A migraine attack is an extraordinarily complex brain event that takes place over hours to days. This review focuses on recent human studies that shed light on the evolution of a migraine attack. It begins with a constellation of premonitory symptoms that are associated with activation of the hypothalamus and may involve the neurotransmitter dopamine. Even in the premonitory phase, patients experience sensitivity to sensory stimuli, indicating that central sensitization is a primary phenomenon. The migraine attack progresses to a phase that in some patients includes aura, which involves changes in cortical function, blood flow, and neurovascular coupling. The aura phase overlaps with the headache phase, which is associated with further changes in blood flow and function of the brainstem, thalamus, hypothalamus, and cortex. Serotonin receptors, nitric oxide, calcitonin gene-related peptide, pituitary adenylate cyclase-activating polypeptide, and prostanoids are demonstrated specific chemical mediators of migraine based on therapeutic and triggered migraine studies. A number of migraine symptoms persist beyond resolution of headache into a postdromal phase, accompanied by persistent blood flow changes in several brain regions. Although these phases of migraine have substantial temporal, neurochemical, and anatomical overlap, each represents an important window onto the pathophysiology of migraine as well as a target for therapeutic intervention. A comprehensive approach to migraine requires an understanding of the entire range of mechanisms and resultant symptoms that occur throughout the evolution of an attack.
Showing posts with label aura. Show all posts
Showing posts with label aura. Show all posts
Thursday, January 3, 2013
Wednesday, September 9, 2009
Right-to-left shunt is common in chronic migraine
Right-to-left shunt is common in chronic migraine
SJ Nahas 1 , WB Young 1 , R Terry 2 , A Kim 2 , T Van Dell 2 , AJ Guarino 3 & SD Silberstein 1
1 Thomas Jefferson University Hospital, Department of Neurology and 2 Jefferson Medical College, Philadelphia, PA, and
3 Massachusetts General Hospital, Institute of Health Professions, Boston, MA, USA
Correspondence to Stephanie J Nahas, 111 S. 11th St., Suite 8130, Philadelphia, PA 19107, USA. Tel. + 1-215-955-2031, fax + 1-215-955-1960, e-mail stephanie.nahas@jefferson.edu
Copyright © 2009 International Headache Society
ABSTRACT
Our aim was to determine the prevalence of right-to-left shunt (RtLS) in patients with chronic migraine (CM), and to correlate the presence and grade of RtLS with aura and neurological symptoms, and duration and severity of disease. The prevalence of RtLS in migraine without aura is similar to that of the general population (between 20 and 35%). In migraine with aura, the prevalence is much higher (approximately 50%). The prevalence in CM, with or without aura, is unknown. Consecutive patients between the ages of 18 and 60 years with CM attending a tertiary care specialty headache clinic over an 8-week period were eligible. There were 131 patients in the study. A structured diagnostic interview was performed. Bubble transcranial Doppler with Valsalva manoeuvre determined RtLS presence and grade. Sixty-six percent (86/131) of patients had RtLS, a statistically significantly greater rate than those reported in the general population and in migraine with or without aura (P < 0.001). There was no difference in RtLS rate or grade between those with and those without aura. Specific headache features and the presence of neurological symptoms were similar between those with and those without RtLS. Compared with both the general population and the episodic migraine population (with and without aura), patients with CM, with or without aura, are more likely to have RtLS. The clinical implications of our findings need to be determined.
Received 1 June 2009, accepted 31 July 2009
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1468-2982.2009.02002.x About DOI
SJ Nahas 1 , WB Young 1 , R Terry 2 , A Kim 2 , T Van Dell 2 , AJ Guarino 3 & SD Silberstein 1
1 Thomas Jefferson University Hospital, Department of Neurology and 2 Jefferson Medical College, Philadelphia, PA, and
3 Massachusetts General Hospital, Institute of Health Professions, Boston, MA, USA
Correspondence to Stephanie J Nahas, 111 S. 11th St., Suite 8130, Philadelphia, PA 19107, USA. Tel. + 1-215-955-2031, fax + 1-215-955-1960, e-mail stephanie.nahas@jefferson.edu
Copyright © 2009 International Headache Society
ABSTRACT
Our aim was to determine the prevalence of right-to-left shunt (RtLS) in patients with chronic migraine (CM), and to correlate the presence and grade of RtLS with aura and neurological symptoms, and duration and severity of disease. The prevalence of RtLS in migraine without aura is similar to that of the general population (between 20 and 35%). In migraine with aura, the prevalence is much higher (approximately 50%). The prevalence in CM, with or without aura, is unknown. Consecutive patients between the ages of 18 and 60 years with CM attending a tertiary care specialty headache clinic over an 8-week period were eligible. There were 131 patients in the study. A structured diagnostic interview was performed. Bubble transcranial Doppler with Valsalva manoeuvre determined RtLS presence and grade. Sixty-six percent (86/131) of patients had RtLS, a statistically significantly greater rate than those reported in the general population and in migraine with or without aura (P < 0.001). There was no difference in RtLS rate or grade between those with and those without aura. Specific headache features and the presence of neurological symptoms were similar between those with and those without RtLS. Compared with both the general population and the episodic migraine population (with and without aura), patients with CM, with or without aura, are more likely to have RtLS. The clinical implications of our findings need to be determined.
Received 1 June 2009, accepted 31 July 2009
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1468-2982.2009.02002.x About DOI
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