Abstract

Pathogenesis of migraine is still far from clear understanding. Vascular, neurogenic and mixed mecha- nisms are suggested as its etiogenesis. Currently, clinical characteristics of paroxysmal attack, common genetic trait, and neurophysiological evidence of hyperexcitability of cortical neuron in migraineurs sugges- ted migraine as an episodic disorder sharing common pathogenesis, certain types of epilepsy, and other channelopathies. Paroxysmal nature of migraine precipitated by trigger factors resembles periodic paralysis or episodic ataxia. Also, though genetic basis of migraine needs to be determined, the classical concept of genetic trait playing a crucial role in migraine attack is well established. Neurophysiological data from migraineurs are controversial in many aspects, but previous investigations using transcranial magnetic stimulation(TMS), visual evoked potentials(VEPs), and other evoked potentials suggests the cortical neurons of migraine patients are more easily excitable and facilitated than controls. Recently, functional MRI(fMRI) showed hyperemia during the classic spreading depression of potassium-induced migraine in rats. Prog- ression in neurophysiological methods and imaging technique will be helpful in understanding the mechanisms of migraine and clinical diagnosis as well. Research for genetic and molecular basis of migraine is largely obtained from uncommon varieties of familial hemiplegic migraine and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy(CADASIL). Although molecular and genetic understanding of migraine headache in these disorders are firmly established, whether these findings can be generalized in classic/common migraine patients is still under investigation. These new concepts of pathogenesis of migraine answers to many old questions of the nature of spreading depression, triggering of migraine attacks, and the precise cellular mechanisms undergoing in the brain of migraine patients. Korean Journal of Headache 1(1):49-56, 2000