Migraine pathophysiology: Anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain

Noseda, Rodrigo; Burstein, Rami

doi:10.1016/j.pain.2013.07.021

Cited by 734 publications

(697 citation statements)

References 128 publications

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“…This molecule is also involved in sensory regulation and neuropathic pain 23 . CCL5/RANTES has been previously shown to be higher during migraine attacks 25 , but in the present study this molecule was higher in migraine regardless of presence of pain.…”

Section: Discussioncontrasting

confidence: 74%

Serum levels of adiponectin, CCL3/MIP-1α, and CCL5/RANTES discriminate migraine from tension-type headache patients

Domingues

Duarte

Senne

et al. 2016

Arq. Neuro-Psiquiatr.

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Migraine and tension-type headache (TTH) are the most frequent primary headaches and their differentiation is based on strict clinical diagnostic criteria 1 . Though different theories have been formulated to explain these disorders, their physiopathology remains largely unknown.Migraine is considered a neurovascular disorder with complex genetic background. Trigeminovascular system activation with subsequent release of vasoactive neuropeptides has been proposed to explain migraine attacks 2 , while central sensitization possibly plays a role in migraine chronification 3 . Conversely, TTH pathophysiology has been thought to be associated with both peripheral (increased myofascial pain sensitivity and peripheral sensitization of myofascial nociceptors) and central ABSTRACTObjectives: Inflammatory molecules and neurotrophic factors are implicated in pain modulation; however, their role in primary headaches is not yet clear. The aim of this study was to compare the levels of serum biomarkers in migraine and tension-type headache. Methods: This was a cross-sectional study. We measured serum levels of adiponectin, chemokines, and neurotrophic factors in patients with migraine and tension-type headache. Depression and anxiety symptoms, headache impact and frequency, and allodynia were recorded. Results: We included sixty-eight patients with migraine and forty-eight with tension-type headache. Cutaneous allodynia (p = 0.035), CCL3/MIP-1α (p = 0.041), CCL5/RANTES (p = 0.013), and ADP (p = 0.017) were significantly higher in migraine than in tension-type headache. The differences occurred independently of anxiety and depressive symptoms, frequency and impact of headache, and the presence of pain. Conclusions: This study showed higher CCL3/MIP-1α, CCL5/RANTES, and ADP levels in migraine in comparison with tension-type headache. Our findings suggest distinctive roles of these molecules in the pathophysiology of these primary headaches.Keywords: migraine disorders; tension-type headache; adiponectin; chemokines; neurotrophic factors. RESUMO Objetivos:Moléculas inflamatórias e fatores neurotróficos estão implicados na modulação dolorosa, contudo, seu papel nas cefaleias primárias não é claro. O objetivo do presente estudo foi comparar níveis de biomarcadores séricos na migrânea e cefaleia do tipo tensional. Métodos: Este foi um estudo transversal, no qual foram avaliados níveis de adiponectina, quimiocinas e fatores neurotróficos em pacientes com migrânea e cefaleia do tipo tensional. Sintomas depressivos e ansiosos, o impacto e a frequência da cefaleia e alodínea foram registrados. Resultados: Foram incluídos 68 pacientes com migrânea e 48 pacientes com cefaleia do tipo tensional. A alodínia cutânea (p = 0.035), CCL3/MIP-1α (p = 0.041), CCL5/RANTES (p = 0.013), e adiponectina (p = 0.017) foram maiores na migrânea, independentemente de sintomas depressivos e ansiosos, frequência e impacto da cefaleia. Conclusões: Níveis de CCL3/MIP-1α, CCL5/RANTES e adiponectina foram maiores na migrânea do que na cefaleia do tipo tensional...

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Section: Discussioncontrasting

confidence: 74%

Serum levels of adiponectin, CCL3/MIP-1α, and CCL5/RANTES discriminate migraine from tension-type headache patients

Domingues

Duarte

Senne

et al. 2016

Arq. Neuro-Psiquiatr.

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“…Cortical spreading depression, a presumed core mechanism in migraine pathophysiology, is thought to activate the trigeminovascular pathway, leading to the release of vasoactive peptides (Noseda & Burstein, 2013). Prolonged exposure to these vasoactive peptides may affect vessel wall integrity and facilitate development of UIA in susceptible individuals, but this is still a speculative theory.…”

Section: Discussionmentioning

confidence: 99%

Migraine prevalence in patients with unruptured intracranial aneurysms: A case–control study

et al. 2017

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ObjectivesMigraine is a suggested risk factor for aneurysmal subarachnoid hemorrhage (aSAH). An increased risk of aSAH in migraineurs may be explained by an increased prevalence of unruptured intracranial aneurysms (UIA). We performed a case–control study to compare lifetime migraine prevalence in patients with UIA, patients with a history of transient ischemic attact (TIA) or ischemic stroke and controls without a history of aSAH, TIA or ischemic stroke.Materials and MethodsPatients with UIA were recruited from two university hospitals. Data on patients with TIA/stroke were retrieved from a previous study. Partners of patients with UIA or TIA/stroke were included as controls. Migraine history was assessed via a telephone interview based on the International Classification of Headache Disorders, second edition criteria. We calculated odds ratios (OR) for migraine with univariable and multivariable logistic regression analyses, adjusted for age, sex, hypertension and smoking.ResultsWe included 172 patients with UIA, 221 patients with TIA or stroke, and 164 controls. In UIA patients, migraine prevalence was 24.4% compared with 14.6% in controls (UIA vs. controls; OR 1.9; 95% confidence interval [CI] 1.1–3.5) and 22.2% in TIA/stroke patients (UIA vs. TIA/stroke; OR 1.1; 95% CI 0.7–1.8). After adjustments, the OR for migraine in UIA patients versus controls were 1.7 (95% CI 1.0–3.1) and 0.9 (95% CI 0.5–1.0) versus TIA/stroke. Results were comparable for migraine with and without aura.ConclusionsMigraine prevalence is possibly increased in patients with UIA compared with controls and comparable with the prevalence in patients with TIA or stroke. Further studies are needed to confirm our findings and to investigate the underlying pathophysiology.

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“…CA represents the sensitization of central trigeminal neurons that receive convergent input from the dura and the periorbital skin (1,4,8,9,10). It has been proposed that CA is the result of the repeated sensitization of pain pathways (11,12).…”

Section: Introductionmentioning

confidence: 99%

Identification of Allodynic Migraine Patients with the Turkish Version of the Allodynia Symptom Checklist: Reliability and Consistency Study

Yalın¹,

Uludüz

Sungur

et al. 2017

Arch Neuropsychiatr

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Introduction: Cutaneous allodynia is regarded as an expression of central sensitization in migraine. Although the gold standard is quantitative sensory testing, several practical assessment questionnaires have been developed to assess allodynia in migraine. We aimed to establish the first valid Turkish allodynia assessment questionnaire based on a 12-item allodynia symptom checklist and to evaluate the associated factors.Methods: The first part of the study included the translation and cultural adaptation of a Turkish version of the checklist. The Turkish version of the questionnaire was administered to 344 episodic and chronic migraine patients, who were chosen according to the International Classification of Headache Disorders -III beta criteria.Results: The total checklist score showed excellent test-retest reliability (r=0.821). The internal consistency of the checklist was assessed usingCronbach alpha values and was found to be acceptable (Cronbach alpha for the checklist=0.767). Data analysis revealed that 10 items of the questionnaire adequately identified allodynic subjects. Cutaneous allodynia was present in 218 (63.4%) migraine patients. Allodynia was more prominent in patients experiencing migraine with aura (p=0.008) and in females (p<0.001). Multiple logistic regression analysis found that female gender, aura existence, longer headache duration, and higher attack frequency were the major determinants of cutaneous allodynia. Conclusion:Allodynia is common and has clinical significance in migraine; therefore, establishing a validated Turkish questionnaire for the assessment of allodynia was necessary. In this study, a Turkish version of the allodynia symptom checklist was validated and found to be convenient for the identification of allodynia in migraine patients.

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Migraine pathophysiology: Anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain

Cited by 734 publications

References 128 publications

Serum levels of adiponectin, CCL3/MIP-1α, and CCL5/RANTES discriminate migraine from tension-type headache patients

Serum levels of adiponectin, CCL3/MIP-1α, and CCL5/RANTES discriminate migraine from tension-type headache patients

Migraine prevalence in patients with unruptured intracranial aneurysms: A case–control study

Identification of Allodynic Migraine Patients with the Turkish Version of the Allodynia Symptom Checklist: Reliability and Consistency Study

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