Migraine: from pathophysiology to treatment

Journal of Neurology, Journal Year: 2023, Volume and Issue: 270(7), P. 3654 - 3666

Published: April 8, 2023

Migraine is an extremely disabling, common neurological disorder characterized by a complex neurobiology, involving series of central and peripheral nervous system areas networks. A growing increase in the understanding migraine pathophysiology recent years has facilitated translation that knowledge into novel treatments, which are currently becoming available to patients many parts world substantially changing clinical approach disease. In first part this review, we will provide up date overview analyzing anatomy function main regions involved disease, focusing on how these give rise plethora symptoms characterizing attacks overall The second paper discuss therapeutic agents have emerged for treatment migraine, including molecules targeting calcitonin gene-related peptide (gepants monoclonal antibodies), serotonin 5-HT1F receptor agonists (ditans) non-invasive neuromodulation, as well providing brief new evidence classic treatments.

Language: Английский

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Chronic Stress and Headaches: The Role of the HPA Axis and Autonomic Nervous System

Biomedicines, Journal Year: 2025, Volume and Issue: 13(2), P. 463 - 463

Published: Feb. 13, 2025

Chronic stress significantly influences the pathogenesis of headache disorders, affecting millions worldwide. This review explores intricate relationship between and headaches, focusing on dysregulation hypothalamic-pituitary-adrenal (HPA) axis autonomic nervous system (ANS). Persistent could lead to neuroinflammation, increased pain sensitivity, vascular changes that contribute development progression. The bidirectional nature this creates a vicious cycle, with recurrent headaches becoming source additional stress. Dysregulation HPA ANS imbalance amplify susceptibility intensifying their frequency severity. While pharmacological interventions remain common, non-pharmacological approaches targeting reduction, such as cognitive-behavioral therapy, biofeedback, relaxation techniques, offer promising avenues for comprehensive management. By addressing underlying stress-related mechanisms, these provide sustainable strategy reduce improve patients' quality life.

Language: Английский

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Idiopathic intracranial hypertension: a step change in understanding the disease mechanisms

Nature Reviews Neurology, Journal Year: 2023, Volume and Issue: 19(12), P. 769 - 785

Published: Nov. 13, 2023

Language: Английский

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Navigating the Neurobiology of Migraine: From Pathways to Potential Therapies

Cells, Journal Year: 2024, Volume and Issue: 13(13), P. 1098 - 1098

Published: June 25, 2024

Migraine is a debilitating neurological disorder characterized by recurring episodes of throbbing headaches that are frequently accompanied sensory disturbances, nausea, and sensitivity to light sound [...]

Language: Английский

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Medication “underuse” headache

Cephalalgia, Journal Year: 2024, Volume and Issue: 44(4)

Published: April 1, 2024

Background Many risk factors have been associated with migraine progression, including insufficient and ineffective utilization of medications; however, they inadequately explored. This has resulted in suboptimal usage medications without effective altering prescribing recommendations for patients, posing a chronification. Methods Our aim is to conduct comprehensive review the available evidence regarding underuse medications, both acute preventive. The term “underuse” includes, but not limited to: ( 1 ) use appropriate inappropriate medication; 2 underutilization; 3 timing usage; 4 patient dissatisfaction medication. Results preventive shown contribute progression migraine. In terms medication, chronification occurs as result drug use, failure prescriber select type based on pain intensity disability, patients taking medication too late (more than 60 minutes after onset or central sensitization occurred evidenced by allodynia), discontinuation because lack effect intolerable side effects. underlying cause inadequate effectiveness lies its inability halt propagation peripheral activation timely manner. For oral injectable efficacy effects led poor adherence subsequent pathophysiology here rooted repetitive stimulation afferent sensory fibers, followed ascending brainstem pathways plus dysfunction endogenous descending inhibitory pathway. Although anti-calcitonin gene-related peptide (CGRP) partially address caused above factors, decreased tolerability from conventional therapy, some do respond well this treatment. Research suggests that initiating anti-CGRP treatment at an early stage (during low frequency episodic attacks) more beneficial commencing it during high attacks when chronic begun. Conclusions “medication underuse” underrecognized, holds significant importance. Optimal care could potentially prevent improve attacks.

Language: Английский

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The roles of the kynurenine pathway in COVID-19 neuropathogenesis

Infection, Journal Year: 2024, Volume and Issue: 52(5), P. 2043 - 2059

Published: May 27, 2024

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of highly contagious disease Corona Virus Disease 2019 (COVID-19) that may lead to various neurological and psychological disorders can be acute, lasting days weeks or months possibly longer. latter known as long-COVID more recently post-acute sequelae COVID (PASC). During COVID-19 infection, a strong inflammatory response, cytokine storm, occurs in some patients. levels interferon-γ (IFN-γ), interferon-β (IFN-β), interleukin-6 (IL-6) tumour necrosis factor-alpha (TNF-α) are particularly increased. These cytokines activate enzyme indoleamine 2,3-dioxygenase 1 (IDO-1), catalysing first step tryptophan (Trp) catabolism through kynurenine pathway (KP) leading production several neurotoxic immunosuppressive metabolites. There already data showing elevation KP metabolites both acutely PASC, especially regarding cognitive impairment. Thus, it likely involvement significant SARS-CoV-2 pathogenesis neurologically.

Language: Английский

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Healthy women show more experimentally induced central sensitization compared with men

Pain, Journal Year: 2024, Volume and Issue: 165(6), P. 1413 - 1424

Published: Jan. 11, 2024

Abstract Women more often experience chronic pain conditions than men. Central sensitization (CS) is one key mechanism in that can differ between the sexes. It unknown whether CS processes are already pronounced healthy women In 66 subjects (33 women), a thermal induction protocol was applied to dorsum of foot and sham other. Spatial extent [cm 2 ] secondary mechanical hyperalgesia (SMH) dynamic allodynia were assessed as subjective proxy measures, relying on verbal feedback. Changes nociceptive withdrawal reflex magnitude (NWR-M) response rate (NWR-RR) recorded through surface electromyography at biceps rectus femoris muscles used objective proxies. The effect SMH higher men (effect size 2.11 vs 1.68). Nociceptive results statistically meaningful for 0.31-0.36) but not 0.12-0.29). Differences meaningful. increased after different from NWR-RR (median differences 13.7 8.4% 120 140% threshold current). indicate dorsal horn women. even larger sex proxies potentially reflect greater supraspinal influence This study shows present experimentally induced subjects, which might contribute women's vulnerability pain.

Language: Английский

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Environmental enrichment alleviates hyperalgesia by modulating central sensitization in a nitroglycerin-induced chronic migraine model of mice

The Journal of Headache and Pain, Journal Year: 2024, Volume and Issue: 25(1)

Published: May 9, 2024

Chronic migraine (CM) is a debilitating neurofunctional disorder primarily affecting females, characterized by central sensitization. Central sensitization refers to the enhanced response sensory stimulation, which involves changes in neuronal excitability, synaptic plasticity, and neurotransmitter release. Environmental enrichment (EE) can increase movement, exploration, socialization other behaviors of mice. EE has shown promising effects various neurological disorders, but its impact on CM underlying mechanism remains poorly understood. Therefore, purpose this study was determine whether potential serve as cost-effective intervention strategy for CM.

Language: Английский

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PACAP6-38 improves nitroglycerin-induced central sensitization by modulating synaptic plasticity at the trigeminal nucleus caudalis in a male rat model of chronic migraine

The Journal of Headache and Pain, Journal Year: 2023, Volume and Issue: 24(1)

Published: June 4, 2023

Chronic migraine (CM) is a common neurological disorder with complex pathogenesis. Evidence suggests that pituitary adenylate cyclase-activating peptide (PACAP) induces migraine-like attacks and may be potential new target for treatment, but the therapeutic results of targeting PACAP its receptors are not uniform. Therefore, aim this study was to investigate regulatory effect type I receptor (PAC1R) antagonist, PACAP6-38, on nitroglycerin (NTG)-induced central sensitization in CM model.Sprague-Dawley (SD) rats received repeated injections NTG construct model. Mechanical thermal thresholds were measured using Von Frey filaments hot plate tests. C-Fos expression by western blotting immunofluorescence staining assess sensitization. PACAP6-38 intracerebrally injected into trigeminal nucleus caudalis (TNC), then changes c-Fos, synaptic-associated proteins, phospho-ERK1/2 (p-ERK1/2), phosphorylation cyclic adenosine monophosphate response element-binding protein (p-CREB) brain-derived neurotrophic factor (BDNF) detected. Transmission electron microscopy (TEM) Golgi-Cox used observe ultrastructure synapses dendritic structures TNC neurons.The showed PAC1R significantly raised after injections. Additionally, treatment alleviated nociceptive sensitization, inhibited NTG-induced overexpression c-Fos proteins rat, restored aberrant synaptic structures. Furthermore, ERK/CREB/BDNF pathway depressed PACAP6-38.Our demonstrated abnormal structure CM, which could reversed inhibition via down-regulating signaling pathway. improves regulating plasticity provide insights treatments PACAP/PAC1R migraine.

Language: Английский

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Targeting Glutamate Neurotoxicity through Dietary Manipulation: Potential Treatment for Migraine

Nutrients, Journal Year: 2023, Volume and Issue: 15(18), P. 3952 - 3952

Published: Sept. 12, 2023

Glutamate, the main excitatory neurotransmitter in central nervous system, is implicated both initiation of migraine as well sensitization, which increases frequency attacks. Excessive levels glutamate can lead to excitotoxicity system disrupt normal neurotransmission and contribute neuronal injury or death. Glutamate-mediated also leads neuroinflammation, oxidative stress, blood-brain barrier permeability, cerebral vasodilation, all are associated with pathophysiology. Experimental evidence has shown protective effects several nutrients against excitotoxicity. The current review focuses on mechanisms behind glutamate’s involvement migraines a discussion how specific able work towards restoring homeostasis. Understanding role vital importance for understanding why commonly comorbid widespread pain conditions informing future research directions.

Language: Английский

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