Migraine is much more than an episodic headache. It is a complex brain disorder, characterized by a global dysfunction in multisensory information processing and integration. In a third of patients, the headache is preceded by transient sensory disturbances (aura), whose neurophysiological correlate is cortical spreading depression (CSD). The molecular, cellular and circuit mechanisms of the primary brain dysfunctions that underlie migraine onset, susceptibility to CSD and altered sensory processing remain largely unknown and are major open issues in the neurobiology of migraine. Genetic mouse models of a rare monogenic form of migraine with aura provide a unique experimental system to tackle these key unanswered questions. I will describe the functional alterations we have uncovered in the cerebral cortex of genetic mouse models and discuss the insights into the cellular and circuit mechanisms of migraine obtained from these findings.

This seminar will focus on the extraordinary shift in migraine research during the last 4 decades with the discovery of the trigeminovascular system (TVS) and it’s major impact on pathophysiology and treatment.  Compelling evidence supporting the importance of TVS, cortical spreading depression and parameningeal inflammation will be explored as will the implications of newly discovered microvascular channels within the meninges on an attack.

Lifelong devotion to headache research has led to many discoveries. First a series of studies of brain blood flow during attacks of migraine. The results showed changes compatible with cortical spreading depression in migraine without aura effectively negating the then prevailing vasospastic/ischemic theory. In migraine without aura no changes in brain blood flow. This difference was crucial for the separation of migraine with aura and migraine without aura in the first and subsequent editions of the international headache classification headed by me. Then a human migraine provocation model that has elucidated the molecular mechanisms of migraine. Successively we showed in series of papers the importance of nitric oxide, histamine, CGRP, PACAP and prostanoids. Therapeutic effectiveness of antagonizing these provokers by tonabersat, L-NMMA, CGRP receptor antagonists and monoclonal antibodies and of NSAIDs. Present and future attempts to put all these signaling mechanisms into a framework but it is not easy