Concluding remarks on the Capri symposium: myths, facts and new trends in migraine.

The speculative efforts of the scientists who research the atavistic enigma of the "spontaneous" aches which affect the head, nuc and neck of a great number of people, seem to be driven by the conviction that they are faced with a systemic autonomic illness rather than a local one. Pain is an obligatory phenomenon which dominates this ailment, and is more or less patently paralleled by a constellation of autonomic functions such as nausea, vomiting, vaso-constrictor dilation and arterial hypotension. An analogous vegetative constellation emerges at "cascades", that is, a stereotypical succession, following upon intense physiological (induced) pain. In a migraine attack, the autonomic hyperfunctions are the same in quality but their chronology is completely disrupted: the usual vegetative "cascade" being deeply perverted. In spite of concentric assaults by clinicians, biologists, rhythmologists and psychologists this species of medical sphynx has remained throughout the centuries. The core of the dilemma is in essence the following: are we dealing with a physiological or a pathological pain? The former (physiological pain) should be symptomatic of vascular (migraine) or psychic (muscle contraction headache) disorder; the latter (pathological) should be symptomatic of a malfunctioning of the nociceptor system.