Mechanisms of migraine as a chronic evolutive condition

Anna P Andreou, Lars Edvinsson, Anna P Andreou, Lars Edvinsson

Abstract

Understanding the mechanisms of migraine remains challenging as migraine is not a static disorder, and even in its episodic form migraine remains an "evolutive" chronic condition. Considerable progress has been made in elucidating the pathophysiological mechanisms of migraine, associated genetic factors that may influence susceptibility to the disease, and functional and anatomical changes during the progression of a migraine attack or the transformation of episodic to chronic migraine. Migraine is a life span neurological disorder that follows an evolutive age-dependent change in its prevalence and even clinical presentations. As a disorder, migraine involves recurrent intense head pain and associated unpleasant symptoms. Migraine attacks evolve over different phases with specific neural mechanisms and symptoms being involved during each phase. In some patients, migraine can be transformed into a chronic form with daily or almost daily headaches. The mechanisms behind this evolutive process remain unknown, but genetic and epigenetic factors, inflammatory processes and central sensitization may play an important role.

Conflict of interest statement

N/A.

Figures

Fig. 1
Fig. 1
Migraine is cyclic disorders with a complex sequence of symptoms within every headache attack. In its episodic form, migraine is characterised by recurrent attacks involving different phases, with a complex sequence of symptoms within every phase. Significant advances have been made in characterising migraine as a brain disorder and in identifying evolutive functional changes in different brain areas during the different phases of a migraine attack
Fig. 2
Fig. 2
Migraine pathophysiology involves activation of the hypothalamic region during the early premonitory phase, and activation of the trigeminal system during the headache phase. Cortical spreading depression (CSD) is thought to be the biological process of the migraine aura. How activation of the hypothalamus may lead to the development of CSD and activation of the trigeminal system remains unknown. Potentially the hypothalamus may activate direct or indirect pathways involving other brain areas, such us the brainstem, or the parasympathetic system, leading to the development of migraine aura and activation of the ascending trigeminothalamic pathway

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