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Provoked versus spontaneous migraine attacks: pathophysiological similarities and differences.

Håkan Ashina1,2, Rune Häckert Christensen1, Messoud Ashina3

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Provoked migraine attacks, induced by substances like calcitonin gene-related peptide, mimic spontaneous attacks in people with migraine. However, these studies may not fully capture the pre-attack events of spontaneous migraine.

Keywords:
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Area of Science:

  • Neuroscience
  • Pharmacology
  • Clinical Neurology

Background:

  • Spontaneous migraine attacks are unpredictable, hindering controlled neurobiological studies.
  • Human provocation studies using signaling molecules (e.g., calcitonin gene-related peptide) induce migraine-like attacks for research.
  • These studies are crucial for understanding migraine pathways and identifying drug targets.

Purpose of the Study:

  • To discuss the similarities and differences between provoked and spontaneous migraine attacks.
  • To evaluate the utility of human provocation models in migraine research.

Main Methods:

  • A literature search of the PubMed database was conducted in July 2022.
  • Original research articles on human provocation studies involving participants with migraine were selected.
  • Reference lists of identified articles were also reviewed for relevant studies.

Main Results:

  • Provoked attacks are subjectively similar to spontaneous attacks and respond to usual treatments.
  • Neurobiologically, provoked and spontaneous attacks share similarities, differing mainly in the source of migraine-inducing substances (exogenous vs. endogenous).

Conclusions:

  • Provoked migraine attacks largely resemble spontaneous ones in patients and are treatable with standard medication.
  • While useful, provocation studies may not fully replicate the pre-attack phase of spontaneous migraines, particularly the preceding signaling molecule release.
  • The exogenous vs. endogenous origin of triggers is a key distinction between provoked and spontaneous attacks.