Issue N# 1 - 2004
Migraine, neurone and vessel
Authors : M. Ballester (Dijon)
Ref. : Rev Laryngol Otol Rhinol. 2004;125,1:71-72.
Article published in french
Downloadable PDF document french
What, of the neurone or the vessel, triggers a migraine? Neuronal theory seems to dominate. Functional imaging confirms a neuronal primum movens. It shows that the classical hypothesis – a migraine is linked to the reduction of the regional cerebral blood flow (rCBF), followed by a vasodilatation responsible for the headache –, is false. On the contrary, an increase of the rCBF is very often observed at the phase of the aura. One of the possible pathophysiological mechanisms would be the activation of the trigemino-vascular system, with neurogen inflammation of meningeal vessels and central sensitization of trigeminal neurones. The primum movens could be a propagated cortical depression, already observed in patients having presented crises while they were in a positron emission tomography scan (PET-Scan). The links with the cerebral trunk structures remains to clarify. The anti-epileptics acting on the cerebral cortex but also on the cerebral trunk, as well as the anti-5-HT2 on the trigemino-vascular system, are effective therapeutics. The mechanisms of action of calcic inhibitors and beta blockers remains unclear.
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