[Migraine-update--current concepts of migraine pathogenesis]

Abstract

The pathophysiology of migraine still remains unclear. However, abundant evidence in support of the view that migraine as an illness of the central nervous system has been accumulated. First, the hyperexitability in the brain is recognized even in the stage between attacks in migraineurs according to findings of transcranial magnetic stimulation techniques, MRI-BOLD studies or 31P SPECT examinations. Second, cortical spreading depression originating in the occipital cortex is more likely to be related to the aura. Third, sensitization of the trigeminal nerve system is substantially involved in process of headache pain in migraine. Fourth, clonic dysfunction of the priaqueductal gray matter in the brain stem may underlie the migraine pathogenesis. Thus, current concept of susceptibility of migraine is attributed to certain dysfunction of the deep brain structures such as the brain stem rather than the blood vessels in the brain or dura mater.