Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Diversity, Equity, & Inclusion (DEI)
    • Neurology: Clinical Practice Accelerator
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Neurology Future Forecasting Series
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
    • UDDA Revision Series
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Diversity, Equity, & Inclusion (DEI)
    • Neurology: Clinical Practice Accelerator
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Neurology Future Forecasting Series
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
    • UDDA Revision Series
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Neurology Video Journal Club
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Neurology Video Journal Club
  • Residents & Fellows

Migraine: A cycling disorder driven by the brain

  • Arne May, University Clinic Hamburg[email protected]
  • Laura Schulte
Submitted September 27, 2017

We thank Dr. Gupta for the comments on our article. [1] We agree that neither aura nor headache mark the true onset of a migraine attack. We disagree, however, that the examples presented by Dr. Gupta contradict the hypothesis of central migraine mediators.

All named triggers, including stress and exercise, are dependent on the threshold or susceptibility for attack generation, which varies over time. [2] This threshold variation is, per definition, based on central neuronal changes. Moreover, most reported triggers may not be triggers at all, but misinterpreted (premonitory) migraine symptoms. Delayed headache onset after trigger exposure is thus merely an observation which supports, rather than contradicts, the hypothesis of a central mediator in migraine pathophysiology.

The distinct clinical presentation of the premonitory phase of migraine strongly suggests hypothalamic and central dopaminergic involvement; [3,4] although, at present, involvement of peripheral changes cannot be ruled out.

A unilateral or side-locked headache is not pathognomonic of migraine. Bilateral neuronal activations are, consequently, not contradictory to the clinical presentation of migraine headaches.

The fact that a prophylactic treatment does not cross the blood brain barrier does not contradict the hypothesis that central mechanisms are crucially involved in migraine [5] and chronic migraine [1] pathophysiology: central mechanisms lead to peripheral changes and vice versa. Inhibition of the peripheral side will, based on feed-back mechanisms, alter central modulators and does not contradict a central modulator of migraine.

1. Schulte LH, Allers A, May A. Hypothalamus as a mediator of chronic migraine: Evidence from high-resolution fMRI. Neurology 2017;88:2011-2016.

2. May A, Schulte LH. Chronic migraine: risk factors, mechanisms and treatment. Nat Rev Neurol 2016;12:455-464.

3. Akerman S, Goadsby PJ. Dopamine and migraine: biology and clinical implications. Cephalalgia 2007;27:1308-1314.

4. Charbit AR, Akerman S, Goadsby PJ. Dopamine: what's new in migraine? Curr Opin Neurol 2010;23:275-281.

5. Schulte LH, May A. The migraine generator revisited: continuous scanning of the migraine cycle over 30 days and three spontaneous attacks. Brain 2016;139:1987-1993.

For disclosures, please contact the editorial office at [email protected].

Navigate back to article

Neurology: 101 (22)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Education
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2023 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise