What is the role of cortical spreading depression in the pathogenesis of pediatric migraine headache?

Updated: Jan 02, 2019
  • Author: J Ivan Lopez, MD, FAAN, FAHS; Chief Editor: George I Jallo, MD  more...
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Another mechanism thought to result in migraine headache has its origin in the brain stem. The onset of the aura in migraine headache is thought to be mediated by cortical spreading depression (CSD)—caused by neuronal activation followed by suppression—which spreads over the cortical surface. A simultaneous change occurs in cerebral blood flow, characterized by hyperperfusion, followed by hypoperfusion.

CSD is thought to be caused by either trauma or changes in the local concentrations of hydrogen ions, potassium, and glutamate. CSD activates central nervous system (CNS) nociceptors, possibly through the release of nitric oxide, atrionatriuretic factor, activation of noradrenergic pathways, and/or changes in cerebral blood flow. CSD also causes neurogenic inflammation, which stimulates the release of several different neurotransmitters that lead to cerebral vasodilatation and activation of CNS nociceptors.

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