Cortical spreading depression (CSD) is a phenomenon characterized by a slowly spreading depolarization of cortical cells and is postulated to cause aura associated with migraine. Recently drugs that block gap junctions have been developed to inhibit CSD. In this paper the authors tested the effect of one such drug, tonabersat in patients with migraine. They examined 39 patients in a double blind crossover study and measured attacks of aura with or without headache and migraine headache days with or without aura as primary outcomes. The results showed that tonabersat reduced the number of aura attacks and attacks of aura followed by headache but not the number of migraine headache days. These results suggest that migraine with aura and migraine without aura involve different pathophysiological mechanisms. The study also suggests that drugs targeting gap junctions may be effective in treating migraine with aura (Lancet Neurol 2009 8:718-723).
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