A Phase-by-Phase Review of Migraine Pathophysiology

Area of Science:

• Neurology
• Neuroscience
• Pathophysiology

Background:

• Migraine is a common and disabling neurological disorder.
• It is characterized by multiple distinct phases: premonitory, aura, headache, postdrome, and interictal.
• Understanding the pathophysiology of each phase is crucial for effective treatment.

Purpose of the Study:

• To provide an update on the prevailing concepts of migraine pathophysiology.
• To highlight the evolving understanding of the mechanisms underlying each phase of a migraine attack.
• To emphasize the importance of detailed pathophysiological characterization for identifying new therapeutic targets.

Main Methods:

• This study is a review of current literature on migraine pathophysiology.
• It synthesizes recent findings on the complex interplay of brain regions involved in different migraine phases.
• The review discusses the trigeminovascular system activation during the headache phase and cortical spreading depression during the aura phase.

Main Results:

• The premonitory phase involves complex interactions between cortical and subcortical brain regions, including the hypothalamus and brainstem.
• The headache phase is characterized by activation of the trigeminovascular system.
• The aura phase is associated with cortical spreading depression, a wave of neuronal and glial cell depolarization and hyperpolarization.

Conclusions:

• Improved characterization of migraine pathophysiology across all phases is essential.
• This understanding will facilitate the identification of novel therapeutic targets for migraine prevention.
• Further research into the specific mechanisms of each phase holds promise for better migraine management.