**Dorsolateral Pons**: The dorsolateral pons is implicated in migraine pathogenesis due to its role in the trigeminovascular network. Dysfunctional brainstem regulation here may lead to impaired regional blood flow and perimeningeal vasodilation, contributing to migraine symptoms. – *Rationale*: Harrison’s Principles of Internal Medicine (2025) and the Oxford Handbook of Neurology highlight the brainstem’s role in cranial autonomic dysfunction, which is secondary to the headache cascade. – **Circulation**: While no specific pontine circulation is uniquely tied to migraine, the posterior circulation (e.g., basilar artery) supplies the pons and may be indirectly involved in brainstem dysfunction. However, primary vascular changes are not causative but secondary to trigeminovascular activation. – *Rationale*: Vascular changes in migraine are secondary, as per Harrison’s, and not the primary driver of the headache cascade.
Context: [HarrisonPrincipleofInternalMedicine2025] studies indicate that vascular changes in migraine and cluster headache, when present, are similarly driven by these cranial auto - nomic systems. Thus, they are secondary, and not causative, events in the headache cascade. Moreover, they can often be mistaken for symptoms or signs of cranial sinus ... [pdfcoffee.com_oxford-handbook-neurology-pdf-free] produced by dysfunctional brainstem regulation of craniovascular afferents. In a genetically predisposed individual, activation of the trigeminovascular network in the dorsal midbrain and dorsolateral pons presumably causes: (a) impaired regional blood fl ow to the brain, (b) perimengeal vasodilat... [HarrisonPrincipleofInternalMedicine2025] peripheral or central nervous system (CNS) are damaged or activated inappropriately. Headache may originate from either or both mechanisms. Relatively few cranial structures are pain-producing; these include the scalp, meningeal arteries, dural sinuses, falx cerebri, and proximal segments of the lar...
Source Document: HarrisonPrincipleofInternalMedicine2025
pdfcoffee.com_oxford-handbook-neurology-pdf-free