The Concept of Migraine as a State of Central Neuronal Hyperexcitability

Welch, K. M. A.; D’Andrea, Giovanni; Tepley, N.; Barkley, Gregory L.; Ramadan, Nabih M.

doi:10.1016/s0733-8619(18)30319-0

Cited by 257 publications

(200 citation statements)

References 31 publications

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“…At first sight, increased amplitudes of cortical evoked responses would favour the hypothesis that migraine is characterised by cortical hyperexcitability between attacks [88]. However, from a strictly semantic point of view, we can refer to hyperexcitability when a normal stimulus produces an abnormally increased response.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiological response patterns of primary sensory cortices in migraine

Ambrosini

Schoenen

2006

J Headache Pain

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Migraine is an ictal disorder characterised by a particular vulnerability of patients to sensory overload, both during and outside of the attack. Central nervous system dysfunctions are supposed to play a pivotal role in migraine. Electroneurophysiological methods, which aim to investigate sensory processing, seem thus particularly appropriate to study the pathophysiology of migraine. We have thus reviewed evoked potential studies performed in migraine patients. Although results are in part contradictory, these studies nonetheless demonstrate an interictal dysfunction of sensory cortices, and possibly of subcortical structures, in migraine with and without aura. The predominant abnormality is a deficient habituation of evoked responses to repeated stimuli, probably due to cortical, and possibly widespread neural, "dysexcitability".

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Section: Discussionmentioning

confidence: 99%

Electrophysiological response patterns of primary sensory cortices in migraine

Ambrosini

Schoenen

2006

J Headache Pain

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“…Migraine has been related with cortical hyperexcitability 9 , and the migrainous occipital cortex is particularly responsive to interictal visual stimulation 10 . There are limited data on CSD provoked by stimuli either than seizure induction or direct chemical/mechanical stimulation; but it is well known that migraine attacks may be triggered by visual stimuli such as sunlight 11 , red-green flickering 12 , or particular striped patterns 13 .…”

Section: Discussionmentioning

confidence: 99%

Aura-like features and photophobia in sightless migraine patients

Silva

Goes

Vincent

2014

Arq. Neuro-Psiquiatr.

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Migraine is a neurological disorder that frequently involves cortical paroxysmal dysfunction expressed as aura 1 . The most frequent type of aura is visual, sometimes experienced as fortification spectra, known as teichopsia. This typical zigzag, horseshoe-shaped expanding bright perception, usually perceived as complex interlacing lines named "chevaux de frises" by Gowers, followed by a bean-shaped loss of visual acuity, strongly suggests the involvement of visual processing areas. Clinical, experimental, and neuroimaging evidence demonstrates that cortical spreading depression (CSD) is the phenomenon underlying the pathophysiology of bizarre visual perceptions among migraineurs. Computerized models simulating a CSD wave passing through cortical area V1 convincingly reproduce the teichopsia pattern 2 .The cortical function is deeply dependent on neuronal input. Depriving the cortex of its natural input may influence the cerebral function and change the cortical maps both locally and distantly 3 . In blind individuals, the occipital cortex is critical for tactile Braille reading 4 . The visual cortex is pivotal in the pathophysiology of the migraine aura, the objective of the present study was to investigate whether the phenotype of migraine-related visual phenomena would change in amaurotic patients. AbstrActMigraine is a central nervous system disorder frequently expressed with paroxysmal visual dysfunctions. Objective: To test the hypothesis that a normal visual input is vital for migrainous aura and photophobia. Methods: We studied the migraine-related visual disturbances in 8 sightless migraineurs identified among 200 visually impaired subjects. Results: The main findings were visual aura and photophobia disappearance along with the development of blindness, abnormal aura [too short, colorful (e.g., blue or fire-like), auditory in nature, or different in shape (round forms)], and the lack of photophobia. Conclusions: We propose that the aura duration should be accepted as shorter in visually impaired subjects. The changes in the aura phenotype observed in our patients may be a result of cerebral plasticity induced by visual impairment and/or the lack of a visual input per se. Integrity of visual pathways plays a key role in migraine visual aura and photophobia.Keywords: migraine with aura, subnormal vision, blindness, visual aura, photophobia resumo A enxaqueca é doença neurológica frequentemente associada a anormalidades visuais transitórias. Objetivo: Testar a hipótese de que a visão normal é importante para o fenótipo da aura e da fotofobia. Métodos: Estudamos 8 enxaquecosos deficientes visuais identificados em uma população de 200 indivíduos com visão subnormal. Resultados: Os principais achados foram: o desaparecimento da aura visual e da fotofobia com o início da cegueira; a ocorrência de aura atípica -muito curta, colorida (p. ex. azul, ou cor de fogo) auditiva ou diferente na forma (arredondadas); e a ausência de fotofobia. Conclusões: Propomos que a duração da aura possa ser admitida como mais cur...

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“…A aura migranosa pode estar associada a estado de hiperexcitabilidade cortical que envolva alguns aminoácidos, como o glutamato e o aspartato 11 . Baixo nível de magnésio cerebral pode também estar envolvido, acentuando a responsividade de receptores de NMDA, que parecem se relacionar com o evento deflagrador da depressão alastrante, esse sim, o evento fisiopatológico correlacionado com a aura 12 .…”

Section: Discussionunclassified

Eficácia de três drogas sobre a aura migranosa: um estudo randomizado placebo controlado

Bigal

Bordini

Speciali

2002

Arq. Neuro-Psiquiatr.

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RESUMO -A despeito da enorme quantidade de pesquisas referentes à classificação, epidemiologia, diagnóstico, fisiopatologia e tratamento da migrânea, a aura migranosa permanece bem menos estudada. O objetivo do presente estudo é, portanto, verificar a evolução da aura em pacientes submetidos a placebo e a três diferentes drogas disponíveis em unidades públicas de saúde brasileiras. Foram estudados 86 pacientes em vigência de crise de migrânea com aura, apresentando aura no momento da randomização. Após a randomização os pacientes recebiam uma das seguintes substâncias, por via endovenosa: placebo, dipirona, clorpromazina, sulfato de magnésio. O sulfato de magnésio foi superior ao placebo (p < 0,05) 30 e 60 minutos após a administração. Dipirona e clorpromazina reduziram o número de pacientes com aura, em relação ao placebo, 60 minutos após a administração. Os achados acima possibilitam especulações sobre a fisiopatologia da migrânea e apresentam opções terapêuticas para o tratamento da aura.PALAVRAS-CHAVE: migrânea com aura, aura, tratamento, placebo, dipirona, clorpromazina, sulfato de magnésio.Efficacy of three drugs in the treatment of migrainous aura: a randomized, placebo-controlled study Efficacy of three drugs in the treatment of migrainous aura: a randomized, placebo-controlled study Efficacy of three drugs in the treatment of migrainous aura: a randomized, placebo-controlled study Efficacy of three drugs in the treatment of migrainous aura: a randomized, placebo-controlled study Efficacy of three drugs in the treatment of migrainous aura: a randomized, placebo-controlled study ABSTRACT -In spite of the enormous amount of research regarding classification, epidemiology, diagnosis, pathophisiology and treatment of migraines, aura, one of its hallmarks, stays much less studied. The objective of this study is, therefore, to evaluate the evolution of aura in patients submitted to placebo and three different drugs available in Brazilian public health units. We studied 86 patients during an acute migrainous attack, with aura at the moment of the evaluation. Patients were randomized to receive one of the following substances, in a parenteral route: placebo, dipyrone, chlorpromazine and magnesium sulphate. Magnesium sulphate was superior to placebo (p <0,05) 30 and 60 minutes after its administration. Dipyrone and chlorpromazine reduced the duration of the aura, when compared to placebo, 60 minutes following their administration. Our findings make possible some speculations about the pathophisiology of migraine, as well as about the therapeutic approach of patients presenting migrainous aura.KEY WORDS: migraine with aura, aura, treatment, placebo, dipyrone, chlorpromazine, magnesium sulphate.A despeito da enorme quantidade de pesquisas referentes à classificação, epidemiologia, diagnós-tico, fisiopatologia e tratamento da migrânea 1-3 , a aura migranosa permanece bem menos estudada. Define-se aura como fenômeno neurológico focal que se relaciona ao ataque de migrânea, durando usualmente de 5 a 20 e não ultrapass...

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The Concept of Migraine as a State of Central Neuronal Hyperexcitability

Cited by 257 publications

References 31 publications

Electrophysiological response patterns of primary sensory cortices in migraine

Electrophysiological response patterns of primary sensory cortices in migraine

Aura-like features and photophobia in sightless migraine patients

Eficácia de três drogas sobre a aura migranosa: um estudo randomizado placebo controlado

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