Headache and Pain Unit, IRCCS San Raffaele Pisana, Rome, Italy.
San Raffaele University, Rome, Italy.
Headache. 2020 Oct;60(9):2103-2114. doi: 10.1111/head.13935. Epub 2020 Aug 26.
Migraine is an exclusively human chronic disorder with ictal manifestations characterized by a multifaceted clinical complexity pointing to a cerebral cortical involvement. The present review is aimed to cover the clinical, neuroimaging, and neurophysiological literature on the role of the cerebral cortex in migraine pathophysiology.
Converging clinical scenarios, advanced neuroimaging data, and experimental neurophysiological findings, indicate that fluctuating excitability, plasticity, and metabolism of cortical neurons represent the pathophysiological substrate of the migraine cycle. Abnormal cortical responsivity and sensory processing coupled to a mismatch between the brain's energy reserve and workload may ignite the trigeminovascular system, leading to the migraine attack through the activation of subcortical brain trigeminal and extra-trigeminal structures, and driving its propagation and maintenance.
The brain cortex emerges as the crucial player in migraine, a disorder lying at the intersection between neuroscience and daily life. Migraine disorder stems from an imbalance in inhibitory/excitatory cortical circuits, responsible for functional changes in the activity of different cortical brain regions encompassing the neurolimbic-pain network, and secondarily allowing a demodulation of subcortical areas, such as hypothalamus, amygdala, and brainstem nuclei, in a continuous mutual crosstalk.
偏头痛是一种仅发生于人类的慢性疾病，其发作期表现为多方面的临床复杂性，提示涉及大脑皮质。本综述旨在涵盖有关大脑皮质在偏头痛发病机制中的作用的临床、神经影像学和神经生理学文献。
趋同的临床情况、先进的神经影像学数据和实验性神经生理学发现表明，皮质神经元的兴奋性、可塑性和代谢波动是偏头痛周期的病理生理学基础。皮质反应性和感觉处理异常，加上大脑的能量储备和工作量之间不匹配，可能引发三叉神经血管系统，通过激活皮质下脑三叉神经和三叉神经外结构，引发偏头痛发作，并驱动其传播和维持。
大脑皮质是偏头痛的关键参与者，偏头痛是神经科学和日常生活的交叉点。偏头痛障碍源于皮质抑制/兴奋回路的失衡，负责不同皮质脑区活动的功能变化，涵盖神经边缘-疼痛网络，其次允许在下丘脑、杏仁核和脑干核等皮质下区域进行解调，在持续的相互串扰中。
