What is the vascular theory of migraine etiology?

Updated: Aug 15, 2019
  • Author: William C Robertson, Jr, MD; Chief Editor: Amy Kao, MD  more...
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The vascular theory, as proposed by Graham and Wolff in 1938, was long accepted as a plausible explanation of the characteristic sensory and motor disturbances in migraine with aura. The vascular theory views migraine as having 2 phases.

The first phase (the prodromal phase) is characterized by vasospasm, which causes focal cerebral ischemia and transient neurologic symptoms. The second phase results from compensatory vasodilation of the intracranial and extracranial vasculature. Brain acidosis and stretching of pain fibers in arterial walls would then cause a pulsating headache.

Although the vascular theory influenced medical literature for many decades, the involvement of the cranial vessels in the initiation and pathogenesis of migraine is now under considerable debate.

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