26.02 Pathogenesis of Migraine

While the biochemical initiators of migraine or underlying abnormality that predisposes some individuals are not well known, migraine is now recognized to have neural and vascular involvement, highlighting the important interaction between nerves and the cerebral vessels. The headache originates from pain-sensitive extracerebral structures such as the meninges and large arteries, which are innervated by nociceptive sensory nerves of the trigeminal system, paving the way for the neurogenic inflammation. Another important phenomenon that occurs in migraine is cortical spreading depression, thought to explain the aura or increased susceptibility to migraine.