Diencephalic and brainstem mechanisms in migraine

  title={Diencephalic and brainstem mechanisms in migraine},
  author={Simon Akerman and Philip Robert Holland and Peter J. Goadsby},
  journal={Nature Reviews Neuroscience},
Migraine is a common and complex brain disorder. Although it is clear that head pain is a key manifestation of the disorder for most patients, what drives the activation of neuronal pain pathways in susceptible patients is less obvious. There is growing evidence that migraine pathophysiology may, in part, include dysfunction of subcortical structures. These include diencephalic and brainstem nuclei that can modulate the perception of activation of the trigeminovascular system, which carries… 

Update on Animal Models of Migraine

This review will highlight some of the latest findings from established animal models of migraine, as well as discuss the latest in the development of novel approaches in animals to study migraine.

Pathophysiology of migraine.

This review focuses on emerging concepts that drive the science of migraine in both a mechanistic direction and a therapeutic direction.

Divergent influences of the locus coeruleus on migraine pathophysiology

Experiments reveal a potent role for LC disruption in the differential modulation of migraine-related phenotypes, inhibiting dural-evoked activation of wide dynamic neurons in the trigeminocervical complex while increasing cortical spreading depression susceptibility.

Cerebellar involvement in migraine

It is hoped that future studies can provide an answer as to how the cerebellum may be involved and whether treatment options specifically targeting the cere bellum could provide alleviation of this disorder.

Current and novel insights into the neurophysiology of migraine and its implications for therapeutics

Migraine and Inhibitory System – I Can't Hold It!

This review focuses on recent structural and functional neuroimaging studies that investigated the role of subcortical and cortical structures in modulating nociceptive input in migraine, which outlined the presence of an imbalance between inhibitory and excitatory modulation of pain processing in the disease.

Neurovascular mechanisms of migraine and cluster headache

  • J. HoffmannS. BacaS. Akerman
  • Biology, Medicine
    Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism
  • 2019
The findings have shifted the understanding of these disorders to a primarily neuronal origin with the vascular manifestations being the consequence rather than the origin of trigeminal activation.



The neurobiology of migraine.

The Trigeminovascular System in Humans: Pathophysiologic Implications for Primary Headache Syndromes of the Neural Influences on the Cerebral Circulation

  • A. MayP. Goadsby
  • Medicine, Psychology
    Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism
  • 1999
It is taken the view that these disorders should be collectively regarded as neurovascular headaches to emphasize the interaction between nerves and vessels, which is the underlying characteristic of these syndromes.

The Hypothalamic Orexinergic System: Pain and Primary Headaches

The hypothalamic involvement in the modulation of trigeminovascular processing is discussed and the involvement of the hypothalamic orexinergic system as a key regulator of this function is examined.

Are Cortical Spreading Depression and Headache in Migraine Causally Linked?

All patients reported that aura symptoms resolved completely, whereas the migraine headache attacks persisted or even increased, calling into question the theory that CSD (silent or not) is a prerequisite for migraine headaches.

Interictal Dysfunction of a Brainstem Descending Modulatory Center in Migraine Patients

Altered descending modulation has been postulated to contribute to migraine, leading to loss of inhibition or enhanced facilitation resulting in hyperexcitability of trigeminovascular neurons, which has important implications for the evaluation of therapies for migraine.

Brainstem Modulation of Caudal Trigeminal Nucleus: A Model for Understanding Migraine Biology and Future Drug Targets

The possible mechanisms by which brainstem structures could drive a dysfunction in trigeminal nociception homeostasis are reviewed.

Sensitization of meningeal sensory neurons and the origin of headaches

The activity of primary afferent neurons in the rat trigeminal ganglion that innervate the dural venous sinuses are recorded, showing properties of meningeal afferents that may contribute to the intracranial mechanical hypersensitivity that is characteristic of some types of clinically occurring headaches, and to the throbbing pain of migraine.

Therapeutic potential of novel glutamate receptor antagonists in migraine.

The preclinical and clinical data argue strongly for a role of glutamatergic receptor activation in migraine, and glutamate receptors represent a promising target for a valuable, non-vasoconstrictor, and perhaps more importantly neuronal-specific therapeutic approach to the treatment of migraine.