What is the neurovascular theory for migraine headache pathophysiology?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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The neurovascular theory holds that a complex series of neural and vascular events initiates migraine. [11] According to this theory, migraine is primarily a neurogenic process with secondary changes in cerebral perfusion. [12]

At baseline, a migraineur who is not having any headache has a state of neuronal hyperexcitability in the cerebral cortex, especially in the occipital cortex. [13] This finding has been demonstrated in studies of transcranial magnetic stimulation and with functional magnetic resonance imaging (MRI).

This observation explains the special susceptibility of the migrainous brain to headaches. [14] One can draw a parallel with the patient with epilepsy who similarly has interictal neuronal irritability.

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