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Cortical spreading depression in migraine-time to reconsider?
Alan J McComas1, Adrian R M Upton1
1Department of Medicine, McMaster University, Hamilton Ontario, Canada.
Arquivos De Neuro-Psiquiatria
|July 30, 2015
Summary
New research using therapeutic transcranial magnetic stimulation (tTMS) suggests cortical spreading depression is unlikely to cause migraine. tTMS may work by stopping abnormal nerve activity in the brain.
Area of Science:
- Neuroscience
- Neurology
- Medical Physics
Background:
- Migraine pathophysiology remains incompletely understood.
- Cortical spreading depression (CSD) has been a leading hypothesis for migraine mechanisms.
- Therapeutic transcranial magnetic stimulation (tTMS) offers a novel tool to probe brain activity.
Purpose of the Study:
- To investigate the role of CSD in migraine pathophysiology using tTMS.
- To explore the potential mechanisms of tTMS in migraine treatment.
- To provide new insights into the neural basis of migraine attacks.
Main Methods:
- Application of single-pulse therapeutic transcranial magnetic stimulation (tTMS) during migraine aura or headache phases.
- Observation of instantaneous patient responses to tTMS.
- Analysis of tTMS effects on neuronal activity.
Main Results:
- Instantaneous patient responses to tTMS challenge the involvement of CSD in migraine.
- tTMS appears to modulate abnormal impulse activity in cortical pyramidal neurons.
- Evidence suggests tTMS may abolish aberrant neuronal firing patterns.
Conclusions:
- CSD is unlikely to be the primary mechanism underlying migraine.
- tTMS may exert its therapeutic effects by normalizing excessive neuronal activity.
- Further research is warranted to elucidate the precise mechanisms of tTMS in migraine.
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