CP Zwetsloot

Elliot Shevel

GG Schoonman

M Ashina

P Geppetti

T Wienecke

Journal of Headache and Pain

English

PubMed

Crossref

The Journal of Headache and Pain

Comments on the review article ‘Antidromic vasodilatation and the migraine mechanism’ by Geppetti et al. in the Journal of Headache and Pain 2012; 13:103–111

Springer - Publisher Connector

LETTER TO THE EDITOR
Comments on the review article ‘Antidromic vasodilatation
and the migraine mechanism’ by Geppetti et al. in the Journal
of Headache and Pain 2012; 13:103–111
Elliot Shevel
Received: 16 February 2012 / Accepted: 24 February 2012 / Published online: 18 March 2012
 The Author(s) 2012. This article is published with open access at Springerlink.com
The authors reviewed the role of antidromic vasodilatation in
migraine, and concluded that the weight of evidence shows
that the concept of antidromic vasodilatation in migraine
cannot be discarded [1]. Unfortunately they included refer-
ences that they wrongly claimed mitigate against the con-
cept, weakening their position unnecessarily.
In the section entitled ‘Neurogenic vasodilatation in
migraine’, they state that Graham and Wolff’s proposal that
the headache phase of migraine is associated with dilata-
tion of the superficial temporal artery, was subsequently
challenged by failure to measure significant vasodilatation
during migraine (a) using Doppler flowmetry [2], and
(b) using magnetic resonance angiography [3]. In fact in
neither of these studies were the terminal branches of the
external carotid artery studied. Zwetsloot studied the only
middle cerebral artery and not the extracranial vessels, and
Schoonman studied the intracranial vessels, and the last
10 mm of the external carotid before it divides into its
terminal branches. This section of the external carotid
artery has never been implicated in migraine, and is
therefore irrelevant in any discussion of Graham and
Woolf’s proven theory.
The authors also cite the ‘lack of correlation between the
degree of vasodilatation and the severity of headache’ as
possibly challenging Woolf’s theory. Both studies that they
cite, however, were on headache induced in healthy vol-
unteers [4, 5], and not in migraineurs. Graham and Woolf’s
findings relate to the temporal arteries in migraineurs, and
should not be compared to the findings in non-migraineurs.
The conclusion of Geppetti et al. that the concept of
antidromic vasodilatation is valid is strengthened when the
incorrect references are removed from the equation.
Conflict of interest None.
Open Access This article is distributed under the terms of the
Creative Commons Attribution License which permits any use, dis-
tribution, and reproduction in any medium, provided the original
author(s) and the source are credited.
References
1. Geppetti P, Rossi E, Chiarugi A, Benemei S (2012) Antidromic
vasodilatation and the migraine mechanism. J Headache Pain
13:103–111
2. Zwetsloot CP, Caekebeke JF, Ferrari MD (1993) Lack of
asymmetry of middle cerebral artery blood velocity in unilateral
migraine. Stroke 24:1335–1338
3. Schoonman GG, van der Grond J, Kortmann C, van der Geest RJ,
Terwindt GM, Ferrari MD (2008) Migraine headache is not
associated with cerebral or meningeal vasodilatation—a 3T
magnetic resonance angiography study. Brain 131:2192–2200
4. Ashina M, Tfelt-Hansen P, Dalgaard P, Olesen J (2011) Lack of
correlation between vasodilatation and pharmacologically induced
immediate headache in healthy subjects. Cephalalgia 31:683–690
5. Wienecke T, Olesen J, Ashina M (2011) Discrepancy between
strong cephalic arterial dilatation and mild headache caused by
prostaglandin D (PGD). Cephalalgia 31:65–76
E. Shevel (&)
The Headache Clinic, Parktown, South Africa
e-mail: drshevel@headclin.com
123
J Headache Pain (2012) 13:259
DOI 10.1007/s10194-012-0431-z


Comments on the review article ‘Antidromic vasodilatation and the migraine mechanism’ by Geppetti et al in the Journal of Headache and Pain 2012; 13:103–111

Antidromic vasodilatation and the migraine mechanism.

Discrepancy between strong cephalic arterial dilatation and mild headache caused by prostaglandin D (PGD). Cephalalgia 31:65–76 E. Shevel (&) The Headache Clinic, Parktown, South Africa e-mail: drshevel@headclin.com J Headache Pain

Lack of asymmetry of middle cerebral artery blood velocity in unilateral migraine.

Lack of correlation between vasodilatation and pharmacologically induced immediate headache in healthy subjects.

Migraine headache is not associated with cerebral or meningeal vasodilatation—a 3T magnetic resonance angiography study.

file:///data/core-remote/dit/data/Springer-OA/pdf/ade/aHR0cDovL2xpbmsuc3ByaW5nZXIuY29tLzEwLjEwMDcvczEwMTk0LTAxMi0wNDMxLXoucGRm.pdf

Comments on the review article ‘Antidromic vasodilatation and the migraine mechanism’ by Geppetti et al. in the Journal of Headache and Pain 2012; 13:103–111

Abstract

Similar works

Full text

Available Versions

Crossref

Springer - Publisher Connector

Springer - Publisher Connector