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These CN's and nuclei serve major functions primarily in the head and neck but also in the stomach and intestines.
CN V, the trigeminal nerve, and its nucleus, trigeminal nucleus caudalis (TNC), provide the sensory and pain nerves to the face, sinuses, and temples. CN X and its nuclei serves as the nausea and vomiting center as well as innervation to the GI tract. Finally, the TNC extends far enough down the brainstem to stimulate the upper cervical nerves (C2 and C3).
These are the most commonly activated brain structures in HA because of their close proximity to the PAG. In some cases the INA extends along the outer surface of the brain in an area called the cortex and meninges in what is called cortical spreading depression. Migraine begins as a marked increase in neuronal activity that starts deep within the brain. When this is a new, undeveloped process the neurons start in a pristine undisturbed state then abruptly escalate into an excitability and inflammatory chaos along a few select pathways. As this process is repeated the neurons fail to return to a baseline level of activity and involve many neurological pathways.
This may be confused with EM or chronic tension type headache (CTTH) but a more accurate diagnosis is transformed migraine (TM).


Arguably, the greatest advances in the treatment of head and neck pain has come with the understanding that migraine is a condition with evolving symptoms and that it is related to other headaches.
Assist Family Friendly projects and organizations with fund raising efforts by providing products and promotional events. The unified theory of headache (HA) states that all headaches originate as increased nerve activity (INA) in the center of the brain at the periaquaductal grey (PAG). The most common headaches are associated with the activation of CN's 5,10 and 11 (V,X and XI), their origins in the brain stem (called nuclei) and nerves that exit from the upper spine called spinal nerves 2 and 3 (C2,C3) as well as other deep brain stem structures. These structures are involved in sensory integration that when activated is thought to be responsible for the throbbing as well as light and sound sensitivity associated with some headache. C2 and C3 innervate the muscles at the base of the head, called the suboccipital muscles directly and via the greater and lesser occipital nerves. However, other brain structures can be activated causing somewhat less common symptoms in HA types. This increase propagates through the brain leaving neuronal inflammation and hyperexcitability in its wake. This creates a change in patient symptoms which are typically of a dull, relentless nature. This INA propagates through the brain leaving neuronal inflammation and hyperexcitability in its wake.


The most common aura is bright spots in the vision called scotomata, however it can also exist as sensing smells that are not present or tingling, numbness or even temporary paralysis. This is better treated with PT, deep tissue therapy, biofeedback, tizanidine, corticosteroids, burst phenergan or compazine with toradol, anticonvulsants, peripheral nerve blocks and Botox for migraine. The INA can advance along nerve paths or in a wave-like expansion like a stone dropped in a pond. Symptoms combine decreasing or lost features of EM with periods of face and temple pressure as well as neck, shoulder and back of the head tension. The first step in treating head and neck is determining where a patient is on this continuum and then creating a treatment plan tailored to them. As this INA flows over and through the brain and upper spinal cord it activates nerves and structures that hang off the brain and spinal cord called cranial nerves, spinal nerves and nuclei.



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