Negative modultors of excitatory amino acids in episodic and chronic migraine: preventing and reverting chronic migraine. Special lecture 7th INWIN Congress.
The mechanism capable of transforming episodic migraine into chronic migraine is attributed by the authors to hyperalgesia and related neuroplastic changes, chiefly long-term potentiation, due to the action of excitatory amino acids, chiefly the ones acting at N-methyl D-aspartate (NMDA) receptor. A preeminent role has been attributed to 'third hyperalgesia', a newly observed type of hyperalgesia which is inheritable and can act as a ground for the above-mentioned mechanism of 'chronicization' of migraine. The role of primary and secondary hyperalgesia in giving redundance to neuraxial abnormalities is also discussed. The fact that NMDA noncompetitive antagonist ketamine and gabapentin, inhibitor of the neuronal synthesis of L-glutamate, can cure chronic migraine, so far considered refractory to prophylactic therapies, gives indirect but evident support to the mechanism suggested above. The antinociceptive role of the above-mentioned negative modulators of excitatory amino acids and the possible interplay between ionotropic and metabotropic receptors are also taken into consideration.
Nicolodi
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M
Interuniversity Center of Neurochemistry, Florence University, Italy.
Sicuteri
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F
D000085:Acetates / Q000494:pharmacology; D000328:Adult; D000588:Amines; D002986:Clinical Trials as Topic; D003509:Cyclohexanecarboxylic Acids; D004791:Enzyme Inhibitors / Q000494:pharmacology; D018691:Excitatory Amino Acid Antagonists / Q000494:pharmacology; D018846:Excitatory Amino Acids / Q000378:metabolism*; D005260:Female; D000077206:Gabapentin; D005971:Glutamates / Q000378:metabolism; D006801:Humans; D007649:Ketamine / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000378:metabolism* / Q000503:physiopathology / Q000517:prevention & control; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors; D000637:Transaminases / Q000037:antagonists & inhibitors / Q000378:metabolism; D005680:gamma-Aminobutyric Acid
D000085:Acetates; D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D004791:Enzyme Inhibitors; D018691:Excitatory Amino Acid Antagonists; D018846:Excitatory Amino Acids; D005971:Glutamates; D016194:Receptors, N-Methyl-D-Aspartate; D005680:gamma-Aminobutyric Acid; D007649:Ketamine; D000077206:Gabapentin; D000637:Transaminases