Intracranial nociception

Understanding intracranial nociceptive innervation is essential to understand the pathophysiology of headaches. Our knowledge about human nociception comes from sparse observations during neurosurgical procedures performed in awake patients, anatomical studies and experimental animals. In this article we review functional organization underlying innervation. Intracranial mainly mediated by trigeminal system, except posterior cranial fossa that innervated first cervical roots. For decades, dura mater, its vessels major cerebral blood were considered as only pain-sensitive structures. Recent animal have suggested smaller brain arteries potentially pia mater might also be pain sensitive. Nociceptive neurons innervating project via ophthalmic division (V1) ganglion store several neurotransmitters including glutamate, substance P calcitonin gene-related peptide (CGRP). The ganglion, root brainstem nuclei a specific topographic somatotopy. Progressive transition between spinal nucleus dorsal horn cord, convergence inputs face, structures occipital area on so-called “trigemino-cervical complex” may explain some headache features, relations facial pain, efficacy nerve stimulation headache. anatomic primary-order neuron second-order nuclei, part various characteristics