What Are the Four Phases of a Migraine Episode?

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In summary, migraines are often associated with severe pain, but they actually consist of four phases: prodrome, aura, headache, and postdrome. Not all migraine sufferers experience all four phases, and episodes can vary from person to person. Interestingly, some people experience aura without the accompanying headache, known as a "silent migraine." There may be a connection between allergies and migraines, as well as other triggers such as stress, hormones, and certain foods. Researchers believe that migraines may be triggered by the nervous system reacting differently to changes in the body or environment, but the exact cause is still unknown.
  • #1
zoobyshoe
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When many people think "migraine" they think only of the pain of migraine. In reality, a migraine episode consists of far more. The typical migraine episode actually consists of four parts, referred to as phases or components. It's important to note that not every migraineur experiences all four phases. Also, episodes can vary with different phases experienced during different episodes. The four phases of a migraine episode are:

* Prodrome
* Aura
* Headache
* Postdrome

http://headaches.about.com/cs/headpain101/a/anatomy_mig.htm

Here's an interesting thing to note:

As noted earlier, not all migraine episodes include all phases. Although not the majority of episodes, there are some migraine episodes in which migraineurs experience aura but no headache. There are several terms used for this experience, including "silent migraine," "sans-migraine," and "migraine equivalent."

So, interestingly enough, having a migraine attack does not necessarily mean having a headache.
 
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  • #2
Interesting, zooby. I never knew us migraine sufferers were referred to as "migraineurs" lol :rofl:.

There was a time in my life when I was crippled by migraines. A non-sufferer wouldn't undersand how they interrupt normal life.

But once I got my allergies under control, the headaches basically went away. Yet all those years I never had the classic allergy symptoms, i.e., nasal congestion, sneezing, etc.
 
  • #3
I have spring allergies, with nasal congestions and the whole nine yards, plus once in a while I will get that migraine too, but only during allergy season. I read about the aura before but never actually experienced it though, it's pretty scary.
 
  • #4
lisab said:
Interesting, zooby. I never knew us migraine sufferers were referred to as "migraineurs" lol :rofl:.
Leave it to the French!

There was a time in my life when I was crippled by migraines. A non-sufferer wouldn't undersand how they interrupt normal life.

But once I got my allergies under control, the headaches basically went away. Yet all those years I never had the classic allergy symptoms, i.e., nasal congestion, sneezing, etc.
Did you experience the four stages?
 
  • #5
lisab said:
But once I got my allergies under control, the headaches basically went away. Yet all those years I never had the classic allergy symptoms, i.e., nasal congestion, sneezing, etc.

Interesting. I'd heard about the connection for some migrane sufferers between menstrual cycle and migranes, but hadn't heard about the allergy connection. Is it common?
 
  • #6
berkeman said:
Interesting. I'd heard about the connection for some migrane sufferers between menstrual cycle and migranes, but hadn't heard about the allergy connection. Is it common?

I can't find anything in the way of a hard science paper about this. Only this sort of thing:

http://health.families.com/blog/allergies-and-migraines-linked

Allergies are not mentioned as prime suspects in discussions of Migraine cause. More often you read it being laid to genetic disposition.
 
  • #7
I had one allergy doctor tell me my headaches are not related, while another doc said definitely. Now as I take allergy shots, migraines are triggered more often.
 
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  • #8
waht said:
I had one allergy doctor tell my headaches are not related, while another doc said definitely. Now as I take allergy shots, migraines are triggered more often.

What were your allergy symptoms?
 
  • #9
zoobyshoe said:
What were your allergy symptoms?

Sneezing, running nose, watery itchy eyes, and congestion.
 
  • #10
waht said:
Sneezing, running nose, watery itchy eyes, and congestion.
And the allergy shots trigger severe headaches? What's in the allergy shots?
 
  • #11
zoobyshoe said:
And the allergy shots trigger severe headaches?

I used get migraines and nausea without the shots only during the allergy season. But with the shots it can occur any time during a year, but with less frequency as in the allergy season.

What's in the allergy shots?

I have custom prepared allergen doses, which are the actual things that the immune system responds to, and there is a plethora of those. If it works, it should reduce sensitivity of the immune system to these allergens.
 
  • #12
waht said:
I have custom prepared allergen doses, which are the actual things that the immune system responds to, and there is a plethora of those. If it works, it should reduce sensitivity of the immune system to these allergens.
So, you're essentially triggering the allergic response, which supports the alleged link between the allergy and the headaches, right?
 
  • #13
The four phases of a migraine episode are:

* Prodrome
* Aura
* Headache
* Postdrome
The most interesting thing in the sequence is that migraineurs are aware of the sequence itself.
If you know the images of a movie you may change the end and/or play it, actively.
It just means that you have some control on it: principally, headhaches which is the painful state.
 
  • #14
I had spring allergies while in graduate school (Tennessee Valley region), and would get regular migraines during allergy season. When I left the area, the allergies subsided, and so did the migraines.

Feeling the 'aura'- and there's no question what that feels like- was never a good day.
 
  • #15
Andy Resnick said:
I had spring allergies while in graduate school (Tennessee Valley region), and would get regular migraines during allergy season. When I left the area, the allergies subsided, and so did the migraines.

Feeling the 'aura'- and there's no question what that feels like- was never a good day.

Of what did your aura consist?
 
  • #16
I'd get a nasty cold every year around Christmas until I realized it was an allergy reaction to the decorated pine tree in my home.

I've had one migraine in my lifetime which occurred when I was twelve years old. That was a mighty long, long time ago. :smile:

Some scientists believe that people who get migraines have inherited a tendency for their nervous systems to react differently to changes in their bodies or their environment. Certain things may trigger a reaction in the person's nervous system and start a migraine attack.

Some common triggers are:

stress
menstruation (having a period)
skipping meals
too much caffeine (like cola drinks)
certain foods (cheese, pizza, chocolate, ice cream, fatty or fried food, lunch meats, hot dogs, yogurt, or anything with MSG, a seasoning often used in Asian foods)
too much or too little sleep
weather changes
travel

No one is really sure why people get migraines. But chances are, if you get migraines, another member of your family gets them as well. That's because scientists think migraines are genetic, which means that certain genes passed on from parents make a kid more likely to get them.
http://kidshealth.org/kid/ill_injure/aches/migraines.html#
 
  • #17
zoobyshoe said:
So, you're essentially triggering the allergic response, which supports the alleged link between the allergy and the headaches, right?

That seems to be the case. When I started this immunotherapy before spring, got a migraine three to four days after the first shot, and so for the first three weeks at same time intervals. And the shots were administered every week as well. Then later on I've been getting less migraines, and they happen very erratically.
 
  • #18
ViewsofMars said:
I've had one migraine in my lifetime which occurred when I was twelve years old.
Only once? Why do you think it was a migraine?

The basic problem may well stem from not communicating this one basic fact: A migraine is not a headache. Yes, you read that correctly. A Migraine is not a headache.

Whether you call it "Migraine,' "Migraine Disease," or "Migraine Disorder," Migraine is actually a recurrent, episodic, genetic, neurological disease. What does that mean? It means that Migraineurs have a genuine neurological disease -- all the time.

When Migraineurs have a Migraine episode or attack, the headache is just one symptom of the episode. It is not the actual episode. The point is, the term "Migraine headache" is not only incorrect, it's misleading, and may be a source of the misunderstanding of Migraine. As Migraineurs, we don't experience "Migraine headaches;" we experience "Migraine episodes" or "Migraine attacks."

http://headaches.about.com/cs/education/a/mig_not_ha.htm
 
  • #19
zoobyshoe said:
Only once? Why do you think it was a migraine?

Zoobyshoe, a licensed physician diagnosed it as a *migraine* due to the onset of my first menstrual period. (Please note previous post on p.g.1) I was flat on my back unable to do anything. It was horrible, and I won’t ever forget it even at my age (over fifty)! Apparently, that migraine that occurred in my youth was a once in a lifetime event, which is rare. As far as headaches, I should mention that I’ve only had a few. I'll leave it at that since I don’t think it wise to conduct a full blown clinical trial study on an internet forum about migraines and headaches. :smile:
 
  • #20
ViewsofMars said:
...a licensed physician diagnosed it as a *migraine* due to the onset of my first menstrual period.
I see.
 
  • #21
I've had Opthalmic Migraines, painless, with just visual images as I first described in the post below. So bizarre and beautiful. Similar to this except much more complex.

http://www.richmondeye.com/images/migraine2.jpg [Broken]

Ophthalmic migraine

I had a very weird experience earlier today. I suddenly noticed a thin glowing white crescent filled with black geometrical designs in my peripheral vision.

The only way I can explain it is if you were to take a thin glowing ring and cut it in half, keeping only the left half. It's glowing white, but is filled with portions of concentric circles and diagonal lines as if parts of triangles were visible, these are all black. The light is somehow flickering very fast, but not getting darker or brighter.

The half ring continued to grow larger, then the designs at the top started rotating to the left as the bottom designs started rotating to the right, then the designs in the middle started undulating. The entire ring started to turn clockwise very slowly.

I was very concerned, to say the least. I could tell it had to do with my vision as the half ring remained in my peripheral vision when I moved my eyes. I found online a description that might explain what I was seeing. It is called ophthalmic migraine. The ring finally drifted out of my vision after about 15 minutes, changing the entire time. When I was reading online I noticed the the letters under the "ring" were not visible at all.

It was absolutely fascinating.

Has anyone here experienced one of these or know about them?

Here is the explanation: "Ophthalmic migraine is quite common. Patients usually experience visual symptoms of seeing bright zig-zag type lines in their central or peripheral (side) vision. These bright lines may have associated flashing light sensations and sometimes can interfere with vision. There are many variations of symptoms. These symptoms usually resolve spontaneously after several minutes but usually less than one hour. Often, rest in a darkened room can be helpful during a migraine attack. Medical treatment is usually not necessary."

http://eugeneeyecare.com/conditions/..._Migraine.html [Broken]


https://www.physicsforums.com/showpost.php?p=533806&postcount=1
 
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  • #22
zoobyshoe said:
Of what did your aura consist?

Fortunately, I haven't had a migraine in years, so my memory is faulty (I mean, why would I want to remember that?)...

Going by the website you posted, I guess I am referring to both the prodrome and aura. I would get muscle stiffness in my neck (specifically, along the back of the neck) which would preceed to hypersensitivity to touch (all over) and a 'tingling sensation'... that's not exactly right, it was like I could feel the inside of my head. There was always a clear mental image of glowing light located at the locus of pain.

Ok, now I can remember... and my head hurts. I better stop now.
 
  • #23
Evo said:
I've had Opthalmic Migraines, painless, with just visual images as I first described in the post below. So bizarre and beautiful. Similar to this except much more complex.
I remember when you posted about this.

Has this happened again since then?
 
  • #24
Andy Resnick said:
Fortunately, I haven't had a migraine in years, so my memory is faulty (I mean, why would I want to remember that?)...

Going by the website you posted, I guess I am referring to both the prodrome and aura. I would get muscle stiffness in my neck (specifically, along the back of the neck) which would preceed to hypersensitivity to touch (all over) and a 'tingling sensation'... that's not exactly right, it was like I could feel the inside of my head. There was always a clear mental image of glowing light located at the locus of pain.

Ok, now I can remember... and my head hurts. I better stop now.

Do you drink coffee or tea or caffeinated soda fairly often?

When I was a kid I used to get wicked unilateral headaches now and then but they started to diminish in frequency in high school, which is also when I started drinking coffee everyday. Oliver Sacks reports in his book Migraine that caffein is sometmes the only thing that will sooth some people's migraines. I was never taken to the doctor for these headaches so I don't know if I'd have been told they were Migraine attacks, there was no prodrome or aura, but in college I made the specific association between coffee and headache relief. First I'd try an aspirin. Sometimes that worked. If it didn't I go get a coffee, and that always worked. I reccomended this to a friend who had a headache and he came back ready to kill me because the coffee had made his much worse. That made no sense to me till I read what Oliver Sacks had said, and suspected I'd been having Migraine attacks.
 
  • #25
zoobyshoe said:
I remember when you posted about this.

Has this happened again since then?
Yes, it happened again shortly after that, but not since. Very cool though. Amazing what you can see that is not there. Of course it was scary at first since I wasn't sure what was happening. I wonder why it is always recognizable geometric patterns?
 
  • #26
Evo said:
Yes, it happened again shortly after that, but not since. Very cool though. Amazing what you can see that is not there. Of course it was scary at first since I wasn't sure what was happening. I wonder why it is always recognizable geometric patterns?
Well, with a bit of googling I discovered that Oliver Sacks, himself, turns out to be a migraineur:

...But we still have only a very primitive understanding of what, to my mind, are among the most intriguing phenomena of migraine — the geometric hallucinations it so often evokes. What we can say, in general terms, is that these hallucinations reflect the minute anatomical organization, the cytoarchitecture, of the primary visual cortex, including its columnar structure — and the ways in which the activity of millions of nerve cells organizes itself to produce complex and ever-changing patterns. We can actually see, through such hallucinations, something of the dynamics of a large population of living nerve cells and, in particular, the role of what mathematicians term deterministic chaos in allowing complex patterns of activity to emerge throughout the visual cortex. This activity operates at a basic cellular level, far beneath the level of personal experience. They are archetypes, in a way, universals of human experience.

The whole article is pretty fascinating:

http://migraine.blogs.nytimes.com/2008/02/13/patterns/
 
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  • #27
Thanks for the article! I would actually like to see it again, it was that fascinating. Sure beats the painfull migraines.
 
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  • #28
Evo said:
Thanks for the article! I would actually like to see it again, it was that fascinating. Sure beats the painfull migraines.

The next article by Siri Hustvedt is also a great read, on the same subject of migraine aura:

I was lying in bed reading a book by Italo Svevo, and for some reason, looked down, and there they were: a small pink man and his pink ox, perhaps six or seven inches high. They were perfectly made creatures and, except for their color, they looked very real. They didn’t speak to me, but they walked around, and I watched them with fascination and a kind of amiable tenderness. They stayed for some minutes and then disappeared. I have often wished they would return, but they never have.

http://migraine.blogs.nytimes.com/2008/02/17/lifting-lights-and-little-people/
 
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  • #29
can you actually experience aura without the headache?
 
  • #30
waht said:
can you actually experience aura without the headache?
See the opening post.
 
  • #31
:smile:

how has this been diagnosed as a result of a migraine episode? Is it because the person experienced a lot of migraines accompanied by headaches before?
 
  • #32
waht said:
:smile:

how has this been diagnosed as a result of a migraine episode? Is it because the person experienced a lot of migraines accompanied by headaches before?
The article linked to in the OP lists common migraine auras:

# visual symptoms: flashing lights, wavy lines, spots, partial loss of sight, blurry vision
# olfactory hallucinations (smelling odors that aren't there)
# tingling or numbness of the face or extremities on the side where the headache develops.
# difficult finding words and/or speaking
# confusion
# vertigo
# partial paralysis
# auditory hallucinations
# decrease in or loss of hearing
# reduced sensation
# hypersensitivity to feel and touch

Anyone presenting with one of these symptoms would be put through a differential diagnosis by the neurologist. Any given symptom might be associated with, say, 5 different conditions. Each of those conditions, though, has other symptoms included in their sine qua non. When those other symptoms are not present that other condition can be excluded.

The list of suspects might then be reduced to say, three possible diseases. There might be tests for two of them. Testing positive for one of the two indicates that is the culprit. Testing positive for neither points the finger at the third. Treatment would be started for the most likely culprit, and the patient monitored. If the treatment works, the diagnosis would be considered accurate. If the treatment doesn't have the expected results, everything has to be reconsidered.

This procedure is carried to the extreme on just about every episode of House if you have ever had the chance to see that television program.
 
  • #33
Unusual Migrain Aura - Personal Account by Oliver Sacks

I find it to be exceptionally fortunate for anyone interested in learning about migraine that Neurologist Oliver Sacks, who is the foremost writer of popular literature on neurology, suffers from migraine himself, and also spent many years as a specialist at a clinic for migraine. His abilities as a writer, his personal and clinical experiences, and his professional training put him in a unique position to understand and articulate the condition:

While visual auras are the commonest, there may be other types. There are sometimes auditory auras in which sounds seem abnormally loud, soft, or distorted; one may hear hallucinatory tunes, as Hilary Mantel describes in her book; one may lose all sense of pitch and tone, or become unable to recognize (normally) familiar music. I have twice had such “amusic” migraine auras myself, and I have described them recently in “Musicophilia.” Here is the passage from the book:

I experienced amusia myself on two occasions, both in 1974. On the first, I was driving along the Bronx River Parkway, listening to a Chopin ballade on the radio, when a strange alteration of the music occurred. The beautiful piano tones started to lose their pitch and their character and were reduced, within a couple of minutes, to a sort of toneless banging with an unpleasant metallic reverberation, as if the ballade were being played with a hammer on sheet metal. Though I had lost all sense of melody, I had no impairment of rhythmic structure. A few minutes later, just as the piece was ending, normal tonality returned. Greatly puzzled by all of this, when I got home I phoned the radio station and asked them if this had been some sort of experiment or joke. They said no, of course not, and suggested that I get my radio checked.

A few weeks later I had a similar episode while playing a Chopin mazurka on my piano. There was again a profound loss of tone, and the music seemed to decompose into a disconcerting racket, along with an unpleasant metallic reverberation. But this time it was accompanied by a brilliant, scintillating zigzag expanding in half of my visual field—I had often experienced such zigzags during attacks of migraine. Now, it was evident, I was experiencing an amusia as part of a migraine aura. Still, when I went downstairs and spoke to my landlord, I found that my voice and his voice sounded perfectly normal. It was only music, and not speech or sound in general, that was so strangely affected.

http://migraine.blogs.nytimes.com/2008/02/26/answers-to-reader-questions/
 
  • #34
I get migraines with changes in weather (there was actually an article out on this recently confirming that weather changes can cause migraines...I was surprised nobody had figured that out sooner), and had one that lasted two days this week through a combination of weather and menstrual symptoms (those are the real killer headaches, when both triggers coincide). Ugh! I don't always get the olfactory symptoms, but this time I did...kept swearing I was smelling cigarette smoke, even in my own house where nobody is ever allowed to smoke. I also get a weird, hazy feeling starting a few hours before the headache itself kicks in.

What's interesting is that I know of plenty of people who just call any headache a migraine and don't know the difference, but an ENT gave a talk recently, and mentioned that he sees a lot of patients who think they are getting sinus headaches and when he checks them out, they have perfectly clear sinuses, and it'll turn out that they are getting migraines with the pain mostly localizing around the sinuses.
 
  • #35
Moonbear said:
I get migraines with changes in weather (there was actually an article out on this recently confirming that weather changes can cause migraines...I was surprised nobody had figured that out sooner), and had one that lasted two days this week through a combination of weather and menstrual symptoms (those are the real killer headaches, when both triggers coincide). Ugh! I don't always get the olfactory symptoms, but this time I did...kept swearing I was smelling cigarette smoke, even in my own house where nobody is ever allowed to smoke. I also get a weird, hazy feeling starting a few hours before the headache itself kicks in.

What's interesting is that I know of plenty of people who just call any headache a migraine and don't know the difference, but an ENT gave a talk recently, and mentioned that he sees a lot of patients who think they are getting sinus headaches and when he checks them out, they have perfectly clear sinuses, and it'll turn out that they are getting migraines with the pain mostly localizing around the sinuses.
Since you are a neuroscientist and also suffer from migraine I'm sure you'll be interested in the phenomenon of Cortical Spreading Depression , which has been at the center of most Migraine research for a couple decades now, but which isn't very often mentioned in popular literature for Migraineurs:

Pathophysiology of the migraine aura. The spreading depression theory.

Lauritzen M.

Laboratory of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark.

The characteristic form and development of sensory disturbances during migraine auras suggests that the underlying mechanism is a disturbance of the cerebral cortex, probably the cortical spreading depression (CSD) of Leão. The demonstration of unique changes of brain blood flow during attacks of migraine with aura, which have been replicated in animal experiments during CSD, constitutes another important line of support for the 'spreading depression' theory, which may be a key to an understanding of the migraine attack. Cortical spreading depression is a short-lasting depolarization wave that moves across the cortex at a rate of 3-5 mm/min. A brief phase of excitation heralds the reaction which is immediately followed by prolonged nerve cell depression synchronously with a dramatic failure of brain ion homeostasis, efflux of excitatory amino acids from nerve cells and enhanced energy metabolism. Recent experimental work has shown that CSD in the neocortex of a variety of species including man is dependent on activation of a single receptor, the N-methyl-D-aspartate receptor, one of the three subtypes of glutamate receptors. The combined experimental and clinical studies point to fruitful areas in which to look for migraine treatments of the future and provide a framework within which important aspects of the migraine attack can be modeled.
http://www.ncbi.nlm.nih.gov/pubmed/7908596?dopt=Abstract

This is primarily linked to the visual aura, but probably also explains other auras, such as yours, when it happens in other brain regions.

There is a lot of debate about how the CSP might be linked to the pain. Hyperexitability of the neurons of Migraineurs has been demonstrated with Transcranial Magnetic Stimulation, and that was suggested as the underlying cause of Migraine, but the most interesting abstract to catch my attention was one in which it's asserted that malformations or variants of the arterial circle of willis best explains all manifestations of the condition:

Migraine and circle of Willis anomalies.

Cucchiara B, Detre J.

Department of Neurology, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, United States. cucchiar@mail.med.upenn.edu

Several mechanisms are currently thought to contribute to migraine pathogenesis, including interictal neuronal hyperexcitability, cortical spreading depression underlying the symptom of aura, and trigeminal nerve activation at a peripheral and central level. However, these mechanistic concepts incompletely explain migraine susceptibility in individual patients and do not fully account for the well documented association between migraine and ischemic cerebrovascular disease, including increased risk of both clinical stroke and subclinical brain lesions in migraine patients. The circle of Willis is a major source of collateral blood flow supply in the human brain, and developmental morphologic variants of the circle of Willis are extremely frequent. Altered cerebral blood flow (CBF) has been demonstrated in regions supplied by variant circle of Willis vessels. Our central hypothesis is that circle of Willis anomalies correlate with alterations in cerebral hemodynamics and contribute to migraine susceptibility and ischemic complications of migraine. Dysregulation of CBF may allow relative ischemia to develop in the setting of increased metabolic demand related to neuronal hyperexcitability, may trigger cortical spreading depression, and may predispose individuals with migraine to ischemic lesions and stroke. Identification of structural alterations in the cerebral vasculature in migraine patients would have several important pathophysiological and clinical implications. First, it would provide a developmental mechanism for migraine susceptibility that may lead to further insights into genetic predisposition to migraine. Second, it would expand understanding of potential mechanisms underlying migraine aura and linking migraine with both clinical and subclinical cerebral infarction. Third, it could help to identify the subpopulation of patients at risk of progressive cerebral ischemia so as to target preventative therapies appropriately. Fourth, it would suggest a role for further diagnostic evaluation to determine migraine mechanism in individual patients, analogous to the current paradigm in ischemic stroke in which determination of stroke mechanism is critical to therapeutic decision-making.

PMID: 18226467 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/18226467?dopt=Abstract

As it says, "developmental morphologic variants of the circle of Willis are extremely frequent". I googled and found that this is, in fact the case, and that it's quite possible to be born with an incomplete circle of willis, or a grossly varied one, and that suggests to me that the genetic predisposition to a willis variant is the genetic "cause" of migraine.

The circle of willis hypothesis was also extremely exiting to me because ischemia is a well know seizure trigger and this would strongly point to willis variations as the reason for the unusually high cormorbidity of seizures and migraine, and also, therefore, could explain why predisposition to seizures tends to run in some families. I hope migraine and seizure researchers notice that paper and that people start collecting images of the circle of willis of migraineurs and idiopathic seizure sufferers to see if there's a high incidence of variant ones.

In the meantime, here's a link to a massive page of abstracts on Cortical Spreading Depression many of which go deep into chemical activities that you are in a position to fathom:

http://neurotransmitter.net/migrainecsd.html
 

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