Therapy for Migraine Headaches in Nashville, TN

Migraine: What’s Happening in the Brain and Nervous System?

Migraines are more than “bad headaches.” They are a neurologic condition involving brain network excitability, sensory processing, and inflammatory pain pathways. Understanding the biology helps explain why symptoms can look different from person to person — and why targeted, receptor based neurological rehabilitation can be so effective.[1,2]

The Premonitory Phase: Why Symptoms Start Before Pain

Many people experience a premonitory or prodrome phase hours to days before head pain. Research links this early phase to changes in the hypothalamus and brainstem, which regulate sleep, stress responses, and autonomic function.[1,4–6]

That’s why early warning signs often include:

food cravings
yawning
mood shifts or irritability
fatigue or brain fog
neck stiffness

These symptoms are recognized in clinical literature as part of the migraine attack itself — not “separate issues.[4–6]

Migraine Physiology (Key Mechanisms)

Genetic + ion-transport hyperexcitability:

Migraine risk is mostly polygenic, meaning many small genetic variants combine to shape susceptibility. A significant portion of these variants affect ion-channel/ion-transport and synaptic signaling pathways, biasing cortical networks toward hyperexcitability and lowering the trigger threshold for attacks. [7,8]

Cortical spreading depolarization (CSD):

In susceptible brains, hyperexcitability can trigger cortical spreading depolarization — a slowly propagating wave of near-complete neuronal/glial depolarization across cortex. CSD is the leading mechanism for migraine aura and can initiate downstream headache pathways. [6,9–11]

Trigeminovascular + CGRP pain cascade:

The headache phase involves activation of trigeminal meningeal afferents, which release neuropeptides — especially CGRP. This drives neurogenic inflammation, tissue/vascular hypersensitivity, and pain signaling into the brainstem. [3,12,13]

Putting It Together: The Migraine Loop

Migraine is an excitability plus inflammation loop: genetic variants bias ion-channel and synaptic signaling toward hyperexcitability, neural networks flip into a vulnerable state, and trigeminal/CGRP pathways generate the attack. [3,7–9,12]

How We Help at Brain & Spine Wellness Center

Because migraines are a neurological condition, effective care often goes beyond “pain control.” Our approach focuses on the systems known to drive attacks:

Vestibular + visual network regulation (especially for dizziness, motion sensitivity, or vestibular migraine patterns)
Neck and trigeminocervical input (a frequent amplifier of migraine excitability)
Autonomic and sensory threshold retraining
Neuromodulation tools when appropriate
Vagus Nerve stimulation (including home device rentals)

If your migraines include dizziness, rocking/imbalance, visual overwhelm, or persistent post-migraine disequilibrium, we also evaluate for vestibular migraine patterns.

Ready for a Personalized Plan?

Migraines are preventable — especially when we address brain excitability, sensory thresholds, vestibular/neck triggers, and recovery capacity together.

Learn about our Precision Brain Program

References

Ashina M, et al. “Migraine: from pathophysiology to treatment.” Journal of Neurology. 2023. SpringerLink
Messina R, Filippi M. “Cerebro-cerebellar networks in migraine symptoms and headache.” Frontiers in Pain Research. 2022. Frontiers
Karsan N, et al. “The premonitory phase of migraine is due to hypothalamic dysfunction…” Journal of Headache and Pain. 2022. SpringerLink
Giffin NJ, et al. “Biological insights from the premonitory symptoms of migraine.” Nature Reviews Neurology. 2018. Nature
Maniyar FH, et al. “A phase-by-phase review of migraine pathophysiology.” Headache. 2018. Headache
Hansen JM, et al. “Genetics of migraine: complexity, implications, and potential clinical relevance.” The Lancet Neurology. 2024. ScienceDirect
Ashina M, et al. “Migraine: disease characterisation, biomarkers, and precision medicine.” The Lancet. 2021. The Lancet
Chong CD, et al. “Polygenic risk score: use in migraine research.” Journal of Headache and Pain. 2018. SpringerLink
Sutherland HG, Griffiths LR. “A comprehensive review on the role of genetic factors in migraine.” Molecular Neurobiology. 2020. SpringerLink
Dreier JP, et al. “Spreading depolarization as a therapeutic target in migraine.” Nature Reviews Neurology. 2025. Nature
Kaya Z, et al. “Spreading depolarization triggers pro- and anti-inflammatory signalling: a potential link to headache.” Brain. 2025. OUP Academic
Hougaard A, et al. “The mysterious link between migraine aura and migraine headache.” PLOS Biology. 2025. PLOS
Schulte LH, May A. “Migraine pathophysiology: Anatomy of the trigeminovascular pathway and associated mechanisms.” Neuroscience & Biobehavioral Reviews. 2013. ScienceDirect

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2424 21st Ave S Ste 202 Nashville, TN 37212