Andrew Charles1. 1. Headache Research and Treatment Program, Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. acharles@ucla.edu
Abstract
PURPOSE OF REVIEW: Migraine has traditionally been categorized as a pain disorder, focusing on headache as its central feature. This narrow view does not account for the complex array of premonitory and postrdromal symptoms that occur in the hours before and after headache. This review outlines evidence that supports a broader view of migraine as a pathological brain state. RECENT FINDINGS: Studies of the clinical features of a migraine attack, in combination with imaging and electrophysiological studies, provide evidence that migraine involves widespread changes in brain function and connectivity. These changes parallel those seen in other brain states such as sleep. Neurochemical mediators, including adenosine, and nonsynaptic signalling mechanisms involving astrocytes may play a role in the migraine state. SUMMARY: Consideration of a migraine attack as a brain state provides an expanded framework for understanding all of its symptoms, and the underlying alterations in the activity of multiple brain networks. Mechanisms driving the transition to the migraine state may represent novel targets for acute and preventive therapies.
PURPOSE OF REVIEW: Migraine has traditionally been categorized as a pain disorder, focusing on headache as its central feature. This narrow view does not account for the complex array of premonitory and postrdromal symptoms that occur in the hours before and after headache. This review outlines evidence that supports a broader view of migraine as a pathological brain state. RECENT FINDINGS: Studies of the clinical features of a migraine attack, in combination with imaging and electrophysiological studies, provide evidence that migraine involves widespread changes in brain function and connectivity. These changes parallel those seen in other brain states such as sleep. Neurochemical mediators, including adenosine, and nonsynaptic signalling mechanisms involving astrocytes may play a role in the migraine state. SUMMARY: Consideration of a migraine attack as a brain state provides an expanded framework for understanding all of its symptoms, and the underlying alterations in the activity of multiple brain networks. Mechanisms driving the transition to the migraine state may represent novel targets for acute and preventive therapies.
Authors: M N Landgraf; H König; I Hannibal; T Langhagen; M V Bonfert; B Klose; B Rahmsdorf; R M Giese; A Straube; R von Kries; L Albers; F Ebinger; B Ertl-Wagner; B Kammer; I Körte; N Sollmann; S Krieg; F Heinen Journal: Nervenarzt Date: 2017-12 Impact factor: 1.214