Of generators, networks and migraine attacks

TY - JOUR

T1 - Of generators, networks and migraine attacks

AU - Schulte, Laura H

AU - May, Arne

PY - 2017/6

Y1 - 2017/6

N2 - PURPOSE OF REVIEW: One of the most discussed topics in migraine pathophysiology is where migraine attacks originate. Although recent evidence suggests central attack generating loci, there is an ongoing debate about the involved centres of the brain and brainstem.RECENT FINDINGS: Recent neuroimaging studies focussing on the preictal stage of migraine attacks suggest a predominant role of the hypothalamus and its functional connectivity shortly before the beginning of migraine headaches. In interictal migraineurs, changes in resting state functional connectivity of the dorsal pons and the hypothalamus have been found.SUMMARY: Based on the clinical presentation of the premonitory phase of migraine, the hypothalamus and changes within the dopaminergic system have been discussed as likely candidates for attack generation. Neuroimaging studies however suggested the dorsal pons as attack generator. Taking into account the recent findings of hypothalamic involvement and changing connectivity in the preictal stage, the available evidence suggests that the idea of a single migraine generator within the human brain is probably too simplistic. More likely, spontaneous oscillations of complex networks lead to activity changes in certain subcortical and brainstem areas. This in turn might constitute functional changes of descending pain-modulating pathways, and thus the generation of migraine pain.

AB - PURPOSE OF REVIEW: One of the most discussed topics in migraine pathophysiology is where migraine attacks originate. Although recent evidence suggests central attack generating loci, there is an ongoing debate about the involved centres of the brain and brainstem.RECENT FINDINGS: Recent neuroimaging studies focussing on the preictal stage of migraine attacks suggest a predominant role of the hypothalamus and its functional connectivity shortly before the beginning of migraine headaches. In interictal migraineurs, changes in resting state functional connectivity of the dorsal pons and the hypothalamus have been found.SUMMARY: Based on the clinical presentation of the premonitory phase of migraine, the hypothalamus and changes within the dopaminergic system have been discussed as likely candidates for attack generation. Neuroimaging studies however suggested the dorsal pons as attack generator. Taking into account the recent findings of hypothalamic involvement and changing connectivity in the preictal stage, the available evidence suggests that the idea of a single migraine generator within the human brain is probably too simplistic. More likely, spontaneous oscillations of complex networks lead to activity changes in certain subcortical and brainstem areas. This in turn might constitute functional changes of descending pain-modulating pathways, and thus the generation of migraine pain.

KW - Brain

KW - Brain Stem

KW - Humans

KW - Hypothalamus

KW - Migraine Disorders

KW - Nerve Net

KW - Neuroimaging

KW - Pons

KW - Journal Article

KW - Review

U2 - 10.1097/WCO.0000000000000441

DO - 10.1097/WCO.0000000000000441

M3 - SCORING: Review article

C2 - 28240611

VL - 30

SP - 241

EP - 245

JO - CURR OPIN NEUROL

JF - CURR OPIN NEUROL

SN - 1350-7540

IS - 3

ER -