Current understanding of meningeal and cerebral vascular function underlying migraine headache

Author:

Levy Dan12ORCID,Labastida-Ramirez Alejandro3,MaassenVanDenBrink Antoinette3

Affiliation:

1. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

2. Harvard Medical School, Boston, MA, USA

3. Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands

Abstract

Background The exact mechanisms underlying the onset of a migraine attack are not completely understood. It is, however, now well accepted that the onset of the excruciating throbbing headache of migraine is mediated by the activation and increased mechanosensitivity (i.e. sensitization) of trigeminal nociceptive afferents that innervate the cranial meninges and their related large blood vessels. Objectives To provide a critical summary of current understanding of the role that the cranial meninges, their associated vasculature, and immune cells play in meningeal nociception and the ensuing migraine headache. Methods We discuss the anatomy of the cranial meninges, their associated vasculature, innervation and immune cell population. We then debate the meningeal neurogenic inflammation hypothesis of migraine and its putative contribution to migraine pain. Finally, we provide insights into potential sources of meningeal inflammation and nociception beyond neurogenic inflammation, and their potential contribution to migraine headache.

Funder

National Institute of Neurological Disorders and Stroke

Publisher

SAGE Publications

Subject

Clinical Neurology,General Medicine

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