Cited by 1,998Migraine and Headache StudiesPain Mechanisms and TreatmentsInflammasome and immune disorders

Pathophysiology of migraine: a disorder of sensory processing

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Goadsby, Peter J., Holland, Philip R., Martins-Oliveira, Margarida, Hoffmann, Jan, Schankin, Christoph, Akerman, Simon·2017·Physiological Reviews

Abstract

Plaguing humans for more than two millennia, manifest on every continent studied, and with more than one billion patients having an attack in any year, migraine stands as the sixth most common cause of disability on the planet. The pathophysiology of migraine has emerged from a historical consideration of the “humors” through mid-20th century distraction of the now defunct Vascular Theory to a clear place as a neurological disorder. It could be said there are three questions: why, how, and when? Why: migraine is largely accepted to be an inherited tendency for the brain to lose control of its inputs. How: the now classical trigeminal durovascular afferent pathway has been explored in laboratory and clinic; interrogated with immunohistochemistry to functional brain imaging to offer a roadmap of the attack. When: migraine attacks emerge due to a disorder of brain sensory processing that itself likely cycles, influenced by genetics and the environment. In the first, premonitory, phase that precedes headache, brain stem and diencephalic systems modulating afferent signals, light-photophobia or sound-phonophobia, begin to dysfunction and eventually to evolve to the pain phase and with time the resolution or postdromal phase. Understanding the biology of migraine through careful bench-based research has led to major classes of therapeutics being identified: triptans, serotonin 5-HT 1B/1D receptor agonists; gepants, calcitonin gene-related peptide (CGRP) receptor antagonists; ditans, 5-HT 1F receptor agonists, CGRP mechanisms monoclonal antibodies; and glurants, mGlu 5 modulators; with the promise of more to come. Investment in understanding migraine has been very successful and leaves us at a new dawn, able to transform its impact on a global scale, as well as understand fundamental aspects of human biology.

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Crossref · 10.1152/physrev.00034.2015

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Authors
Goadsby, P. J., Holland, P. R., Martins-Oliveira, M., Hoffmann, J., Schankin, C., & Akerman, S.
Affiliations
University of Bern (CH)
Corresponding author
Goadsby, Peter J.
Venue
Physiological Reviews
Published
2017-04
Volume
97
Issue
2
Pages
553-622
ISSN
  • 0031-9333 (ISSN-L)
  • 1522-1210
OpenAlex
W2586533881
Cited by
1,998
References
893
Citations by year
2026: 243 · 2025: 247 · 2024: 256 · 2023: 245 · 2022: 259 · 2021: 219 · 2020: 212 · 2019: 174 · 2018: 100 · 2017: 41 · 2016: 1
FWCI
21.91
Type
journal article
Language
en
Open access
Locations
  • Physiological Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion, other-oa)
Funders
  • U.S. Department of Defense
  • Sandler Foundation
  • Wellcome Trust (104033/Z/14/Z)
  • National Institute for Health and Care Research
  • European Commission (602633)
  • Fundação para a Ciência e a Tecnologia (SFRH/BD/77127/2011)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Inflammasome and immune disorders
Keywords
migraine pathophysiology, sensory processing, migraine phases, photophobia, phonophobia, migraine genetics, migraine treatment, triptans, gepants, CGRP receptor antagonists, ditans, headache
MeSH terms
Receptor, Serotonin, 5-HT1F, Animals, Brain, Cognition, Humans, Migraine Disorders, Receptors, Serotonin, Calcitonin Gene-Related Peptide, Receptors, Calcitonin Gene-Related Peptide

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