Searching for the Source of Headache Pain

Scientists have long wondered exactly where the pain in headache originates. The brain doesn't feel pain. Have you ever watched brain surgery on The Learning Channel or the Discovery Health Channel? Sometimes the patient is conscious during such surgery, yet when the surgeon touches the brain with an instrument, the patient feels no pain. Amazing.

The physical location of the pain is in the brain's protective covering, called the meninges. When a Johns Hopkins neurologist asked migraineurs where they hurt and compared their answers to a scan of their brain, the pain was located at places where the scan showed the meninges appeared to be inflamed.

Other scientists have been performing MRIs on migraineurs at the time they're experiencing an aura. How do they do that? (Sounds like a TV show, doesn't it?) One particular patient was a man who knew from long experience that vigorous exercise triggered specific symptoms, i.e. an aura, followed by a period of no symptoms, and then the headache began. Hence, the man and his wife played basketball outside the medical facility until he felt the aura was coming on. Then he ran inside to have the MRI.

This kind of testing has led scientists to the conclusion that the brain itself may be the source of headache pain. No longer do they believe abnormalities in the blood vessels of the head actually cause migraines. Now they think the problem is an electrical one which prompts the changes in the blood vessels.

Regular readers know I'm a medical writer, not a doctor or a nurse, but this is my understanding of what happens. It starts with the neurons in the brain. When they are stimulated, an inflow of sodium ions and an outflow of potassium ions occurs. The neuron then has a positive electrical charge which makes it fire off charges to other neurons. This natural process goes haywire in a migraineur, so that visual neurons are firing inefficiently and ineffectively, resulting in a wave effect. During this period of time the sodium ions over-stimulating the visual neurons is seen by the person as flashes of light, an aura.

Meanwhile, potassium ions also flood into the neurons in the meninges (that protective covering) which control pain. Those neurons, in turn, release neuropeptides which send a message of pain to the brain and also make the blood vessels dilate. Dilated blood vessels also emit pain messages to be sent to the brain by the neurons. It's a vicious cycle.

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