Pathophysiology of migraine: a disorder of sensory processing
Open accessAbstract
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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Mechanism of Action of OnabotulinumtoxinA in Chronic Migraine: A Narrative Review
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Biological insights from the premonitory symptoms of migraine
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Migraine: from pathophysiology to treatment
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Glutamate and Its Receptors as Therapeutic Targets for Migraine
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Self-citationAnti-CGRP Monoclonal Antibodies: the Next Era of Migraine Prevention?
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Self-citationSchwann cell endosome CGRP signals elicit periorbital mechanical allodynia in mice
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Eptinezumab for prevention of chronic migraine: A randomized phase 2b clinical trial
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Chronic migraine: A process of dysmodulation and sensitization
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The fifth cranial nerve in headaches
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Neurovascular mechanisms of migraine and cluster headache
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Self-citationTranscutaneous auricular vagus nerve stimulation (taVNS) for migraine: an fMRI study
Zhang, Y., Huang, Y., Li, H., Yan, Z., Zhang, Y., Liu, X., Hou, X., Chen, W., Tu, Y., Hodges, S., et al. (2020) · Regional Anesthesia & Pain Medicine · doi:10.1136/rapm-2020-102088 · Cited by 138 · see citing works
Targeted Nitric Oxide Synthase Inhibitors for Migraine
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Self-citationCGRP and migraine from a cardiovascular point of view: what do we expect from blocking CGRP?
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Imaging of neuroinflammation in migraine with aura
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Longitudinal Neuroimaging over 30 Days: Temporal Characteristics of Migraine
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Migraine review for general practice
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Chronic Migraine Pathophysiology and Treatment: A Review of Current Perspectives
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Animal models of migraine and experimental techniques used to examine trigeminal sensory processing
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Central Sensitization in Migraine: A Narrative Review
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Targeted 5-HT1F Therapies for Migraine
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Therapeutic novelties in migraine: new drugs, new hope?
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Current Prophylactic Medications for Migraine and Their Potential Mechanisms of Action
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The Molecular Fingerprint of Dorsal Root and Trigeminal Ganglion Neurons
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Increased connectivity of pain matrix in chronic migraine: a resting-state functional MRI study
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Risk factors for migraine disease progression: a narrative review for a patient-centered approach
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Recommendations on the Use of Anti‐CGRP Monoclonal Antibodies in Children and Adolescents
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Self-citationCluster headache pathophysiology — insights from current and emerging treatments
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Self-citationDistribution of CGRP and CGRP receptor components in the rat brain
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An fMRI-based neural marker for migraine without aura
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Pathophysiological Bases of Comorbidity in Migraine
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Structural and Functional Brain Changes in Migraine
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Targeted CGRP Small Molecule Antagonists for Acute Migraine Therapy
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Self-citationAntidepressants for Preventive Treatment of Migraine
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β-blockers: Their new life from hypertension to cancer and migraine
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The CGRP Pathway in Migraine as a Viable Target for Therapies
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Current understanding of cortical structure and function in migraine
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On-demand cell-autonomous gene therapy for brain circuit disorders
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Debate: differences and similarities between tension-type headache and migraine
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Non-invasive dural stimulation in mice: A novel preclinical model of migraine
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Sex and Gender Considerations in Episodic Migraine
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Side effects associated with current and prospective antimigraine pharmacotherapies
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Imaging the Visual Network in the Migraine Spectrum
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Probiotics: Current Landscape and Future Horizons
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Triptans and CGRP blockade – impact on the cranial vasculature
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The Role of Magnesium in Pathophysiology and Migraine Treatment
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Structural and functional footprint of visual snow syndrome
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Self-citation
- 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.
- ORCID
- Venue
- Physiological Reviews
- Publisher
- American Physiological Society
- Published
- 2017-04
- Volume
- 97
- Issue
- 2
- Pages
- 553-622
- ISSN
- 0031-9333 (ISSN-L)
- 1522-1210
- PMC
- PMC5539409
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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