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Combining Imaging and Electrophysiology to Visualize and Record Spreading Depolarizations in Mice
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Rethinking migraine with aura: Why cortical spreading depolarization (depression), not aura, causes headaches.

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Cortical spreading depolarization causes migraine aura and potentially headache. The extent of this silent spread, not its location, determines headache severity, according to the Buildup Hypothesis.

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Area of Science:

  • Neuroscience
  • Neurology
  • Pain Research

Background:

  • Migrainous aura is linked to cortical spreading depolarization (CSD).
  • The relationship between CSD, aura, and headache onset is complex and variable.
  • Previous theories haven't fully explained the temporal discrepancies between aura and headache.

Purpose of the Study:

  • To propose a novel hypothesis explaining headache generation in migraine with aura.
  • To elucidate the role of CSD extent in headache genesis.
  • To address temporal variations in aura-headache relationships.

Main Methods:

  • Electrophysiological study of a human case with CSD.
  • Development of the Buildup Hypothesis based on CSD mechanisms.
  • Analysis of temporal relationships between aura and headache.

Main Results:

  • CSD can spread extensively and silently.
  • The extent of CSD, not just its location in eloquent cortex, is critical for headache.
  • The Buildup Hypothesis explains varying headache latencies and absence of headache after aura.

Conclusions:

  • Aura and headache are distinct consequences of CSD.
  • The Buildup Hypothesis provides a unifying framework for understanding migraine with aura and associated headache.
  • CSD's silent spread and subsequent chemical release are key to headache generation.