Symptomatology and Pathogenesis of Migraine

Migraine is a paroxysmal disorder of which headache is the central symptom. The headache is generally so intense that it is associated with other symptoms, such as nausea, vomiting, photo- and phonophobia. In so-called classic migraine or migraine with aura, the headache is preceded by transient focal neurological symptoms, generally referred to as aura symptoms. There is clinical experimental evidence for the involvement of at least three mechanisms in the pathogenesis of the migraine headache. These mechanisms are extracranial arterial vasodilation, extracranial neurogenic inflammation, and decreased inhibition of central pain transmission. The associated symptoms are possibly caused by sympathetic activation at a peripheral (nausea and vomiting) and central level (photo- and phonophobia). The aura symptoms are, in the author's opinion, most likely caused by a mechanism similar to spreading excitation and depression. An adaptation of the traditional concept of the pathogenesis of the migraine attack is presented.