Conceptual divide between adaptive and pathogenetic phenomena in migraine: nausea and vomiting

Drummond and Granston (2004) believe that nausea and headache, two key symptoms of migraine, interact pathogenetically by reinforcing each other in a vicious circle during attacks. These authors elaborate upon the role of extracranial vasodilatation during optokinetic stimulation—painful as well as painless—in patients with migraine and control subjects, respectively, as an important component of the defence (flight-or-fight) response. In considering the pathogenetic role in migraine of extracranial neurovascular responses to stress, it bears emphasis that extracranial vasoconstriction —as seen in conjunctival vessels—is as frequently observed in migraine patients, as is vasodilatation (Blau and Davis, 1970). Skin pallor is commonly noted during migraine attacks (Lance and Anthony, 1971; Campbell, 1990). Elevations of plasma vasopressin sufficient to cause facial pallor have been seen in migraine attacks (Hampton et al ., 1991) and the theoretical basis for an adaptive/defensive role for vasopressin elevations in migraine with pallor as one physiological trade-off has been discussed (Gupta, 1993, 1997). Extracranial neurovascular responses to stress are …