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2010 ; 97
(ä): 99-108
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The neurobiology of migraine
#MMPMID20816413
Charles A
; Brennan KC
Handb Clin Neurol
2010[]; 97
(ä): 99-108
PMID20816413
show ga
The understanding of migraine has moved well beyond its traditional
characterization as a "vascular headache." In considering the basic neurobiology
of migraine, it is important to begin with the concept of migraine as not merely
a headache, but rather a heterogeneous array of episodic symptoms. Among the
array of phenomena experienced by migraine patients are visual disturbances,
nausea, cognitive dysfunction, fatigue, and sensitivity to light, sound, smell,
and touch. These symptoms may occur independently or in any combination, and in
some patients occur even in the absence of headache. The diversity and
variability of symptoms experienced by migraine patients belies a complex
neurobiology, involving multiple cellular, neurochemical, and neurophysiological
processes occurring at multiple neuroanatomical sites. Migraine is a multifaceted
neurobiological phenomenon that involves activation of diverse neurochemical and
cellular signaling pathways in multiple regions of the brain. Propagated waves of
cellular activity in the cortex, possibly involving distinct glial and vascular
signaling mechanisms, can occur along with activation of brainstem centers and
nociceptive pathways. Whether different brain regions become involved in a linear
sequence, or as parallel processes, is uncertain. The modulation of brain
signaling by genetic factors, and by sex and sex hormones, provides important
clues regarding the fundamental mechanisms by which migraine is initiated and
sustained. Each of these mechanisms may represent distinct therapeutic targets
for this complex and commonly disabling disorder.