Update on pathophysiology


Andrew Charles MD discusses the biological pathways that underlie the symptoms associated with migraine.

What biological pathways underlie the symptoms associated with migraine?

World-renowned expert Andrew Charles MD discusses the biological pathways that underlie the symptoms associated with how migraine is more than just a headache in this short video.

Schwedt TJ, Chong CD, Functional imaging and migraine: new connections? Curr Opin Neurol, vol 28, issue 3, pp 265-270, https://insights.ovid.com/article/00019052-201506000-00010.
Reproduced by permission of Wolters Kluwer Health, Inc.
Maniyar FH, et al, Brain activations in the premonitory phase of nitroglycerin-triggered migraine attacks, Brain, 2014, vol 137, issue Pt 1, pp 232-241, by permission of Oxford University Press.


Video recorded at the Amgen/Novartis-supported live symposium “Delving deeper into the science of migraine”.
Held at Scottsdale, Arizona on November 22, 2019.


Recent studies have shown that several anatomic regions and molecular pathways underlie the multifaceted symptoms across all phases of migraine,1-4 including:


1

PRODROME


Activation of the hypothalamus, as well as neuropeptides involved in homeostatic functions, may contribute to symptoms experienced during the prodrome phase5

2

AURA


Cortical spreading depression is considered to be the primary pathophysiology behind the aura phase5,6

3

HEADACHE (ICTAL)


Several neuropeptides have been implicated in the sensitization of the central and peripheral trigeminovascular system, creating a state of hypersensitivity and contributing to both pain and non-pain symptoms during the headache phase5

4

POSTDROME


There are a number of similarities in the symptoms experienced during the prodrome and postdrome phases. 5,7 However, the precise pathophysiological events that underlie these symptoms remain uncertain5,7

5

INTERICTAL


Some regions of the brain remain abnormally activated after headache cessation, including the olfactory regions, the midbrain, and the hypothalamus8-11