Familial hemiplegic migraine (FHM)-causing mutations in the gene encoding the P/Q Ca 2+ channel α 1A subunit (CACNA1A) locate to the pore and voltage sensor regions and normally involve gainof-channel function. We now report on a mutation identified in the first intracellular loop of CACNA1A (α 1A(A454T) ) that does not cause FHM but is associated with the absence of sensorimotor symptoms in a migraine with aura pedigree. α 1A(A454T) channels showed weakened regulation of voltage-dependent steady-state inactivation by Ca V β subunits. More interestingy, A454T mutation suppressed P/Q channel modulation by syntaxin 1A or SNAP-25 and decreased exocytosis. Our findings reveal the importance of I-II loop structural integrity in the functional interaction between P/Q channel and proteins of the vesicle-docking/fusion machinery, and that genetic variation in CACNA1A may be not only a cause but also a modifier of migraine phenotype.CaV 2.1 (P/Q) channels | SNARE proteins | migraine with aura F amilial hemiplegic migraine (FHM) is an autosomal dominantly inherited subtype of migraine with aura that features some degree of hemiparesis during attacks (1, 2). The generally accepted view on migraine pathophysiology points to cortical spreading depression (CSD), an abnormal increase of cortical activity-followed by a long-lasting neuronal suppression wavethat propagates across the cortex, as the cause of the aura and migraine itself (1, 3). FHM-causing mutations have been reported in the CACNA1A gene (encoding the P/Q Ca 2+ channel α 1 subunit) (4), resulting in a gain of P/Q channel function, mainly due to a reduction in the voltage threshold of channel activation favoring CSD initiation and propagation (1, 5-11). Other genetic and environmental factors may also play a role in shaping the phenotype, as identical mutations show different clinical characteristics (2).The P/Q Ca 2+ channel contains a pore-forming α 1A subunit and several regulatory subunits, including intracellular β subunits (Ca V β 1-4 ) that bind to the intracellular loop between transmembrane domains I and II of α 1A (see Fig. 1B for an illustration of the channel complex). The effect of the regulatory subunits is essential for increasing the expression levels and modulating the voltage-dependent activation and inactivation of P/Q channels (12-15).Presynaptic proteins of the vesicle-docking/fusion machinery, including plasma membrane SNARE proteins (syntaxin 1A and SNAP-25) and synaptotagmin, bind to a specific site (synprint) in the large intracellular loop connecting domains II and III of the P/Q channel α 1A subunit (Fig. 1B). This interaction allows secretory vesicles docking to the plasma membrane near the pathway for Ca 2+ entry, optimizing neurotransmitter release.Syntaxin 1A and SNAP-25 also exert an inhibitory effect on P/Q channel activity by left-shifting the voltage dependence of steadystate inactivation (12,16,17). The synprint site serves an important anchoring function that may facilitate SNARE's modulation of channel gating, but the involvem...