What is the pathophysiology of migraine variants (equivalents)?

Updated: Oct 16, 2019
  • Author: Rima M Dafer, MD, MPH, FAHA; Chief Editor: Helmi L Lutsep, MD  more...
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Migraine is associated with a neuronal network excitability, with activation and sensitization of the trigeminovascular system. Cortical spreading depression (CSD), recognized as the neuronal phenomenon underlying visual aura, is believed to begin in the occipital region and then gradually spread anteriorly. [3] This phenomenon is accompanied by a transient oligemia, followed by hyperemia in other parts of the cortex. [4]

Various molecular and cellular mechanisms may lead to the increased susceptibility to CSD in migraineurs, which could potentially play an important role in the pathophysiology of migraine variants. Researchers have suggested that a vasogenic leakage from leptomeningeal vessels, with activation of the trigeminovascular system, probably contribute to the prolonged aura in patients with hemiplegic migraine.

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