Affiliation:
1. School of Medicine Institute of Physiology, Belgrade
Abstract
Introduction. Understanding of migraine pathophysiology has substantially
improved over the last two decades. As a result, migraine is now mainly
considered to be a disorder of the brain, rather than one of the vasculature
or the meninges. Pathophysiology. Although it remains speculative how exactly
they relate to each other, the following three processes are important in
migraine: 1. Cortical spreading depression is a wave of intense
depolarization, it starts in the occipital lobe, propagates through the brain
and is followed by a period of suppressed activity. 2. Activation of the
trigemonovascular system causes the release of neuropeptides (e.g. calcitonin
gene-related peptide, substance P) from the peripheral trigeminal nerve
endings. These neuropeptides are thouglt to play a role in causing and
maintaing headache. 3. Sensitization of peripheral and central brain areas,
it is thought that pulsating quality of migraine headache is caused by a
process of peripheral sensitization. Cutaneous allodynia is a marker of
central sensitization. Link between Aura and Headache. The view that the aura
is caused by cortical spreading depression has become generally accepted, and
the same is true for the view that activation of the trigemonovascular system
underlies migraine headache. However, the relationship between the aura and
the activation of the trigemonovascular system and the start of headache
remains elusive. Genetics of Migraine. One of the most important aspects of
the pathophysiology of migraine is the hereditary nature of the disorder.
Conclusion. Identification of polymorphisms and genetic biomarkers should
help us to understand migraine pathophysiology better and thus enable the
development of specific, effective ?individually-tailored treatment? for each
particular migraine patient (personalized medicine).
Publisher
National Library of Serbia
Cited by
10 articles.
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