Migraine, endothelium, hemodynamics

Excerpt

The involvement of cerebral circulation in migraine physiopathology is a milestone since the first reports on migraine until the more recent reviews. Nevertheless, although vasodilation following vasoconstriction was considered in the past the principle responsible for migraineurs pain, not even when Willis proposed the “vascular hypothesis,” he hypothesized vascular dysfunction to be the initial determinant of migraine. Neuroimaging studies allowed us to localize the first driver of migraine attacks in the functional changes in hypothalamic-brainstem connectivity. Even so, substances with vasodilatory effects may trigger migraine attacks and a recent meta-analysis of susceptibility genes for migraine identified enrichment for genes expressed in vascular and smooth muscle tissues, consistent with the predominant vascular involvement. These observations question again whether vasodilation is the cause of the pulsatile migraine or an associated bystander phenomenon induced by the neuropeptides responsible for pain transmission. Other questions raise: does this hemodynamics involvement explain the increased vascular risk for stroke in migraine patients? Do hemodynamics and endothelium function have a role in migraine chronicization? And the other way around: do recurrent migraines affect cerebral hemodynamics and endothelium function? In addition, the forthcoming commercial use of new class drugs with a potential effect on circulation increases again the interest on the relationship between migraine and hemodynamics. …