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Cortical spreading depression and migraine

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TLDR
Current concepts of CSD and its potential roles in migraine are summarized, and ongoing studies aimed at a clearer understanding of this fundamental brain phenomenon are addressed.
Abstract
Cortical spreading depression (CSD), a slowly propagated wave of depolarization followed by suppression of brain activity, is a remarkably complex event that involves dramatic changes in neural and vascular function. Since its original description in the 1940s, CSD has been hypothesized to be the underlying mechanism of the migraine aura. Substantial evidence from animal models provides indirect support for this hypothesis, and studies showing that CSD is common in humans with brain injury clearly demonstrate that the phenomenon can occur in the human brain. Considerable uncertainty about the role of CSD in migraine remains, however, and key questions about how this event is initiated, how it spreads, and how it might cause migraine symptoms remain unanswered. This Review summarizes current concepts of CSD and its potential roles in migraine, and addresses ongoing studies aimed at a clearer understanding of this fundamental brain phenomenon.

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Citations
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Journal ArticleDOI

Sex differences in the epidemiology, clinical features, and pathophysiology of migraine

TL;DR: Although migraine is often recognised in women, it is underdiagnosed in men, resulting in suboptimal management and less participation of men in clinical trials.
Journal ArticleDOI

The pathophysiology of migraine: implications for clinical management.

TL;DR: The identification of new migraine-associated genes, the visualisation of brain regions that are activated at the earliest stages of a migraine attack, and the recognition of the crucial role for neuropeptides are among the advances that have led to novel targets for migraine therapy.
Journal ArticleDOI

Chaos and commotion in the wake of cortical spreading depression and spreading depolarizations

TL;DR: The once-held view that spreading depolarizations may not exist in the human brain has changed, largely because of the discovery of migraine genes that confer cortical spreading depression susceptibility, the application of sophisticated imaging tools and efforts to interrogate their impact in the acutely injured human brain.
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Calcitonin gene-related peptide (CGRP): a new target for migraine.

TL;DR: Targeting CGRP represents an approachable therapeutic strategy for migraine because of its ability to enhance sensitivity to sensory input at multiple levels in both the periphery and central nervous system.
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The Stroke-Migraine Depolarization Continuum

TL;DR: The neurobiology of SD--its triggers and propagation mechanisms--as well as clinical manifestations of SD, including overlaps and differences between migraine aura and stroke, are presented, and recent developments in neuromonitoring aimed at better diagnosis and more targeted treatments are presented.
References
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Journal ArticleDOI

The International Classification of Headache Disorders, 3rd edition (beta version)

Jes Olesen, +131 more
- 01 Jul 2013 - 
TL;DR: The International Classification of Headache Disorders, 3 edition (beta version), may be reproduced freely for scientific, educational or clinical uses by institutions, societies or individuals as mentioned in this paper. But the authors require the permission of the International Headache Society.
Journal ArticleDOI

Spreading depression of activity in the cerebral cortex

TL;DR: In this article, an interesting response elicited by electrical stimulation was noticed in the cortex of rabbits, and the distinctive feature of this response was a marked, enduring reduction of the "spontaneous" electrical activity of the cortex.
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Glutamate induces calcium waves in cultured astrocytes: long-range glial signaling

TL;DR: It is reported that cultured hippocampal astrocytes can respond to glutamate with a prompt and oscillatory elevation of cytoplasmic free calcium, visible through use of the fluorescent calcium indicator fluo-3.
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Mechanisms of migraine aura revealed by functional MRI in human visual cortex

TL;DR: High-field functional MRI with near-continuous recording during visual aura in three subjects observed blood oxygenation level-dependent signal changes that strongly suggest that an electrophysiological event such as CSD generates the aura in human visual cortex.
Journal ArticleDOI

Intrinsic brain activity triggers trigeminal meningeal afferents in a migraine model

TL;DR: This work establishes a link between migraine aura and headache by demonstrating that cortical spreading depression activates trigeminovascular afferents and evokes a series of cortical meningeal and brainstem events consistent with the development of headache.
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