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Azulfidine (Sulfasalazine)

In spite of years of research, the exact cause of migraine remains unknown. Excessive widening of some blood vessels and narrowing, or constricting, of others play an important role in producing the pain and other unpleasant sensations associated with migraine.
Enlarging (dilation) of the blood vessels of the scalp and face causes pain by exerting pressure on nerves that lie in or around the affected arteries and veins. Narrowing of other blood vessels leads to a diminished supply of blood to various parts of the brain, and this can result in an impairment of brain function. The malfunctioning of these brain areas is reflected by the temporary neurological symptoms associated with many migraine attacks, such as numbness, weakness, or visual impairment. In persons predisposed to migraine, both biological and emotional factors can trigger this abnormal reaction of blood vessels.
Current evidence suggests that the blood vessels of individuals with migraine may simply overreact to a variety of normal stimuli, much like blushing easily when embarrassed or turning pale suddenly when frightened.
Abnormalities of blood vessel size, however, represent only part of the problem in migraine. An inflammation of the tissue around the blood vessels and the accumulation of chemical irritants in the region of the affected veins and arteries have also been detected through scientific research. One of these substances is called neurokinin and is similar to a chemical present in wasp venom.
Much of the current research on migraine focuses on a chemical substance called serotonin. Serotonin is found in a variety of tissues, including the brain, and is suspected of playing a key role in the production of the migraine syndrome. Serotonin constricts some blood vessels and dilates others.
Serotonin is a nitrogen-containing substance called an amine. Like other brain amines, such as noradrenaline, it has an important influence in determining the size of blood vessels, mood, and even sleep patterns. Very low levels of these amines, for example, may be responsible for severe depression, whereas an overabundance may result in the opposite mood, mania.
The level of serotonin in the blood drops dramatically as the migraine attack begins, and a number of medications used to control migraine have a chemical formula similar to serotonin and may substitute for serotonin when levels of it fall.
Other important chemicals of current interest are substances called prostaglandins. Prostaglandins were first thought to come from the male prostate gland but are now recognized to be present in many organs of both men and women. There are many different types of prostaglandins, and research has shown that some of them when injected into volunteers who were not migraine sufferers produced symptoms very close to those of a migraine headache.
Recently, interest has focused on blood-platelet abnormalities in migraine. The platelets are important components of the clotting mechanism, and current research has shown them to be abnormal in migraine patients.
In summary, migraine is considered a condition in which a number of biological reactions may occur throughout the entire body. The tendency for “overreactivity” may be biologically predetermined or “programmed.” Once present, this biological programming may be influenced by a variety of physiological as well as emotional triggering events that will determine the frequency, nature, and severity of the headache attack. Some authorities believe that the migraine potential represents an overactive “protective” response, in which various organ systems respond to what is perceived as a threat, either physiological or emotional. Ironically, the protective response may be more uncomfortable than the perceived threat.

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