Expert Opinion: “Evidence for vascular factor in migraine”

Expert Opinion on the Journal Article “Evidence for vascular factor in migraine”

This published study shows that dilation (enlargement) of arteries in the brain area occurs during a migraine. This helps confirm the theory that migraine is, in part, a vascular headache. This study also demonstrates that dilation of the arteries, both the middle meningeal artery (MMA) and the intracranial middle cerebral artery (MCA) only occurs on the side of the headache if it is a one-sided headache. If the headache is bilateral, then the dilation is bilateral. In addition, this study demonstrates that Sumatriptan (triptan medication also known as Imitrex) constricts the MMA but not the MCA but still helps the headache go away.

In summary, this study helps confirm a vascular role in migraine without aura. One of the roles of the triptan medications is vasoconstriction of the meningeal arteries; this study demonstrates this as well as showing that this activity helps the pain. So much attention in recent years has looked at the trigeminal nerve; the brainstem; and processes such as “cortical spreading depression” and “waves of depolarization” that it is nice to know that some of the basic theory of blood vessel involvement is still true. Years old migraine was referred to as the “vascular” headache; in part, that is still true and this study confirms that what we used to think was not wrong, it was just incomplete. Our knowledge of what occurs during a migraine and what happens with treatment continues to evolve.

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