Brainstem Buzz
This cranial nerve nucleus serves as the key relay point for the transmission of migraine pain to higher centers.
What is the spinal trigeminal nucleus?
This hypothalamic nucleus helps regulate circadian rhythms and may explain why migraines often strike at certain times of day.
What is the suprachiasmatic nucleus?
This thalamic nucleus relays facial pain information from the trigeminal system to the cortex.
What is the ventroposteromedial (VPM) nucleus?
This phenomenon, a wave of neuronal and glial depolarization, underlies migraine aura.
What is cortical spreading depression?
This midline venous sinus runs along the falx cerebri and drains into the confluence of sinuses; thrombosis here can cause elevated intracranial pressure and a severe headache.
What is the superior sagittal sinus?
This noradrenergic nucleus in the pons shows altered activity during migraine attacks.
What is the locus coeruleus?
Neurosecretory cells in the paraventricular nucleus produce this hormone, which is involved in water and sodium balance.
What is antidiuretic hormone (ADH) or vasopressin?
This nucleus, associated with memory, is also a target for DBS in medication-refractory epilepsy.
What is the anterior thalamus?
This sensory cortical area, located in the postcentral gyrus, integrates nociceptive input from the trigeminovascular system during migraine attacks.
What is the primary somatosensory cortex?
The most common venous sinus affected in idiopathic intracranial hypertension.
What is the transverse sinus?
This serotonergic nucleus in the pons contributes to migraine pathophysiology by influencing pain and vascular tone.
What is the dorsal raphe nucleus?
This nucleus produces orexins involved in the balance between wake and sleep and is the hunger/feeding center, thus implicated in altered appetite in migraine.
What is the lateral hypothalamic nucleus?
A 72-year-old patient with PMHX of stroke comes due to persistent lancinating pain in her left face, arm, and leg. Ischemia to this nucleus likely explains her symptoms.
What is the ventroposterolateral (VPL) nucleus?
Migraine-related photophobia is associated with hyperexcitability in this cortical region that receives input from the lateral geniculate nucleus.
What is the visual cortex?
This is the most specific imaging finding for patients with suspected IIH.
What is flattening of posterior sclera?
This midbrain region modulates pain and is a target of descending inhibition, often dysfunctional in migraine.
What is the periaqueductal gray?
The hypothalamus communicates with this purely sensory nucleus in the medulla that is involved in taste sensation (CN VII and CN IX afferents) and BP control (CN IX and CN X afferents), explaining migraine-associated nausea and autonomic symptoms.
What is the nucleus tractus solitarius (or dorsal vagal complex)?
This thalamic nucleus, which is involved in hearing pathways (such as Music!), may show an increase in volume in patients with migraine.
What is the medial geniculate nucleus?
The propagation of cortical spreading depression often moves across this major sulcus, separating the frontal and parietal lobes.
What is the central sulcus?
In a patient with upgaze palsy, convergence nystagmus, conjugate down-gaze, and bilateral eyelid retraction, compression of this structure, located behind the midbrain tectum, should be considered.
What is the quadrigeminal cistern?
DAILY DOUBLE!
These pontine nuclei mediate ipsilateral autonomic symptoms such as lacrimation, eyelid edema, and nasal congestion in cluster headache and TACs.
What are the superior salivatory nuclei?
Involved in heating and stimulating sympathetic neurons, lesions in this hypothalamic nucleus can lead to poikilothermia and also have a role in pain processing during migraines.
What is the posterior hypothalamic nucleus?
A neurologist sends an EEG to a migraine patient. During sleep, this structure, originating from the reticular thalamic nucleus, is seen.
What is a sleep spindle?
Palinopsia, or the persistence of images after the visual stimulus has been removed, originates from the temporo-occipital cortex and may be a side effect of this preventive migraine medication.
What is topiramate?
DOUBLE JEOPARDY!
This finding on the EEG may be indicative of increased intracranial pressure or a diffuse white matter structural process.
What is Frontal Intermittent Rhythmic Delta Activity (FIRDA)?