How migraine headaches occur revealed

A new study has shed light on the cellular-level changes in nerve structure and function that may play a hand in development of migraine headaches.

According to the study by ASPS Member Surgeon Bahman Guyuron, MD, of Case Western Reserve University, Cleveland, nerve specimens from patients with migraine show abnormalities of the myelin sheath that serves as "insulation" around the nerve fibers."

The findings help to explain why a plastic surgery procedure provides effective pain relief for migraine patients-and may provide useful clues for developing new approaches to migraine treatment.

The researchers performed in-depth studies on tiny specimens of the trigeminal nerve, from 15 patients who underwent surgical treatment for migraine. Sample from 15 patients undergoing a cosmetic forehead lift procedure were studied for comparison. The study-conducted through collaboration by three independent departments at Case Western Reserve School of Medicine-included electron microscopy to assess nerve cell structure and proteomic analysis to assess the presence and function of proteins.

The results showed important differences in nerve structure between the migraine and cosmetic surgery patients. Dr. Guyuron said that the protective layer surrounding and insulating the normal nerves, called myelin, was missing or was defective on the nerves of the patients with migraine headaches.

He added that the damage to the myelin sheath may make the nerves more prone to irritation by the dynamic structure surrounding them, such as muscle and blood vessels, potentially triggering migraine attacks.

Dr Guyuron developed migraine surgery techniques after noticing that some migraine patients had reduced headache activity after cosmetic forehead-lifting, which involved removal of some muscle and vessel tissue surrounding the cranial nerves. The new study lends some important new clues for understanding the mechanisms by which migraine headaches occur. It also adds new evidence that the peripheral nerves play an important role in triggering the complex cascade of migraine attacks that ultimately involve the central nervous system.

The study is published in Plastic and Reconstructive Surgery.