ABSTRACT
Headache is a common human experience, diverse in its expression, complex in its manifestation, and difficult to understand by any simple mechanism. Migraine is predominantly an affliction of young people. The strong familial association and early onset of the disorder suggest that there is an important genetic component. It is important to note in terms of understanding the pathophysiology of cluster headache that vasoactive intestinal polypeptide (VIP), a marker for cranial parasympathetic nerve activation, is also elevated in cluster headache and paroxysmal hemicrania. A major cause of disability for patients, and consequently a substantial challenge for clinicians is the management of daily or near daily headache syndromes. The clinical evidence for sensitization in acute migraine is very compelling. Sensitization of the trigeminal neurons would result in increased activation of the trigeminovascular system. The trigeminovascular system provides a therapeutic target for attack treatment as it arrests the final common pathway for expression of neurovascular head pain.
