Pathophysiology of Migraine
1
,MIGRAINE PATHOPHYSIOLOGY:
A NEUROVASCULAR HEADACHE
Objectives
Review the neurobiology of migraine
- Features of acute attack
- neuroanatomical substrates
Discuss the current understanding of migraine,
vulnerability, initiation and activation of the
trigeminocervical pain system
Describe the modulation of head pain in the CNS
2
, WHAT IS MIGRAINE?
Neurobiologically based, common clinical
syndrome characterized by recurrent episodic
attacks of head pain which serve no protective
purpose
The headache is accompanied by associated
symptoms such as nausea, sensitivity to light,
sound, or head movement
The vulnerability to migraine if for many, an
inherited tendency
Migraine is a complex neurobiological disorder that has been recognized since antiquity. Many
current books cover the subject in great detail.
The core features of migraine are headache, which is usually throbbing and often unilateral, and
associated features of nausea, sensitivity to light, sound, and exacerbation with head movement.
Migraine has long been regarded as a vascular disorder because of the throbbing nature of the
pain. However, as we shall explore here, vascular changes do not provide sufficient explanation
of the pathophysiology of migraine. Up to one-third of patients do not have throbbing pain.
Modern imaging has demonstrated that vascular changes are not linked to pain and diameter
changes are not linked with treatment.
This presentation aims to demonstrate that:
• Migraine should be regarded as neurovascular headache.
• Understanding the anatomy and physiology of migraine can enrich clinical practice.
Lance JW, Goadsby PJ. Mechanism and Management of Headache. London, England: Butterworth-Heinemann;
1998.
Silberstein SD, Lipton RB, Goadsby PJ. Headache in Clinical Practice. 2nd ed. London, England: Martin Dunitz;
2002.
Olesen J, Tfelt-Hansen P, Welch KMA. The Headaches. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins;
2000.
3
1
,MIGRAINE PATHOPHYSIOLOGY:
A NEUROVASCULAR HEADACHE
Objectives
Review the neurobiology of migraine
- Features of acute attack
- neuroanatomical substrates
Discuss the current understanding of migraine,
vulnerability, initiation and activation of the
trigeminocervical pain system
Describe the modulation of head pain in the CNS
2
, WHAT IS MIGRAINE?
Neurobiologically based, common clinical
syndrome characterized by recurrent episodic
attacks of head pain which serve no protective
purpose
The headache is accompanied by associated
symptoms such as nausea, sensitivity to light,
sound, or head movement
The vulnerability to migraine if for many, an
inherited tendency
Migraine is a complex neurobiological disorder that has been recognized since antiquity. Many
current books cover the subject in great detail.
The core features of migraine are headache, which is usually throbbing and often unilateral, and
associated features of nausea, sensitivity to light, sound, and exacerbation with head movement.
Migraine has long been regarded as a vascular disorder because of the throbbing nature of the
pain. However, as we shall explore here, vascular changes do not provide sufficient explanation
of the pathophysiology of migraine. Up to one-third of patients do not have throbbing pain.
Modern imaging has demonstrated that vascular changes are not linked to pain and diameter
changes are not linked with treatment.
This presentation aims to demonstrate that:
• Migraine should be regarded as neurovascular headache.
• Understanding the anatomy and physiology of migraine can enrich clinical practice.
Lance JW, Goadsby PJ. Mechanism and Management of Headache. London, England: Butterworth-Heinemann;
1998.
Silberstein SD, Lipton RB, Goadsby PJ. Headache in Clinical Practice. 2nd ed. London, England: Martin Dunitz;
2002.
Olesen J, Tfelt-Hansen P, Welch KMA. The Headaches. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins;
2000.
3
