Migraine attacks are of peripheral origin: the debate goes on

The Journal of Headache and Pain

Review

Thien Phu Do¹  Anders Hougaard¹  Faisal Mohammad Amin²  K. C. Brennan³  Greg Dussor⁴ 

[1] Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;Department of Neurorehabilitation/Traumatic Brain Injury, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, 10461, Bronx, NY, USA;School of Behavioral and Brain Sciences, Center for Advanced Pain Studies, University of Texas at Dallas, 75080, Richardson, TX, USA;

关键词: Headache;    Migraine with aura;    Migraine without aura;    Meningeal artery;    Peripheral;    Central;    Origin;    Premonitory;    Prodromal;    Cortical spreading depression;    Nociception;    Human models;   

DOI  :  10.1186/s10194-022-01538-1

 received in 2022-09-05, accepted in 2022-12-23,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundDespite the pervasiveness of migraine, the underlying pathophysiological mechanisms initiating migraine attacks are far from well understood and are matter of scientific debate.ObjectiveIn this narrative review, we discuss key evidence for that suggest a peripheral origin or central origin and provide directions for future studies that may provide further clarification.DiscussionMigraine pathogenesis is considered to involve the trigeminovascular system, a term that encompasses the trigeminal nerve and its axonal projections to the intracranial blood vessels. Beyond any doubt both peripheral and central mechanisms are involved in migraine pathogenesis, but an unresolved question is the how the initial activation occurs in a migraine attack. Evidence favoring a peripheral origin of migraine attacks, i.e., initial events occur outside of the blood–brain barrier, include the importance of sensitization of perivascular sensory afferents early on in a migraine attack. Evidence favoring a central origin include the occurrence of prodromal symptoms, migraine aura, and activation of structures within the central nervous system early in and during a migraine attack.ConclusionsBoth peripheral and central mechanisms are likely involved in a migraine attack, e.g., peripheral nociceptive input is necessary for pain transmission and cortical activity is necessary for pain perception. Yet, the debate of whether migraine attacks are initiated a peripheral or central site remains unresolved. The increased focus on prodromal symptoms and on the development of a human model of migraine aura will possibly provide key arguments needed to answer this question in the near future. Until then, we cannot draw firm conclusions and the debate goes on.Video linkVideo recording of the debate held at the 1st International Conference on Advances in Migraine Sciences (ICAMS 2022, Copenhagen, Denmark) is available at: https://www.youtube.com/watch?v=NC0nlcKohz0.Graphical Abstract

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 3