Dr. Birgit Scheytt, Head of the Headache Center at the ISZ, Specialist in Neurology, Psychiatry, and Psychotherapy, University Medical Center Freiburg, Interdisciplinary Pain Center: The nerve cells in the brain do not have pain receptors themselves, but there are many structures in and around the skull that contain pain-conducting nerve fibers and cause the Perception of headaches by transmitting pain stimuli to the brain. Inside the skull, the meninges, the Dura mater and pia mater, are particularly noteworthy.

Outside the skull, there are a number of structures surrounding the head that are sensitive to pain. These include the bones, muscles, skin, sensory organs such as the eyes, nose, mouth, and so on. Peripheral nerves are located throughout these areas, whose cell nuclei lie outside the brain, but whose nerve impulses are transmitted to the brain. For example, neck tension can lead to headaches.

Some of the pain stimuli are transmitted by nerves that supply the muscles and skin, while the Trigeminal nerve is another important nerve involved in the development of headaches. This is the fifth cranial nerve, whose receptors are distributed throughout the facial skin, in the conjunctiva of the eye, and in the mucous membranes of the mouth and Nose. In addition, fine branches of this nerve branch out in the meninges. The stimulus reception converges at a junction. From there, the stimulus is transmitted to the spinal nucleus, then to the thalamus, and finally to the cerebral cortex, where it is perceived as a headache.

If, for example, bacterial meningitis is present, the painful area is directly affected, as the inflammation causes swelling and the release of various messenger substances, among other things. This in turn irritates the trigeminal nerve at its branches in the meninges. If, on the other hand, there is bleeding in the brain, for example, the pressure in the brain tissue increases the pressure on the meninges, causing pain.

In addition to these headaches caused by a brain disease, there are also headaches that are not caused by acute damage, such as tension headaches or migraines. In some cases, the entire head hurts, but the stimuli actually come from outside, such as the neck muscles or a stimulus processing disorder, and it is only through interaction with the trigeminal nerve that inflammation is felt in the meninges. The trigeminal nerve receives information from other areas and then releases messenger substances in the meninges that are similar to those released during inflammation caused by a pathogen. This ultimately leads to pain via the activation of the above-mentioned systems.

Recorded by Stefanie Flunkert