The pathophysiology of the migraine attack

Migraine, a word of French origin, is a mediaeval corruption of the Greek hemicrania". Its etymological meaning, half-headache, indicates two important features of the disorder, the headache and its onesidedness. In classical migraine, the headache is preceded by an 'aura' of focal neurological symptoms. The symptoms are generally sensory in nature and often involve disturbances of vision, such as scotomas, either dark or luminous, or the. scintillating scotoma, also called teichopsia, a phenomenon which will be described further in Chapter 3.2. There may also be a sensation of tingling, like 'pins and needles', which often commences in the fingers of one hand, gradually extending up the arm to jump, at a given moment, to the area of the mouth. When this sensory disturbance affects the right side of the body, it may be associated with an aphasic disturbance of speech". However, the classical form of migraine occurs much less frequently than the so-called common migraine in which the headache comes on without an aura. Except for the presence of an aura in the former, classical and common migraine do not differ essentially from each other141 and therefore have been placed under the same nosological entity, migrai~e. The observations on the migraine attack which will be reviewed in. this section, can be roughly subdivided into three groups, i.e., those concerning (i) the circulation of the head, (ii) the gastrointestinal tract and (iii) the chemistry of the body. The circulation of the head - the cephalic circulation - can be subdivided into two compartments, the circulation of the brain - the cerebral circulation - and the circulation of the remaining structures of the head which is here referred to as the cranial circulation. The two parts of the cephalic circulation will be considered separately because of their distinct significance in the pathophysiology of the migraine attac

A ‘complex’ of brain metabolites distinguish altered chemistry in the cingulate cortex of episodic migraine patients

Despite the prevalence of migraine, the pathophysiology of the disease remains unclear. Current understanding of migraine has alluded to the possibility of a hyperexcitable brain. The aim of the current study is to investigate human brain metabolite differences in the anterior cingulate cortex (ACC) during the interictal phase in migraine patients. We hypothesized that there may be differences in levels of excitatory neurotransmitters and/or their derivatives in the migraine cohort in support of the theory of hyperexcitability in migraine. 2D J-resolved proton magnetic resonance spectroscopy (1H-MRS) data were acquired on a 3 Tesla (3 T) MRI from a voxel placed over the ACC of 32 migraine patients (MP; 23 females, 9 males, age 33 ± 9.6 years) and 33 healthy controls (HC; 25 females, 8 males, age 32 ± 9.6 years). Amplitude correlation matrices were constructed for each subject to evaluate metabolite discriminability. ProFit-estimated metabolite peak areas were normalized to a water reference signal to assess subject differences. The initial analysis of variance (ANOVA) was performed to test for group differences for all metabolites/creatine (Cre) ratios between healthy controls and migraineurs but showed no statistically significant differences. In addition, we used a multivariate approach to distinguish migraineurs from healthy subjects based on the metabolite/Cre ratio. A quadratic discriminant analysis (QDA) model was used to identify 3 metabolite ratios sufficient to minimize minimum classification error (MCE). The 3 selected metabolite ratios were aspartate (Asp)/Cre, N-acetyl aspartate (NAA)/Cre, and glutamine (Gln)/Cre. These findings are in support of a ‘complex’ of metabolite alterations, which may underlie changes in neuronal chemistry in the migraine brain. Furthermore, the parallel changes in the three-metabolite ‘complex’ may confer more subtle but biological processes that are ongoing. The data also support the current theory that the migraine brain is hyperexcitable even in the interictal state