Migraine and Headache Pathophysiology

Migraine and Headache Pathophysiology - Lars (red.) Edvinsson

The exact pathogenesis of migraine remains to be determined. Theories describing migraine pathophysiology have moved between primary vascular and primary neural mechanisms. Harold G Wolff, a pioneer of the vascular theory of migraine, proposed that the neurological symptoms of the migraine aura were caused by cerebral vasoconstriction, and the headache by vasodilatation.1 Lashley’s experience2 of his own visual aura led him to believe the cortical spreading depression (CSD) of Leão to be the primary cause, thus promulgating the neural theory of migraine.3,4 Newer imaging techniques have made it possible to study the very early events of migraine, thus both theories have been reconciled by contemporary proponents of a neurovascular mechanism. There is evidence of an inherited disorder that occurs in susceptible individuals. There is also an increasing body of evidence to suggest that central neuronal hyperexcitability is a pivotal physiological disturbance predisposing individuals to migraine.5 The reasons for increased neuronal excitability may be multifactorial.