Migraine symptoms and neurobiology

Critics of cortical spreading depression (CSD) have long pointed out that, although observed in animal studies, CSD has not been consistently observed using electroencephalograms (EEG) in humans with migraine.^{[Charles & Brennan, 2010]} Furthermore, CSD would be expected to have quite profound effects on cognitive functioning – effects that are not universally observed in migraine.^{[Charles & Brennan, 2010]} One of the first therapies for migraine – an ergot alkaloid – works by vasoconstriction; this led to attempts to unravel the pathology of migraine by focussing on the vasculature.^{[Mason & Russo, 2018]} However, although vascular changes do occur during a migraine, it is not yet clear to what extent these changes cause, or are a result of, the migraine pathology and the resulting pain.^{[Mason & Russo, 2018]}

References:
Charles A, Brennan KC. The neurobiology of migraine. Handb Clin Neurol 2010; 97: 99–108.

Mason BN, Russo AF. Vascular contributions to migraine: time to revisit? Front Cell Neurosci 2018; 12: 233.

Other references used on slide:
Burstein R, Noseda R, Borsook D. Migraine: multiple processes, complex pathophysiology. J Neurosci 2015; 35 (17): 6619–6629.

CGRP Forum website. https://www.cgrpforum.org. Accessed January 2020.

Charles A, Brennan KC. Cortical spreading depression – new insights and persistent questions. Cephalalgia 2009; 29 (10): 1115–1124.

Goadsby PJ, Holland PR, Martins-Oliveira M, et al. Pathophysiology of migraine: a disorder of sensory processing. Physiol Rev 2017; 97 (2): 553–622.

Leão AAP. Spreading depression of activity in the cerebral cortex. J Neurophysiol 1944; 7 (6): 359–390.

Russell FA, King R, Smillie SJ, et al. Calcitonin gene-related peptide: physiology and pathophysiology. Physiol Rev 2014; 94 (4): 1099–1142.

Tolner EA, Chen SP, Eikermann-Haerter K. Current understanding of cortical structure and function in migraine. Cephalalgia 2019; 39 (13): 1683–1699.