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Migraine aura: new information on underlying mechanisms
Margarita Sánchez-del-Rio1, Uwe Reuter
1Headache Program, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain and Department of Neurology, Charité, Universitätsmedizin Berlin, Berlin, Germany. msanchezdelrio@ruberinternacional.es
Current Opinion in Neurology
|May 29, 2004
Summary
Migraine aura involves cortical spreading depression, a wave of brain activity that triggers headache pain through complex genetic and molecular pathways. Understanding these mechanisms, including gene and protein interactions, is key to developing new migraine therapies.
Area of Science:
- Neuroscience
- Genetics
- Molecular Biology
Background:
- Cortical spreading depression (CSD) is increasingly recognized as the mechanism underlying migraine aura.
- The transition from cortical aura to the headache phase involves activation of trigeminal pathways.
Purpose of the Study:
- To review the genetic and molecular mechanisms of migraine aura.
- To elucidate the link between cortical events and trigeminal activation.
Main Methods:
- Review of recent scientific literature on migraine aura.
- Analysis of genetic mutations and molecular pathways involved in CSD.
- Investigation of the connection between cortical spreading depression and trigeminal nerve activation.
Main Results:
- CSD triggers a cascade involving neurotransmitter release and gene upregulation (e.g., COX-2, TNF-alpha, IL-1beta, metalloproteinases).
- Metalloproteinase activation leads to blood-brain barrier leakage, sensitizing trigeminal afferents.
- Mutations in familial hemiplegic migraine affect the sodium/potassium pump, altering intracellular calcium levels.
Conclusions:
- Migraine aura is a complex process initiated in the cortex and leading to pain pathway activation.
- Further research is needed to fully understand the brainstem's role.
- Identifying molecular targets holds promise for novel migraine treatments.