Pathophysiology of Migraine: A Disorder of Sensory Processing.

Goadsby, Peter J; Holland, Philip R; Martins-Oliveira, Margarida; Hoffmann, Jan; Schankin, Christoph; Akerman, Simon (2017). Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiological reviews, 97(2), pp. 553-622. American Physiological Society 10.1152/physrev.00034.2015

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Plaguing humans for more than two millennia, manifest on every continent studied, and with more than one billion patients having an attack in any year, migraine stands as the sixth most common cause of disability on the planet. The pathophysiology of migraine has emerged from a historical consideration of the "humors" through mid-20th century distraction of the now defunct Vascular Theory to a clear place as a neurological disorder. It could be said there are three questions: why, how, and when? Why: migraine is largely accepted to be an inherited tendency for the brain to lose control of its inputs. How: the now classical trigeminal durovascular afferent pathway has been explored in laboratory and clinic; interrogated with immunohistochemistry to functional brain imaging to offer a roadmap of the attack. When: migraine attacks emerge due to a disorder of brain sensory processing that itself likely cycles, influenced by genetics and the environment. In the first, premonitory, phase that precedes headache, brain stem and diencephalic systems modulating afferent signals, light-photophobia or sound-phonophobia, begin to dysfunction and eventually to evolve to the pain phase and with time the resolution or postdromal phase. Understanding the biology of migraine through careful bench-based research has led to major classes of therapeutics being identified: triptans, serotonin 5-HT1B/1D receptor agonists; gepants, calcitonin gene-related peptide (CGRP) receptor antagonists; ditans, 5-HT1F receptor agonists, CGRP mechanisms monoclonal antibodies; and glurants, mGlu5 modulators; with the promise of more to come. Investment in understanding migraine has been very successful and leaves us at a new dawn, able to transform its impact on a global scale, as well as understand fundamental aspects of human biology.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Schankin, Christoph

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0031-9333

Publisher:

American Physiological Society

Language:

English

Submitter:

Stefanie Hetzenecker

Date Deposited:

23 Oct 2017 10:49

Last Modified:

23 Oct 2017 10:49

Publisher DOI:

10.1152/physrev.00034.2015

PubMed ID:

28179394

BORIS DOI:

10.7892/boris.102135

URI:

https://boris.unibe.ch/id/eprint/102135

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