Background: Several lines of evidence have shown that trigeminal nerve plays a central role in pathogenesis of the migraine headache. In the current study we are trying to provide an effective treatment for management of migraine headache based on Switchman Hypothesis of the trigeminal nerve.
Case presentation: We hypothesized that trigeminal nerve stimulation will result in decreased number and severity of the migraine headache attacks. In this hypothesis, trigeminal nerve is like train railways that a switchman is on the way; that is why it can only transfer one neural message at once. We share the experience of two patients with chronic migraine headache who used pepper to suppress their attacks. Each patient experienced suppressed migraine headache in 72% and 87% of the attacks and the intensity of the pain was extremely lower in the rest of the attacks.
Conclusion: The Switchman Hypothesis could be an effective and safe therapeutic basis for developing targeted therapies for migraine headache and attacks. Further clinical studies are required to shed light on the issue and evaluate the safety and efficacy of different modalities.

KEYWORDS: Migraine headache; Trigeminal nerve; Switchman Hypothesis; Management; Pathophysiology