Dopaminergic hypersensitivity in migraine: clinical and genetic evidence

Migraine is a common disorder characterized by recurrent pain attacks of mild-severe intensity associated with autonomic and occasionally neurological symptoms. The migraine attack is a complex process that involves both central and peripheral structures. Various pathogenetic hypotheses have been proposed but the pathophysiology of the disease is still unknown. The study of the pathophysiology of migraine includes the investigation of neurotransmitter systems and their potential role in the development of the attack. Several studies performed since the '60s have demonstrated the key role of serotonin. The theory whereby hypersensitivity of the dopaminergic system may be involved in the pathogenesis of migraine has been supported by various authors on the basis of clinical, pharmacological and recent genic evidence. Recent neurophysiological studies performed using new techniques have led to a correlation of migraine with central nervous system disorders characterized by an altered neuronal excitability. Migraine seems to be characterized by a low threshold of neuronal excitability which is in turn regulated by genetic factors involving the dopaminergic system. A genetically determined hypersensitivity of the dopaminergic system may be involved in the onset of the migraine attack.