Migraine pathophysiology: Anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain

Migraine involves inherited changes in brain excitability and pain pathways. The trigeminovascular pathway plays a key role in migraine development. Intracranial arterial dilation contributes to migraine symptoms as well. Sensory auras and hypersensitivity to stimuli are common in migraine patients. Clinical studies show reduced activation of pain-inhibiting pathways during attacks. Additionally, patients experience cephalic and body allodynia during migraines. Structural changes include white matter lesions and thickened cortical areas. These alterations affect sensory information processing and are significant for understanding migraines. Cortical spreading depression is a novel factor in migraine-related photophobia. Recent research highlights modulation of the trigeminovascular pathway by brain regions. The brainstem, hypothalamus, and cortex influence migraine symptoms and pain perceptions. Understanding these mechanisms may enhance treatment approaches for those suffering from migraines. Overall, the findings contribute to a deeper understanding of migraine pathophysiology and its neurological impacts. Clinical relevance: This research enhances understanding of migraine mechanisms, potentially leading to better treatments.