Introdução: Embora a migrânea seja considerada uma desordem primariamente da função cerebral, seu quadro é frequentemente acompanhado de dor e disfunções cervicais associadas, como diminuição da amplitude de movimento, pontos-gatilhos em cabeça e pescoço, diminuição do limiar de dor à pressão, bem como diminuição da força muscular e padrões alterados de atividade dos músculos da cervical. Um protocolo de fortalecimento para os flexores e extensores da cervical demonstra resultados positivos para a dor cervical crônica e melhora da atividade eletromiográfica, porém não está estabelecido se este mesmo protocolo teria efeitos em pacientes com migrânea. Objetivo: Investigar os efeitos de um protocolo de exercícios específicos para os músculos flexores e extensores da coluna cervical na força e atividade eletromiográfica em indivíduos com migrânea. Materiais e Métodos: 23 indivíduos do sexo feminino, entre 18 a 55 anos, com diagnóstico de migrânea passaram por um avaliação inicial contendo os questionários Neck Disability Index (NDI), 12 itemAllodynia Symptom Checklist (ASC-12), TAMPA questionário de Cinesiofobia e Migraine Disability Assesment (MIDAS). Após os questionários, foi avaliada a força da contração isométrica voluntária máxima (CIVM) dos flexores e extensores cervicais, tempo de pico necessário para atingir a contração, e concomitantemente, avaliada as variáveis eletromiográficas para os músculos esternocleidomastóideo, escaleno anterior, esplênio da cabeça e trapézio superior de frequência mediana e slope, além da coativação dos antagonistas. Os pacientes realizaram um protocolo de fortalecimento de oito semanas para os flexores e extensores cervicais e na nona semana, foram reavaliados.. Resultados: Não houve diferença na pontuação dos questionários NDI, ASC-12/Brasil e TAMPA pré e pós intervenção, porém houve diminuição da incapacidade gerada pela migrânea avaliado pelo questionário MIDAS (p=0,017). Foi observado aumento da força dos músculos extensores cervicais (p=0,001) e não houve diferença na força dos músculos flexores e no pico da força pré e pós intervenção. Em relação às variáveis eletromiográficas, os valores da frequência mediana foram diferentes apenas no músculo escaleno anterior pós intervenção na atividade de flexão(p=0,004). Não houve diferença para o slope em ambas as atividades de flexão e10 extensão, porém houve diminuição da coativação antagonista na tarefa de flexão (p=0,001). Conclusão: Um protocolo de fortalecimento dos flexores e extensores cervicais de oito semanas parece ter efeito na diminuição da incapacidade gerada pela migrânea, no ganho de força dos músculos extensores cervicais e na diminuição da coativação antagonista em flexão, resultando em menor atividade antagonista pós treinamento. / Introduction: Although migraine is considered a disorder primarily of brain function, its condition is often accompanied by pain and associated cervical dysfunctions, such as decreased range of motion, trigger points in the head and neck, decreased pressure pain threshold, and such as decreased muscle strength and altered patterns of cervical muscle activity. A strengthening protocol for cervical flexors and extensors demonstrates positive results for chronic neck pain and improved electromyographic activity, but it is not established whether this protocol would have effects in patients with migraine. Objective: To investigate the effects of a specific exercise protocol for the cervical spine flexor and extensor muscles on the force and electromyographic activity in individuals with migraine. Materials and methods: Twenty-three female subjects aged 18 to 55 years with a diagnosis of migraine underwent an initial evaluation containing the Neck Disability Index (NDI) questionnaire, 12 item-Allodynia Symptom Checklist (ASC-12), TAMPA questionnaire Kinesiophobia and Migraine Disability Assesment (MIDAS). After the questionnaires, the strength of the maximal voluntary isometric contraction (MVIC) of the cervical flexors and extensors, the peak time required to achieve the contraction, and the electromyographic variables for the sternocleidomastoid, anterior scalene, splenius and upper trapezoid of medium frequency and slope, besides the coactivation of the antagonists. The patients underwent an eight-week strengthening protocol for flexors and cervical extensors and in the ninth week, they were reevaluated. Results: There was no difference in the scores of the NDI, ASC-12/Brasil and TAMPA questionnaires before and after intervention, but there was a decrease in disability generated by the MIDAS questionnaire (p = 0.017). Increased cervical extensor muscle strength (p = 0.001) was observed and there was no difference in flexor muscle strength and peak pre and post intervention force. Regarding the electromyographic variables, the median frequency values were different only in the anterior scalene muscle post intervention in the flexion activity (p = 0.004). There was no difference for the slope in both flexion and extension activities, but there was decrease of the antagonistic coactivation in the flexion task (p = 0.001). Conclusion: An eight-week protocol for strengthening cervical flexors and12 extensors seems to have an effect on the decrease in the disability generated by migraine, on increase in strenght of the cervical extensor muscles and on the decrease of the antagonist coactivation in flexion, resulting in less antagonist activity post-intervention.

Neurons are specialized cells that communicate via electrical and chemical signaling. It is well-known that homeostatic mechanisms exist to potentiate neuronal output when activity falls. Likewise, while neurons rely on excitable states to function, these same excitable states must be kept in check for stable function. However, the identity of molecular factors and pathways regulating these pathways remain elusive. Chapter 2 of this thesis reports the findings from an RNA interference- and electrophysiology-based screen to identify factors necessary for the long-term maintenance of homeostatic synaptic potentiation. Data is reported to resolve a long-standing question as to the role of presynaptic Cav2-type channels in homeostatic synaptic potentiation at the Drosophila NMJ. It is shown that reduction in Cav2 channel expression and resultant activity is not sufficient to occlude homeostatic potentiation. Thus, the homeostatic block of a amino-acid substituted Cav2-type calcium channel (cacS) channel is presumed to be due to loss of a specific signaling or binding activity, but not due to overall diminishment in channel function. It is also reported that both Drosophila homologs of phospholipase Cβ (PLCβ) and its putative activator Gαq were found to be necessary for a scaling up of neurotransmitter release upon genetic ablation of glutamate receptors. These factors are canonically involved in the activation of intracellular calcium stores through the inositol trisphosphate receptor (IP3R) and the closely related ryanodine receptor (RyR). Likewise, the Drosophila homolog of Cysteine String Protein (Csp) is identified as important for long-term homeostatic potentiation. CSP has also been reported to be involved in regulation of intracellular calcium. PLCβ, Gαq, and CSP are also known to regulate Cav2-type channels directly, and this possibility, as well as others, are discussed as mechanisms underlying their roles in homeostatic potentiation. Chapter 3 of this thesis reports the extended findings from expression of a gain-of-function Cav2-type channel. The Cav2.1 channel in humans is known to cause a dominant, heritable form of migraine called familial hemiplegic migraine (FHM). Two amino-acid substitutions causative for migraine were cloned into their analogous residues of the Drosophila Cav2 homolog. Expression of these migraine-modeled channels gave rise to several forms of hyperexcitability. Hyperexcitability defects included abnormal evoked waveforms, generation of spontaneous action potential-like events, and multi-quantal release. It is shown that these forms of hyperexcitability can be mitigated through targeted down-regulation of the PLCβ-IP3R-RyR intracellular signaling pathway. Chapter 4 presents an extended discussion as to the roles for presynaptic calcium channels, PLCβ, and CSP in homeostatic synaptic potentiation, and the mechanism underlying hyperexcitability downstream of gain-of-function Cav2-type channels. The proposed model aims to bridge the involvement of the PLCβ pathway in both homeostatic potentiation and neuronal excitability. Last, the implications for these findings on human disease conditions are elucidated.

Gate control theory posits the idea that the brain and spinal cord have the ability to control the perception of pain sensation throughout the body. Biofeedback provides a proven way to teach a person how they may control their heart rate, breathing, and skin temperature. Through this process, individuals learn to lessen their migraine frequency and intensity. There are no studies to date that have measured the effectiveness of biofeedback in conjunction with medication for migraines in children despite established evidence of success in adults. In this study, an online format via SurveyMonkey was used to document the perceptions of parents with regard to the observation of their children's migraines. Pre€ and posttreatment measures were recorded to document migraine activity with implementation of biofeedback or medication using the Individualized Numeric Rating Scale. A total number of 48 participants reported about their children's migraine frequency and intensity. One group of 24 parents were asked to give information on medication only treatment, and an additional 24 parents provided information on biofeedback and medication. The data were processed using 2 mixed model (i.e., 1 within and 1 between) ANCOVAs. Although frequency and intensity of migraines decreased across both groups posttreatment, there was no statistically significant interaction between the within subject factors of time and type. In this particular data set, medication plus biofeedback was not more effective than medication alone. The implications for positive social change using the results of this study are the potential for happier, healthier, migraine free children who are more able to be productive and contribute positively to society.

Migraine, comprised of migraine with aura (MA) and migraine without aura (MO), is a painful neurovascular disease, affecting approximately 16% of the general population. It is characterised by a wide variety of symptoms including headache, nausea and vomiting, and photo- and phonophobia. The disorder is complex involving not only multiple genes, but also specific environmental factors, which can induce attacks in genetically predisposed individuals. Hyperhomocysteinaemia is a known risk factor for cerebrovascular, peripheral vascular and coronary heart disease. The Methylenetetrahydrofolate Reductase (MTHFR) enzyme is involved in homocysteine metabolism. Furthermore, it has been reported that a homozygous mutation (677C to T; Ala to Val) in the 5,10-MTHFR gene is associated with an elevation in plasma homocysteine levels (Frosst et al., 1995). This common mutation in the MTHFR gene has recently been associated with migraine with aura in a Japanese cohort (Kowa et al., 2000). The present study was designed to determine the prevalence of the MTHFR C677T mutation in Australian patients with migraine and to determine whether this mutation is associated with the disease in Caucasians. A large case-control study, consisting of 270 patients with migraine (167 with aura and 103 without aura), and 270 normal matched controls was investigated. Genotypic results indicated that the prevalence of the homozygous (T/T) genotype in migraine sufferers (15%) was higher than that of controls (9%) (P = 0.084). Furthermore, the frequency of the mutant (T/T) genotype in individuals with MA (19%) was significantly higher than in controls (9%) (P = 0.006). Interestingly, the risk of MA was ~2.5-fold higher in suffers possessing the homozygous variant (OR = 2.52, CI: 1.42 - 4.47, P = 0.0012). To confirm the MTHFR allelic association with MA, family-based tests were performed in an independent pedigrees group, where only those with MA were considered affected. Results from both the Pedigree Disequilibrium Test (PDT) and Family-Based Association Test (FBAT) analysis revealed slight, although not significant (PDT test, P = 132; and FBAT test, P = 0.390), over-transmission of the mutant allele (T) from parents to affected offspring. However, despite the MTHFR variant having a high heterozygosity (0.48), there were a limited number of informative transmissions for the MTHFR variant in the pedigree group resulting in reduced power for these tests. In conclusion, our results support the trends reported in the Japanese migraine study and suggest that the homozygous 677T gene variant causing mild hyperhomocysteinaemia, is a genetic risk factor for migraine, and indicate that further studies investigating the role of this gene are warranted. Mutations in various ion channel genes are responsible for neurovascular and other neurological disorders. Inherited ion channel mutations or "channelopathies" are increasingly found to be the cause of various neurological disorders in humans. Wittekindt and colleagues (1998) reported that the calcium-activated potassium channel (hKCa3) gene is a good candidate for schizophrenia and bipolar disorder (BD), as well as for other neurological disorders such as migraine. The hKCa3 gene is a neuronal small conductance calcium-activated potassium channel, which contains a polyglutamine tract, encoded by a polymorphic CAG repeat in the gene. The hKCa3 gene encodes a protein of 731 amino acids containing two adjacent polyglutamine sequences in its N-terminal domain separated by 25 amino acids. The C-terminal polyglutamine sequence is highly polymorphic in length (Austin et al., 1999). hKCa3 plays a critical role in determining the firing pattern of neurons via the generation of slow after-polarization pulses and the regulation of intracellular calcium channels (Kohler et al., 1996). Three distinct mutations in the a1 calcium channel gene have been shown to cause SCA-6, episodic ataxia-2 and familial hemiplegic migraine (FHM) (Ophoff et al., 1996). The hKCa3 gene contains a highly polymorphic CAG repeat that was initially mapped (Chandy et al., 1997) to a schizophrenia locus on chromosome 22 (Pulver et al., 1994). Recently Austin et al (1999) re-mapped hKCa3 and found it to reside on chromosome 1q21, a region that has been linked to FHM (Austin et al., 1999), a rare subtype of MA (Ducros et al., 1997; Gardner et al., 1998), and a region recently showing genetic linkage to typical migraine (Lea et al., 2002). The hKCa3 polymorphism results in small variations in polyglutamine number, similar to those that occur in the calcium channel a1a subunit gene (CACNA1A), which is encoded by CAG expansions and thought to cause Spinocerebellar Ataxia Type 6 via loss of channel function (Austin et al., 1999). Given the recent linkage of FHM to the region of chromosome 1q21, to which hKCa3 resides, and also linkage of typical migraine to this region, a large case-control study investigating this hKCa3 CAG marker and consisting of 270 migraine and 270 stringently matched healthy controls was undertaken. Our results indicated that there was no statistically significant difference in allele distributions for this marker between migraine and non-migraine patients (P >0.05). No significant difference in the allelic distribution was observed in the MA or MO groups when compared to controls (P >0.05) and there was no significant difference in CAG repeat length distribution between the migraine group and controls (P = 0.92), or between the MA and MO groups (P = 0.72) collectively. Hence, the CAG repeat in this gene does not show expansion in migraine. Overall, our results provide no genetic evidence to suggest that the hKCa3 CAG repeat polymorphism is involved in migraine aetiology in Australian Caucasians. Thus the involvement of the hKCa3 gene in migraine is not likely, although the hKCa3 gene remains an important candidate for other neurological disorders that may be linked to the 1q21.3 chromosomal region.

<p>Headache is the most frequently reported pain in children and is associated with missed schooldays, anxiety, depressive symptoms and various physical symptoms. A secular trend of increasing headache prevalence has been suggested. Few studies have focused on tension-type headache among children from the general population. </p><p>The aims of this thesis were to describe the prevalence, incidence and prognosis of tension-type headache, migraine and overall headache in schoolchildren, to identify medical, psychological and social factors associated with these headache types, and to determine whether the prevalence of headache has increased over the last decades.</p><p>In 1997, 1850 schoolchildren aged 7-15 years from the city of Uppsala participated in a questionnaire study and 1371 (74.1%) responded. Out of these, a randomly selected, stratified sample of 131 children and their parents were interviewed. Three years later, 122 children from the interview sample replied to an identical headache questionnaire.</p><p>Compared with a similar study in 1955, a significantly lower proportion of schoolchildren reported no headache. The prevalence of tension-type headache increased with age and was significantly higher in girls than boys after the age of twelve. Similar age and gender differences were obtained for migraine. A higher proportion of girls reported frequent headache than boys. Children with headache, especially those with migraine, as well as their first-degree relatives suffered from other pains and physical symptoms more frequently than headache-free children and their first-degree relatives. Although the likelihood of experiencing the same headache diagnosis and symptoms at follow-up was high, about one fifth of children with migraine developed tension-type headache and vice versa. Female gender was a predictor of migraine and frequent headache a predictor of overall headache at follow-up. The estimated annual incidence for tension-type headache, migraine and overall headache was 81, 65 and 131 per 1000 children, respectively. </p><p>In conclusion, the results indicate that headache has become increasingly common among schoolchildren over the last decades. Prevention and treatment of headache is particularly important for girls since they have high prevalence of headache, frequent headache episodes and a poor outcome. In children with headache, diagnoses and treatment should be reassessed regularly and other pains should be asked about and treated as well. </p>

Headache is the most frequently reported pain in children and is associated with missed schooldays, anxiety, depressive symptoms and various physical symptoms. A secular trend of increasing headache prevalence has been suggested. Few studies have focused on tension-type headache among children from the general population. The aims of this thesis were to describe the prevalence, incidence and prognosis of tension-type headache, migraine and overall headache in schoolchildren, to identify medical, psychological and social factors associated with these headache types, and to determine whether the prevalence of headache has increased over the last decades. In 1997, 1850 schoolchildren aged 7-15 years from the city of Uppsala participated in a questionnaire study and 1371 (74.1%) responded. Out of these, a randomly selected, stratified sample of 131 children and their parents were interviewed. Three years later, 122 children from the interview sample replied to an identical headache questionnaire. Compared with a similar study in 1955, a significantly lower proportion of schoolchildren reported no headache. The prevalence of tension-type headache increased with age and was significantly higher in girls than boys after the age of twelve. Similar age and gender differences were obtained for migraine. A higher proportion of girls reported frequent headache than boys. Children with headache, especially those with migraine, as well as their first-degree relatives suffered from other pains and physical symptoms more frequently than headache-free children and their first-degree relatives. Although the likelihood of experiencing the same headache diagnosis and symptoms at follow-up was high, about one fifth of children with migraine developed tension-type headache and vice versa. Female gender was a predictor of migraine and frequent headache a predictor of overall headache at follow-up. The estimated annual incidence for tension-type headache, migraine and overall headache was 81, 65 and 131 per 1000 children, respectively. In conclusion, the results indicate that headache has become increasingly common among schoolchildren over the last decades. Prevention and treatment of headache is particularly important for girls since they have high prevalence of headache, frequent headache episodes and a poor outcome. In children with headache, diagnoses and treatment should be reassessed regularly and other pains should be asked about and treated as well.

Classification of migraineur and healthy subjects using statistical pattern classifiers on functional Near Infrared Spectroscopy (NIRS) data is the main purpose of this study. Also a statistical comparison between trials that have different type of classifiers, classifier settings and feature sets is done. Features are extracted from raw light measurement data acquired with NIRS device, namely Niroxcope, during two separate previous studies, using Modified Beer-Lambert Law. After feature extraction, Na&iuml / ve Bayes classifier and k Nearest Neighbor classifier are utilized with and with-out Principal Component Analysis in separate trials. Results obtained are compared within each other using statistical hypothesis tests namely Mc Nemar and Cochran Q.

Migrena - dažnas lėtinis susirgimas, kuris daugiausiai vargina jaunus žmones. Priepuolių metu dėl skausmo ir lydinčių reiškinių yra sutrikdoma ligonių kasdienė veikla. Be to, sergantiems migrena, o ypač migrena su aura, yra 2-3 kartus padidėjusi išeminių insultų, o taip pat kitų išeminių - kraujagyslinių komplikacijų rizika. Darbo tikslas buvo laikotarpyje tarp priepuolių nustatyti moterims, sergančioms migrena su aura (MA) ir be auros (M0), ryšį su bendraisiais kardiovaskulinės rizikos veiksniais, uždegiminių žymenų specifiškumu, ląstelinės hemostazės ypatumais bei su įvairaus diametro periferinių kraujagyslių endotelio funkcijos bei standumo kitimais. Ištyrėme 60 sveikų, 30 sergančių MA ir 30 M0. M0 moterims nustatytas didesnis sistolinis ir diastolinis kraujospūdis bei hipodinamija. Neįrodytos serumo amiloido A ir C reaktyvaus baltymo sąsajos su migrenos tipais, trombocitų funkcinio aktyvumo kitimais bei su įvairaus diametro periferinių kraujagyslių standumo ar endotelio funkcijos sutrikimais. Sergančiosioms migrena buvo padidėjęs trombocitų funkcinis aktyvumas, kuris priklausė nuo migrenos formos, M0 sergančiosioms ir nuo priepuolių dažnio Migrenos grupėje endotelio funkcija buvo sutrikusi tik mikrocirkuliacijoje. MA grupėje buvo didesnė tėkmės sąlygota dilatacija nei M0. Sergančiosioms migrena nustatytas susidarančių trombocitų monocitų agregatų tiesioginis ryšys su kitimais mikrocirkuliacijoje ir atvirkštinis ryšys su endotelio funkcija smulkiosiose periferinėse... [toliau žr. visą tekstą] / Migraine is a common chronic disease that is usually suffered by young people. During the attacks due to pain and other concomitant phenomena everyday activities of the patients are interrupted. Furthermore, people with migraine, especially with migraine with aura, are subject to 2-3 bigger risk of ischaemic stroke, as well as other ischaemc-blood vessel complications. The goal of the thesis is to determine the relation between migraine with aura (MA) and without aura (M0) (in women) and common cardiovascular risk factors, particularity of inflammatory markers, particularities of cellular hemostasis, as well as changes in functionality and stiffness of endothelium of peripheral blood vessels of various diameter during period between the attacks. 60 healthy women, as well as 30 with MA and 30 with M0 participated in the research. Higher systolic and diastolic blood pressure, as well as hypodynamia was registered in the M0 group. The relation between serum amyloid A, C reactive proteine and types of migraine, changes in functional activity of platelets and changes in functionality or stiffness of endothelium of peripheral blood vessels of various diameter was not proved. Women with migraine had an increased functional activity of platelets that depended on the type of migraine, frequency of attack and was more common in women with M0. In the migraine group endothelial function was unbalanced only in microcirculation. MA group demonstrated a higher flow-induced dilation than... [to full text]

Migrän är en återkommande, anfallsvis huvudvärk som räknas till en av de 20 mest handikappande sjukdomarna i världen. Det är sjuksköterskans ansvar att främja hälsan hos patienter med migrän genom att upplysa om sjukdomen och informera om vilka icke-farmakologiska metoder som kan verka mot migrän. Syftet med studien var att beskriva icke-farmakologiska metoder vid migränanfall hos vuxna. Litteraturstudiens resultat baserades på 13 vetenskapliga artiklar som genererade tre olika teman: akupunktur, kunskap kring utlösande faktorer samt livsstilsförändringar. Resultatet visade att akupunktur, kunskap och utbildning kring utlösande faktorer samt livsstilsförändringar är bra behandlingsalternativ i det hälsofrämjande arbetet vid migrän, då metoderna visade på signifikant minskning av migränanfall. För att bevisa om metoderna är tillförlitliga behövs ytterligare forskning angående icke-farmakologiska metoder vid migrän. Utformning av riktlinjer gällande migrän och adekvata behandlingsmetoder ute i vårdverksamheten vore betydelsefullt. Utökad utbildning om migrän i sjuksköterskeutbildningarna är av stor vikt. / Migraine is a recurrent headache that occurs in periods of sudden attacks and is regarded as one of the 20 most disabling disorders in the world. It is the responsibility of the nurse to promote the health of patients with migraine by educating about migraine and by providing vital information about non-pharmacological methods that has beneficial effects on migraine. The aim of this literature study was to describe non-pharmacological methods on adult migraine patients. The result of this literature study was based on 13 scientific articles that generated three themes: acupuncture, knowledge about trigger factors and lifestyle changes. The result showed that acupuncture, knowledge about migraine triggers and lifestyle changes are favourable alternative treatments in migraine health promotion as they demonstrated significant reduction of migraine attacks. To attest its validity further research regarding the use of non-pharmacological methods on migraine is necessary. Specific guidelines regarding migraine and adequate available treatment methods in healthcare settings would be of great importance. We encourage additional education on migraine and nonpharmacological, preventive methods to be integrated in nursing schools.

Migraine, a neurovascular disorder, is associated with disturbances in brain stem activity during attacks. Interictal persistence of these disturbances might increase vulnerability to recurrent attacks of migraine. To explore this possibility, effects of motion sickness and pain on migrainous symptoms and extracranial vascular reponses were investigated in 27 migraine sufferers in the headache-free interval, and 23 healthy age/sex matched controls. Symptoms of migraine and motion sickness are remarkably similar. As both maladies involve reflexes that relay in the brain stem, they most probably share the same neural circuitry. Furthermore, migraineurs are usually susceptible to motion sickness and, conversely, motion sickness-prone individuals commonly experience migraine. Participants in the present study were exposed to optokinetic stimulation (OKS), a well-established way of inducing symptoms of motion sickness in susceptible individuals. Sensitivity to painful stimulation of the head and hand was also explored. Head pain is a hallmark of a migraine attack and cutaneous allodynia has been observed elsewhere in the body during attacks. The trigeminal nerve is associated with head pain in migraine, and trigeminal activity evokes reflexes that relay in the brain stem. To stimulate the trigeminal nerve, ice was applied to the temple. To stimulate nociceptors elsewhere in the body the participant immersed their fingers and palm in ice-water. Procedures used in this study were physically stressful and probably psychologically stressful. The impact of stress in relation to the development of symptomatic and vascular responses, particularly anticipatory stress-responses, was explored. This research involved one central experiment that consisted of six experimental conditions. On separate occasions participants were exposed to optokinetic stimulation and painful stimulation of the head or limb, individually and in combination. In migraine sufferers, symptomatic responses were enhanced during all procedures involving OKS and during temple pain after OKS, in the presence of residual motion sickness. During trigeminal stimulation independent of OKS, headache initially developed followed by nausea as the procedure progressed. In contrast, symptoms barely developed in controls during any of the six procedures except for slight dizziness, self-motion and visual-illusion during conditions involving OKS, and slight nausea when the temple was painfully stimulated during OKS and during OKS alone. Trigeminal stimulation during OKS intensified nausea and headache in migraine sufferers compared to during OKS alone or limb pain during OKS. However, the remaining symptomatic ratings were not affected by temple pain during OKS, suggesting a specific association between nausea and head pain. It may be that these cardinal symptoms compound one another during a migraine attack. Enhanced symptomatic responses in migraine sufferers during the headache interval may indicate activation of hypersensitive neural pathways that mediate symptoms of motion sickness or migraine. Migraineurs found procedures generally more unpleasant, and ice-induced pain ratings more intense and unpleasant, than controls, which may further indicate hyperexcitable nociception in this group, or a difference in their criterion of discomfort. Vascular responses, particularly during OKS alone, and during painful stimulation independent of OKS, were greater in migraine sufferers than in controls. The added stress of painful stimulation during OKS appeared to boost facial blood flow in controls to approach levels obtained in migraine sufferers. Enhanced vasodilatation was observed in migraineurs prior to painful stimulation, presumably due to anticipatory anxiety. For both groups ipsilateral vascular responses were greater than contralateral responses when the hand was painfully stimulated. During limb pain before OKS asymmetry was minimal in migraine sufferers but more apparent in controls. An enhanced stress response in migraineurs may have drawn ipsilateral and contralateral responses closer together. The development of symptoms during the procedures of this study provides an insight into how symptoms might develop sequentially in a migraine attack. Once the headache is in motion, nausea and headache may mutually exacerbate one another. In turn, trigemino-vascular responses and stress appear to be associated with the migraine crisis. Given the interactive nature of symptomatic, vascular, and stress responses, it may be more effective to target multiple, rather than individual, symptoms, in prophylactic or acute chemical and psychological interventions.