60 years of migraine research. Retrospective review and synopsis

Abstract

At the end of the thirties, the first papers from Wolff and Graham represented the beginning of modern migraine research. Since that time advance is important. Several medical disciplines and special fields in research such as neurology, clinical and experimental neurophysiology, neuroradiology, psychiatry, medical psychology, psychosomatics, biochemistry, genetics, pharmacology, epidemiology contributed to the new cognitions. Further exploration of genetics and of the interictal neuronal and neurovascular dysfunctions are the key for both understanding of migraine as disease and pathogenesis of migraine attacks. All together migraine may be defined as a specific dysfunction in neuronal information processing and neurovascular reagibility corresponding with imbalance of certain neurotransmitters (NA, 5-HT) and leading to ictal reactions of brain areas and intracranial vessels in critical phases of hyperreagibility and hyperactivity. In the pathogenetical and pathophysiological processing both genetic and acquired mechanisms might be involved. Aura symptoms result from abnormal vasoconstriction with oligemia or ischemia of the tissue as Wolff supposed it. The headache phase follows with delay because the pain inducing neurogenic inflammation in the vessel walls need more time for clinical manifestation than the oligemic resp. ischemic brain symptoms.