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Migraines may start in brain stem

Scientists say they might have located the source of migraine headaches, a finding that suggests a new target for drugs to stop the attacks that strike some 16-million Americans.

Brain scans of nine migraine patients, studied within six hours of the start of migraine attacks, showed persistent overactivity in a structure called the brain stem at the base of the brain. The scans revealed a possible migraine "generator" at the point where the brain stem joins the mid-brain, said Dr. Hans Christoph Diener.

Attacks might result from the generator's losing normal control over brain stem centers that regulate perception of pain and the expanding and contracting of blood vessels. Overactivity in those centers might in turn lead to migraine symptoms, said Diener, chairman of the neurology department at the University of Essen in Germany.

The generator "continues firing even when the headache is gone," he said. That fits in with what many patients say, that even after the pain is gone they still feel tired and "they somehow know that the attack is not over," he said.

The work suggests looking for new anti-migraine drugs that not only relieve the pain but also suppress the generator to cut off migraine attacks at the root.

The brain scanning results might be the first direct look at this migraine generator in humans, Diener and colleagues report in the July issue of Nature Medicine.

The scanning results showed overactivity in several brain centers before the patients received an injection of the anti-migraine medicine sumatriptan. Once the drug relieved symptoms, only the brain stem overactivity continued, researchers said.

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