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Kid Stuff: Pain in the membrane
Fall 2019
Not all surgeries require general anesthesia. In fact, surgeons can, and often do, perform brain surgery on patients who are awake. While they cut into the brain, doctors will ask patients questions just to make sure they can move and speak properly. The brain itself has no pain receptors. 
Why, then, do people get headaches? Most of us do at some point.
First, some good news: Only about 1 percent of headaches are caused by a serious condition like a brain infection or a blood bubble in a weakened brain artery. 
Common headaches are a nuisance but easy to manage. They are often caused by tension and irritated muscles around the skull. The pain shows up in a membrane (the meninges) that lines the skull. Over-the-counter pain medications should do the trick to stop the pain. 
When it comes to migraines, an especially distracting and debilitating type of headache, the pain comes from that same membrane, explains Robert Kaniecki, associate professor of neurology at Pitt. Patients travel from as far away as Hawaii to get migraine relief at the UPMC Headache Center, which Kaniecki directs. He knows a thing or two about cranium cargo, and he keeps model brains all over his office to help patients understand what’s going on up there.
“The brain is cushioned by fluid and membranes, basically like a little water pillow,” Kaniecki says. “The edges of that water pillow are where all those nerve endings and blood vessels are. The nerve endings in the membranes start to release chemicals, and those chemicals are very irritating.” 
Blood vessels around the membrane then swell and cause the brain to become inflamed. Some people get a heads-up right before a dreaded migraine sets in.
“About 20 to 30 percent will get a warning sign. Sometimes that is a change in vision, where they see lines, lights, or a patch of blurriness. That’s called an aura,” Kaniecki says.
If you suffer from migraines, Kaniecki suggests building a strict routine of sleep, healthy and timely eating, and exercise. 
“Migraine brains don’t like change,” he says.  
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Image: Wikimedia Commons/Caricature by George Cruikshank