Updated Insight into the Pathophysiology of Migraine – an Update

Česká verzia

Authors: R. Kotas
Authors place of work: Neurologická klinika, LF UK a FN Plzeň
Published in the journal: Cesk Slov Neurol N 2011; 74/107(6): 654-661
Category: Review Article

Summary

This survey consists of an update of information about the pathophysiology of migraine. All the important aspects are described, including cortical spreading depression and the role of Na+, K+, -ATPase transporter activity, the trigeminal vascular system, vasoactive neuropeptides, especially calcitonin gene-related peptide and pituitary adenylate cyclase-activating polypeptide, vasodilatation and sterile neurogenic inflammation, the significance of serotonin and nitric oxide, the transmission of pain along the trigeminal pathway, the significance of the brainstem generator, the role of magnesium and the influence of hormonal factors. The consequences of a knowledge of pathophysiology on the development of specific antimigraine drugs such as the triptans and gepants is mentioned.

Key words:
migraine – pathophysiology – cortical spreading depression – Na+ – K+ – -ATPase transporters – trigeminal vascular system – calcitonin gene-related peptide – serotonin receptors – nitric oxide

Zdroje

1. Diamond S, Medina JL. A headache clinic’s experience: Diamond Headache Clinic, Ltd. NIDA Res Monogr 1981; 36: 130–136.

2. Hanington E. Migraine: a blood disorder? Lancet 1978; 2(8088): 501–503.

3. Lauritzen M, Olesen J. Regional cerebral blood flow during migraine attacks by Xenon 133 inhalation and emission tomography. Brain 1984; 107(Pt 2): 447–461.

4. Pietrobon D, Striessnig J. Neurobiology of migraine. Nat rev Neurosci 2003; 4(5): 386–398.

5. Hansen AJ, Quistorff B, Gjedde A. Relationship between local changes in cortical blood flow and extracellular K+ during spreading depression. Acta Physiol Scand 1980; 109(1): 1–6.

6. Lauritzen M. Long-lasting reduction of cortical blood flow of the brain after spreading depression with preserved autoregulation and impaired CO2 response. J Cereb Blood Flow Metab 1984; 4(4): 546–554.

7. Eikermann-Haerter K, Moskowitz M. Pathophysiology of Aura. In: Silberstein SD, Lipton RB, Dodick DW (eds). Wolff’s Headache and Other Head Pain. New York: Oxford University Press 2008: 121–131.

8. Eikermann-Haerter K, Ayata C. Cortical spreading depression and migraine. Curr Neurol Neurosci Rep 2010; 10(3): 167–173.

9. Hadjikhami N, Sanchez Del Rio M, Wu O, Schwartz D, Bakker D, Fischl B et al. Mechanisms of migraine aura revealed by functional MRI in human visual cortex. Proc Natl Acad Sci USA 2001; 98(8): 4687–4692.

10. Woods RP, Iacoboni M, Mazziotta JC. Brief report: bilateral spreading cerebral hypoperfusion during spontaneous migraine headache. N Engl J Med 1994; 331(25): 1689–1692.

11. Géraud G, Denuelle M, Fabre N, Payoux P, Chollet F. Positron emission tomographic studies of migraine. Rev Neurol (Paris) 2005; 161(6–7): 666–670.

12. Sanchez Del Rio M, Reuter U, Moskowitz MA. New insights into migraine pathophysiology. Cur Opin Neurol 2006; 19(3): 294–298.

13. Harrington MG, Fonteh AN, Arakaki X, Cowan RP, Ecke LE, Foster H et al. Capillary endothelial Na+K+ATPase transporter homeostasis and a new theory for migraine pathophysiology. Headache 2010; 50(3): 459–478.

14. Moskowitz MA, Nozaki K, Kraig R. Neocortical spreading depression provokes the expression of c-fos protein-like immunoreactivity within trigeminal nucleus caudalis via trigeminovascular mechanisms. J Neurosci 1993; 13(3): 1167–1177.

15. Moskowitz MA. The neurobiology of vascular head pain. Ann Neurol 1984; 16(2): 157–168.

16. Moskowitz MA, Macfarlane R. Neurovascular and molecular mechanisms in migraine headaches. Cerebrovasc Brain Metab Rev 1993; 5(3): 159–177.

17. Goadsby PJ, Charbit AR, Andreon AP, Herman S, Holland PR. Neurobiology of migraine. Neuroscience 2009; 161(2): 327–341.

18. Markowitz, Saito K, Moskowitz MA. Neurogenetically mediated plasma extravasation in dura mater: effect of ergot alcaloids. A possible mechanism of action in vascular headache. Cephalalgia 1988; 8(2): 83–91.

19. Dimitriadou V, Buzzi MG, Moskowitz MA, Theoharides TC. Trigeminal sensory fiber stimulation includes morphological changes reflecting secretion in rat dura mater mast cells. Neuroscience 1991; 44(1): 97–112.

20. Dimitriadou V, Buzzi MG, Theoharides TC, Moskowitz MA. Ultrastructural evidence for neurogenically mediated changes in blood vessels of the rat dura mater and tongue following antidromic trigeminal stimulation. Neuroscience 1992; 48(1): 187–203.

21. Bouchelet, Cohen Z, Séguéla P, Hamel E. Differencial expresion of sumatriptan – sensitive 5-HT1 receptors in human neuronal and vascular tissues. In: Sandler M, Ferrari M, Harnet S (eds). Migraine. Pharmacology and genetics. London, Glasgow, Weinheim, New York, Tokyo, Melbourne, Madras: Chapman and Hall 1996; 55–81.

22. Mathew NT. Treatment of Acute Attacks of Migraine. In: Evans RW, Mathew N (eds). Handbook of Headache. 2nd ed. Philadelphia: Lippincott Williams and Wilkins 2005: 60–87.

23. Bartsch T, Knight YE, Goadsby PJ. Activation of 5-HT(1B/1D) receptor in the periaqueductal gray inhibits nociception. Ann Neurol 2004; 56(3): 371–381.

24. Shields KG, Goadsby PJ. Serotonin receptors modulate trigeminovascular responses in ventroposteromedial nucleus of thalamus: a migraine target? Neurobiol Dis 2006; 23(3): 491–501.

25. Goadsby PJ. Pathophysiology of migraine. Neurol Clin 2009; 27(2): 335–360.

26. Wang X, Fang Y, Liang J, Yin Z, Miao J, Luo N. Selective inhibition of 5-HT7 receptor reduces CGRP release in an experimental model for migraine. Headache 2010; 50(4): 579–587.

27. Durham PL. Calcitonin gene-related peptide (CGRP) and migraine. Headache 2006; 46 (Suppl 1): S3–S5.

28. Goadsby PJ, Edvinsson L, Ekman R. Vasoactive peptide release in the extracerebral circulation of humans during migraine headache. Ann Neurol 1990; 28(2): 183–187.

29. Goadsby PJ, Edvinsson L. The trigeminovascular system and migraine: studies characterizing cerebrovascular and neuropeptide changes seen in humans and cats. Ann Neurol 1993; 33(1): 48–56.

30. Lassen LH, Haderslev PA, Jacobsen VB, Iversen HK, Sperling B, Olesen J. CGRP may play a causative role in migraine. Cephalalgia 2002; 22(1): 54–61.

31. Villalón CM, Olesen J. The role of CGRP in the pathophysiology of migraine and efficacy of CGRP receptor antagonists as acute antimigraine drugs. Pharmacol Ther 2009; 124(3): 309–323.

32. Schytz HW, Olesen J, Ashina M. The PACAP receptor: a novel target for migraine treatment. Neurotherapeutics 2010; 7(2): 191–196.

33. Thomsen LL, Olesen J. The role of nitric oxide in migraine pain. In: Sandler M, Ferrari M, Harnet S (eds). Migraine. Pharmacology and genetics. London, Glasgow, Weinheim, New York, Tokyo, Melbourne, Madras: Chapman and Hall 1996: 154–166.

34. Olesen J. The role of nitric oxide (NO) in migraine, tension-type headache and cluster headache. Pharmacol Ther 2008; 120(2): 157–171.

35. Goadsby PJ, Oshinsky ML. Pathophysiology of Headache. In: Silberstein SD, Lipton RB, Dodick DW. Wolff’s Headache and Other Head Pain. 8th ed. New York: Oxford University Press 2008: 105–119.

36. Weiler C, May A, Limmroth V, Jüptner M, Kaube H, Schayck RV et al. Brain stem activation in spontaneous human migraine attacks. Nat med 1995; 1(7): 658–660.

37. Holland PR. Modulation of trigeminovascular processing: novel insights into primary headache disorders. Cephalalgia 2009; 29 (Suppl 3): 1–6.

38. D’Andrea G, Leon A. Pathogenesis of migraine: from neurotransmitters to neuromodulators and beyond. Neurol Sci 2010; 31 (Suppl 1): S1–S7.

39. Sun-Edelstein C, Mauskop A. Role of magnesium in the pathogenesis and treatment of migraine. Expert Rev Neurother 2009; 9(3): 369–379.

40. Zacur HA. Hormonal changes throughout life in women. Headache 2006; 46 (Suppl 2): S49–S54.

41. Newman LC. Understanding the causes and prevention of menstrual migraine: the role of estrogen. Headache 2007; 47 (Suppl 2): S86–S94.

42. Martin VT, Behbehani M. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis – part 2. Headache 2006; 46(3): 365–386.

43. Brennan KC, Charles A. An update on the blood vessel in migraine. Curr Opin Neurol 2010; 23(3): 266–274.

44. Schoonman GG, van der Grond J, Kortmann C, van der Geest RJ, Terwindt GM, Ferrari MD. Migraine headache is not associated with cerebral or meningeal vasodilatation - a 3T magnetic resonance angiography study. Brain 2008; 131(Pt 8): 2192–2200.