Reasons for presenting to the ED include sudden onset of headache, worse headache, first headache, severe headache, prolonged headache episode, and questions regarding diagnosis. The pathophysiology of the migraine headache syndrome is not fully understood. Migraines can be triggered by a large number of stimuli including diet, sleep changes, weather changes, and hormonal changes.
Sleep is effective in aborting many migraines.
The trigeminovascular system has been researched extensively in understanding the pathophysiology and treatment of migraine headache. The trigeminal nerve responds to brain insults such as ischemia, toxins, orientrensic disease with the perception of pain. An understanding of the complex interactions of the trigeminovascular system affords an opportunity to better understand the migraine syndrome. The trigeminal nerve can be stimulated by both electrical and chemical activators including prostaglandins, serotonin, and histamines. Migraine triggers work either to directly alter these chemical mediators or through neural mediators.