It is on "The Mode of Action of Migraine Triggers: A Hypotheis"And the abstract says: Pain of migraine originates in the cortex, the immediate generator is in the brainstem.
Cortical activation induced by many different mechanisms often produce headache.
Normally there is a descending sensory inhibition from the brainstem. Triggers in most migraines produce excitation of cortical neurons. This causes withdrawal of descending sensory inhibition that originate in the brainstem.
Many brainstem nuclei seem to participate in the selective control of trigeminovascular sensation. This is through descending inhibitory mechanisms arising in the cortex. Peri-Aquiductal Gray matter and Nucleus Raphe Magnus are important here. Neurotransmitter 5-hydroxytryptamine is involved.
They summarize that cortical activation by migraine triggers (including cortical spreading depression) inhibits neuronal discharge in the brainstem. This facilitates trigeminovascular sensation.
Headache. 49(2):253-275, February 2009.Lambert, Geoffrey A. PhD; Zagami, Alessandro S. MBBS, MD
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