To refer your patient, please go to REFERRING PHYSICIANS page (on the right of this page) and click ‘Refer a patient’.  Fill the blanks and give age and  a brief summary of your patient.  We will expedite the consultation.  Aside from the usual customary consult reply, we will communicate via e-mail address that you will provide. Try it now!

Migraine is essentially a neural event.  Migraine sufferers have hyperactive neurons capable of firing with the right triggers.  This initiates a spreading hyper-excitable front of neuron followed by a neuronal depression.  The rate of spread is slow [unlike a seizure].   As the Surface electrical discharge spreads, chemical changes occurs in the cortical surface that then is translated into activation of the nerves that surrounds the cortical blood vessels.

The resultant activation of these network of Trigeminal nerves lead to release of proteins that interacts with muscles in the walls of blood vessels resulting in relaxation.  Being oriented in a circular fashion, relaxation leads to dilatation of vessels and in the process, openings are created in the wall that allows escape of inflammatory cells outside the vessels effectively soaking the neurovascular bundle.  This starts to irritate the nerve endings that then sends electrical signals back to the Brainstem via the Trigeminal nerves.  The Electrical signals are  packaged in the Cfos structures in the brainstem and the signals continue onward cephalad to the thalamus and cortex where the brain perceives PAIN.   Along the way, critical structures are turned on; Locus Cereulus, Raphe Nuclei and hypothalamus group of nuclei are activated.  These are the Nausea centers and Autonomic centers that are responsible for the clinical nausea and vomiting that accompanies migraines and the Parasympathetic effects that causes congestion in the nasopharynx, misleading clinicians that the patient has sinus problems.

Once these important brainstem cells are activated [locus ceruleus and Raphe ] and Hypothalamus, they  are in turn capable of reactivating the Trigeminal nerve endings to release more CGRP proteins which then initiates the vicious cycling.      Overtime, these pathways takes a life on their own as they start firing automatically which explains why migraine, over time are self-fulfilling and recurring events.

The ultimate result of these recurring impulses would be a state of brainstem dysregulation and state of hypersensitized pain pathways that will then be difficult to control or quiet down.

To sign out patients for rounding, click ‘Sign-out & Discussion’ tab above

Choose  HOSPITAL (ie: Edward, CDH, GSH)

Click NEW TOPIC

Under title:  put in Date and by whom (ie:  Friday sign out from Rizwan, etc)

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