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| THE PATHOPHYSIOLOGY OF MIGRAINE IN WOMEN AND MEN Rami Burstein, Ph.D., Harvard Medical School, Cambridge, Massachusetts In the US 18% of women and girls and 6% of men and boys suffer migraine attacks. This gender ratio varies with age. Before age 12 migraine is more common in boys than girls. However, after the age of puberty migraine becomes more common in women (women to men ratios range from 2:1 at age 20 to 3:1 at age 40 to 2.5:1 at age 70). While precipitating factors such as lack of sleep, hunger, stress, red wine and heat are common to both, ovulation time, menstrual cycle and pregnancies are factors known to precipitate migraine attacks of great severity, long duration and high frequencies in women only. At present time, only minimal information is available on whether and how the pathophysiology of migraine differs in women and men. Current work in our clinic is trying to address this issue by comparing men and women in regard to changes in sensory, visual, auditory, olfactory, motor, emotional and autonomic neural functions during migraine and by correlating them with factors such as pain distribution areas, periodicity, duration, severity and precipitating factors. Using repeated quantitative sensory testing before during and after migraine attack we found that different attacks are associated with temporary development of thermal and mechanical cutaneous allodynia over different parts of the body. While some migraine attacks exhibit no cutaneous allodynia, others are accompanied by cutaneous allodynia that involve different parts of the body. Affected areas may include small facial skin regions ipsilateral to the pain or large skin areas extending over the forearms bilaterally. Based on the different symptoms, the temporal and spatial changes in intracranial and extracranial pain sensation and our parallel studies in animal model of intracranial pain we propose that different classes and groups of neurons are involved in the pathophysiology of different migraine attacks. Such differentiation allows to diagnose better the source of the pain and thus, to treat it more effectively.
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