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Migraine Diagnosis and Pathophysiology

Ward, Thomas N. MD, FAAN, FAHS

CONTINUUM: Lifelong Learning in Neurology: August 2012 - Volume 18 - Issue 4, Headache - p 753–763
doi: 10.1212/01.CON.0000418640.07405.31
Review Articles

Purpose of Review: This article describes current knowledge regarding headache, especially migraine, and includes information on genetics, anatomy, pathophysiology, and pharmacology in order to demonstrate their relevance to clinical phenomenology.

Recent Findings: Animal models show that drugs effective in migraine prevention may work by raising the threshold for initiating cortical spreading depression and may also attenuate the response to simulation.

Summary: Great advances have been made in diagnosing and understanding migraine over the past several decades. Tools such as the International Classification of Headache Disorders assist in making diagnoses. Although blood vessel changes do occur in migraine, they are not timelocked to the occurrence of head pain. Cortical spreading depression is at least one trigger for the events that occur in migraine. Migraine may be due to the interplay of host susceptibility and various triggers. Nitric oxide and calcitonin gene-related peptide are important mediators, and estrogen seems to “ramp up” the system.

Address correspondence to Dr Thomas N. Ward, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Department of Neurology, Lebanon, NH 03756,

Relationship Disclosure: Dr Ward serves as a consultant for Cowan and Company and the US Department of Justice Vaccine Injury Compensation Program and has served as a medicolegal consultant for the State of New Hampshire and the University of Vermont. Dr Ward serves as editor of Headache Currents. Dr Ward served as a local investigator for a study sponsored by GlaxoSmithKline for which his institution received funding.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Ward discusses the unlabeled use of amitriptyline for migraine prevention.

© 2012 American Academy of Neurology
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