Department of Neurology and Algology, Gazi University Faculty of Medicine, Besevler, 06510, Ankara, Turkey.
Neuropsychiatry Center, Gazi University, Besevler, Ankara, Turkey.
J Headache Pain. 2019 Sep 3;20(1):94. doi: 10.1186/s10194-019-1042-8.
Migraine is a complex brain disorder and initiating events for acute attacks still remain unclear. It seems difficult to explain the development of migraine headache with one mechanism and/or a single anatomical location. Cortical spreading depression (CSD) is recognized as the biological substrate of migraine aura and experimental animal studies have provided mechanisms that possibly link CSD to the activation of trigeminal neurons mediating lateralized head pain. However, some CSD features do not match the clinical features of migraine headache and there are gaps in translating CSD to migraine with aura. Clinical features of migraine headache and results from research are critically evaluated; and consistent and inconsistent findings are discussed according to the known basic features of canonical CSD: typical SD limited to the cerebral cortex as it was originally defined. Alternatively, arguments related to the emergence of SD in other brain structures in addition to the cerebral cortex or CSD initiated dysfunction in the thalamocortical network are proposed. Accordingly, including thalamus, particularly reticular nucleus and higher order thalamic nuclei, which functions as a hub connecting the visual, somatosensory, language and motor cortical areas and subjects to modulation by brain stem projections into the CSD theory, would greatly improve our current understanding of migraine.
偏头痛是一种复杂的脑部疾病，其急性发作的起始事件仍不清楚。用一种机制和/或单一解剖部位来解释偏头痛的发生似乎很困难。皮质扩散性抑制（CSD）被认为是偏头痛先兆的生物学基础，实验动物研究提供了可能将 CSD 与介导偏侧头痛的三叉神经神经元激活联系起来的机制。然而，CSD 的一些特征与偏头痛头痛的临床特征不匹配，并且 CSD 向有先兆偏头痛的转化存在差距。对偏头痛头痛的临床特征和研究结果进行了批判性评估；并根据经典 CSD 的已知基本特征，根据一致和不一致的发现进行了讨论：最初定义的仅限于大脑皮层的典型 SD。或者，提出了除大脑皮层之外的其他脑结构中 SD 的出现或丘脑皮质网络中 CSD 引发的功能障碍的相关论点。因此，包括丘脑，特别是网状核和高级丘脑核，作为连接视觉、躯体感觉、语言和运动皮质区域的枢纽，受脑干投射到 CSD 理论中的调制，将极大地提高我们对偏头痛的理解。
