Abstract
Despite the fact that an unprecedented series of new discoveries in neurochemistry, neuroimaging, genetics and clinical pharmacology accumulated over the last 20 years has significantly increased our current knowledge, the underlying mechanism of the migraine headache remains elusive. The present review article addresses, from early evidence that emerged at the end of the nineteenth century, the role of ‘antidromic vasodilatation’ as part of the more general phenomenon, currently defined as neurogenic inflammation, in the unique type of pain reported by patients suffering from migraine headaches. The present paper describes distinctive orthodromic and antidromic properties of a subset of somatosensory neurons, the vascular- and neurobiology of peptides contained in these neurons, and the clinical–pharmacological data obtained in recent investigations using provocation tests in experimental animals and human beings. Altogether, previous and recent data underscore that antidromic vasodilatation, originating from the activation of peptidergic somatosensory neurons, cannot yet be discarded as a major contributing mechanism of the throbbing head pain and hyperalgesia of migraine.
Highlights
Early studiesPioneering physiological studies at the end of the nineteenth century through the beginning of the twentieth postulated the existence of a double function of a subset of sensory, afferent neurons with cell bodies located in the dorsal root ganglia (DRG)
Despite the fact that an unprecedented series of new discoveries in neurochemistry, neuroimaging, genetics and clinical pharmacology accumulated over the last 20 years has significantly increased our current knowledge, the underlying mechanism of the migraine headache remains elusive
The present review article addresses, from early evidence that emerged at the end of the nineteenth century, the role of ‘antidromic vasodilatation’ as part of the more general phenomenon, currently defined as neurogenic inflammation, in the unique type of pain reported by patients suffering from migraine headaches
Summary
Pioneering physiological studies at the end of the nineteenth century through the beginning of the twentieth postulated the existence of a double function of a subset of sensory, afferent neurons with cell bodies located in the dorsal root ganglia (DRG). ‘There are nerve-fibres in the posterior roots of the 5th, 6th, and 7th lumbar and 1st sacral nerves, excitation of which, when cut away from the spinal cord, gives rise to vascular dilatation in the hind-limb of the same side. 2. ‘They do not degenerate when cut between spinal cord and posterior root ganglion, they are not spinal efferent fibres. 3. ‘They are, identical with the ordinary sensory afferent posterior root-fibres; the name ‘‘antidromic’’ is suggested for the process by which nerve-fibres convey impulses in a direction contrary to that assumed by the Bell–Majendie law, when such impulses produce effects in the organs at the origin of such fibres, e.g. when afferent fibres excited at their ends in the central nervous system produce vascular dilatation at their peripheral ends in the tissues of the body.’
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