Insufficient attention has been given to reports in the literature describing patients with symptomatic migraine who, in addition to, or instead of, the well-recognized zones of hypofusion, have zones of hyperperfusion, which can be interpreted as hypermetabolism due to neuronal activation. A new neural theory of migraine is proposed in which it is hypothesized that migraine is an electrical disease of the brain in which abnormally-functioning serotonergic pacemaker cells in the raphe nuclei inappropriately activate and inhibit wide areas of the brain. Excessive neuronal activation could cause migraine stroke by excitotoxicity and could explain the association of migraine with epilepsy. The serotonergic nuclei are positioned to mediate stress-induced migraine.
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