren't expecting it and we can also decrease our pain threshold for our next attack. Some Migraineurs may create a self-fulfilling prophecy (a positive or negative expectation regarding events that may affect the outcome) of pain. Dr. Schwedt reported that about 50% of Migraineurs think about Migraine even on pain-free days. The placebo and nocebo effects may come into play in this instance, in that, when we think something will happen - it probably will. Many Migraineurs have said, "I've tried every medication that any doctor has given me and nothing has worked and I don't think anything will ever work." There may be a physiological reason for this, but many times our cognitive processing may be involved. 
    • The temporal cortex refers to the integrative domain - this area helps integrate other pain domains and multisensory integration, which is the way our brain senses many things the same time. During a Migraine attack, we can experience phonophobia, photophobia and osmophobia at the same time, among other things.

     

  • Dr. Schwedt indicated in his session that Migraineurs may have overly sensitive brains that may be wired differently than people who don't have Migraines, proving once again - in my opinion - that Migraine is a disease. 

     

    In Part II, I'll talk about the remainder of Dr. Schwedt's session and the various ways we process sensory stimuli like photosensitivity, auditory and olfactory hypersensitivities in the Migraine brain.   

    _____________

    Resources:

     

    Schwedt, Todd, M.D."The Cerebral Cortex and Migraine." Platform Presentation. 54th Annual American Headache Society Scientific Meeting. June, 2012.

     

    Photo: National Institute of Mental Health. "Brain Basics."  National Institutes of Health. Last reviewed November 9, 2012.

     

    Thanks for reading and feel well, 


     

     

    Follow me on  or 

     

     

    visit my blog, Migraine and Other Headache Disorders

     

     

    © HealthCentral Network, 2012.
    Last updated November 13, 2012.

5 Comments
  • Sandra Allen
    Nov. 30, 2012

    I'm looking forward to further postings related to the AHS meeting in Arizona this year.  The focused intellect of these specialists is of such great value. Many of us have gotten some relief as a result of their research.  Many thanks!

     

    I'd like to add this to the thought regarding emotional response to pain:

    Of course migraineurs have an emotional...

    RHMLucky777

    Read More

    I'm looking forward to further postings related to the AHS meeting in Arizona this year.  The focused intellect of these specialists is of such great value. Many of us have gotten some relief as a result of their research.  Many thanks!

     

    I'd like to add this to the thought regarding emotional response to pain:

    Of course migraineurs have an emotional response to the first sign of their next episode!  You can also tell a dog that's been abused with a shovel when you pick up a shovel in their presence.

    Anyone who's experienced the agony of intractable migraine attack cannot help but feel panic at the first sign of the next one.

     

    Does that mean that we are more sensitive to pain or does that mean that the pain of chronic, intractable migraine is greatly underestimated by those who've not personally experienced it?

     

     

    • Nancy Harris Bonk
      Dec. 03, 2012

      I'm not sure Sandra. I think it may mean, according to Dr. Schwedt, that an already sensitive brain such as a Migraineurs has a lower pain threshold. 

       

      If we constantly anticipate a Migraine attack we are sort of training our brain to be "waiting for the pain" which doesn't do us any good. 

  • cking
    Nov. 29, 2012

    Hi Nancy!

     

    Thank you for the overview of the various parts of the cerebral cortex describing their various functions.  While it is disturbing to think about these "functions" going awry for migraineurs, I must also admit that it is exciting to be alive at this time in the evolution of "research" to see all of the newest information coming out of...

    RHMLucky777

    Read More

    Hi Nancy!

     

    Thank you for the overview of the various parts of the cerebral cortex describing their various functions.  While it is disturbing to think about these "functions" going awry for migraineurs, I must also admit that it is exciting to be alive at this time in the evolution of "research" to see all of the newest information coming out of clinical investigations.

     

    Many thanks to you and Teri for interpretting these various studies and results in language that we, as followers of this site, can understand and use.  I look forward to all that you and Teri learned at the conference--thank you both for attending, and for taking the time to digest and write-up the findings to share with us.

     

    All the best, Clemmie

    • Nancy Harris Bonk
      Dec. 03, 2012

      Hi Clemmie,

       

      It's so good to see you posting again, I was worried about you! Yes, the conference is a wonderful learning experience. There never seems to be enough time in the day to absorb all the information!

       

      Take care and happy holidays

      Nancy

    • cking
      Dec. 03, 2012

      Thanks, Nancy!  Happy Holidays to you as well!  I'm wishing us ALL a pain-free "spell" so that can enjoy as much as possible, of our time with family and Holiday Cheer!

       

      All the best, Clemmie  PS.  Thanks for your concern--I do not post during periods when i am feeing chronically defeated with headaches.  Frown Maybe I'm...

      RHMLucky777

      Read More

      Thanks, Nancy!  Happy Holidays to you as well!  I'm wishing us ALL a pain-free "spell" so that can enjoy as much as possible, of our time with family and Holiday Cheer!

       

      All the best, Clemmie  PS.  Thanks for your concern--I do not post during periods when i am feeing chronically defeated with headaches.  Frown Maybe I'm crazy, but I'd rather post when I have the mental energy, and can be more helpful and uplifting to others.  It amazes me that you and Teri can continue your efforts publicly despite setbacks.  Smile 

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