Brain blood perfusion hypothesis for migraine, anger, and epileptic attacks.

The common physiological rationale for migraine, anger, and epileptic attacks is discussed. The potential importance of homeostatic reactions in brain blood perfusion is described. The author speculates that these attacks are induced to meet some urgent biological needs. Each attack of migraine, anger, and epilepsy results in increased regional cerebral blood flow, with hypoperfusion being shown in inter-icteric states. This hypoperfusion may also be related to cerebral ischemic disease, organic change, some critical condition, or vasoconstriction due to sympathetic hyperactivity. Migraine attack is a subacute local vasomotor response. In contrast, anger and epileptic attacks are different manifestations of acute solemn general neuropsychiatric vasomotor reflexes. The newer paradigm of the etiological integration of these three kinds of attacks based on cerebral hemodynamic change does not only explain the mechanism of seizure-producing treatments such as electroconvulsive therapy, but also indicates the significance of cerebral vasodilative demands for the particular treatment of migraine, aggressive behavior, and epileptic seizures.