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Recent progress in migraine pathophysiology: role of cortical spreading depression and magnetic resonance imaging
Sonu Bhaskar1, Kolsoum Saeidi, Parvin Borhani
1Department of Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; University Hospital Miguel Servet, Universidad de Zaragoza, Zaragoza, Spain.
Abstract:
Migraine is characterised by debilitating pain, which affects the quality of life in affected patients in both the western and the eastern worlds. The purpose of this article is to give a detailed outline of the pathophysiology of migraine pain, which is one of the most confounding pathologies among pain disorders in clinical conditions. We critically evaluate the scientific basis of various theories concerning migraine pathophysiology, and draw insights from brain imaging approaches that have unraveled the prevalence of cortical spreading depression (CSD) in migraine. The findings supporting the role of CSD as a physiological substrate in clinical pain are discussed. We also give an exhaustive overview of brain imaging approaches that have been employed to solve the genesis of migraine pain, and its possible links to the brainstem, the neocortex, genetic endophenotypes, and pathogenetic factors (such as dopaminergic hypersensitivity). Furthermore, a roadmap is proposed to provide a better understanding of pain pathophysiology in migraine, to enable the development of strategies using leads from brain imaging studies for the identification of early biomarkers, efficient prognosis, and treatment planning, which eventually may help in alleviating some of the devastating impact of pain morbidity in patients afflicted with migraine.
Insights
Migraine pain pathophysiology involves cortical spreading depression (CSD), a key factor in understanding this neurological disorder. This research explores CSD and brain imaging to improve migraine diagnosis and treatment.
Area of Science:
- Neurology
- Neuroscience
- Pain Medicine
Background:
- Migraine is a prevalent neurological disorder causing debilitating pain and reduced quality of life globally.
- Understanding the complex pathophysiology of migraine pain is crucial for effective clinical management.
Purpose of the Study:
- To provide a comprehensive overview of migraine pain pathophysiology.
- To critically evaluate existing theories and explore the role of cortical spreading depression (CSD).
- To discuss brain imaging findings and their implications for understanding migraine genesis.
Main Methods:
- Critical evaluation of scientific literature on migraine pathophysiology.
- Analysis of brain imaging studies investigating CSD in migraine.
- Review of research on links between migraine, brainstem, neocortex, genetics, and dopaminergic hypersensitivity.
Main Results:
- Cortical spreading depression (CSD) is identified as a significant physiological substrate in migraine pain.
- Brain imaging studies reveal potential links between migraine, brainstem, neocortex, and genetic factors.
- Dopaminergic hypersensitivity is highlighted as a potential pathogenetic factor.
Conclusions:
- A deeper understanding of migraine pathophysiology, particularly CSD, is essential.
- Brain imaging studies offer valuable insights for identifying biomarkers, prognosis, and treatment strategies.
- Developing targeted interventions based on imaging findings can alleviate the impact of migraine pain.
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