Why Migraines Strike David W. Dodick and J. Jay Gargus Kevin Kawchak Chemistry 555 3/23/2011 “That no one dies of migraine seems, to someone deep into an attack, an ambiguous blessing.” -Joan Didion

Why Migraines Strike David W. Dodick and J. Jay Gargus Kevin Kawchak Chemistry 555 3/23/11

Triggers Four Phases of Migraines 1. Prodrome : 60% experience -Fatigue, Difficulty Concentrating 3. Headache -100% experience -Excruciating Pain, Nausea. 4. Postdrome - 70% experience -Lethargy “Zombie” phase 2. Aura : 30% experience -Visual Illusions Act as catalysts and may be controlled: Alcohol, emotional stress, behavioral state, physical exertion, dehydration, hunger, altitude, menstruation, fluorescent lights. (Most mechanisms unknown)

Scenario 1:Cortex Scenario 2:Brain Stem 1. Raphe nucleus, locus coeruleus, and periaqueductal gray behave abnormally. 2. Brain stem triggers spreading depression in cortex, activating the trigeminal system. 3. Brain stem also activates pain pathways to sensory cortex independently. 1. Cortical spreading depression triggered. 2. Trigeminal nerves activated. 3. Pain signals sent to trigeminal nucleus in brain stem. 4. Trigeminal nucleus sends signal to thalamus, relaying to sensory cortex.

Medications Controlling Triggers May be Best Approach Determining the events leading up to a migraine may help to curtail the number of headaches. Originally developed for hypertension, depression, and epilepsy. Partial inhibition of cortical spreading depression. New drugs: block ion transfer from glia cell to neurons. (Arteries) New drugs: inhibit trigeminal neurons by blocking the release of Calcitonin Gene-Related Peptide (CGRP). Triptans. Handheld magnetic stimulation: interrupts hyperexcitation. Webmd recommends logging a Headache diary to help identify and control migraines.

Why Migraines Strike David W. Dodick and J. Jay Gargus Kevin Kawchak Chemistry 555 3/23/2011

References All About Addiction: Alcohol – Blackouts, Brownouts and how they affect your body. http://www.allaboutaddiction.com/addiction/alcohol-blackouts-brownouts-and-how-they-affect-your-body (accessed March 22, 2011). AMPA Receptors get ‘pickled’: Learning and Memory. http://www.slideboom.com/presentations/543300/AMPA-receptors-get-%E2%80%98pickled%E2%80%99 Dodick, D. W.; Gargus, J. J. Why Migraines Strike. Scientific American, August 2008, pp 56-63. Kawchak, K. M.S. Thesis, Eastern Michigan University, 2012. commons.emich.edu/cgi/viewcontent.cgi?article=1753&context=theses http://www.kevinskawchak.com/Kevin%20S%20Kawchak%20Thesis%20Eastern%20Michigan%20University.pdf KRAS mutations: Tumor Growth. http://prezi.com/cfzym3j-g9ch/kras-mutations-tumor-growth/ Webmd: Migraines & Headaches Health Center. http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/media/pdf/hw/form_aa164142.pdf (accessed March 20, 2011).